EP Education

ECG Academy: A Different Way To Learn ECGs

Nicholas G. Tullo, MD, FACC, FHRS, Cardiac Education Resources, LLC, Towaco, New Jersey

Nicholas G. Tullo, MD, FACC, FHRS, Cardiac Education Resources, LLC, Towaco, New Jersey

Nurses and techs who start working in the cardiac EP lab can often get overwhelmed by all of the new technology and terminology they have to become familiar with. It’s almost like working on the bridge of a starship, which is why I frequently refer to electrophysiology as “the rocket science of medicine.” New members of the EP lab staff soon learn that electrophysiologists look at arrhythmias differently than cardiologists and other physicians. Electrophysiologists live and breathe ECGs, and can recognize and correctly identify rhythm disturbances in the blink of an eye. These are physicians who live in the world of milliseconds, when everyone else is thinking beats per minute. They are able to discuss how there are many different kinds of SVT or atrial flutter, a concept totally foreign to anyone who had previously worked on a telemetry unit or in an ICU/CCU before joining the EP lab staff. For those nurses and techs who are perhaps just starting to work in the field of electrophysiology, learning to read complex ECGs puts you one step closer to feeling comfortable in your new role. ECG Academy® is an online educational resource that teaches users how to expertly analyze and interpret basic and advanced 12-lead ECGs and rhythm strips like an electrophysiologist. 

I first learned to read an ECG as a first-year medical student in 1978. Even though I read the basic textbook that everyone recommended, it barely scratched the surface. I spent that first summer with a cardiologist and would sit with him every day analyzing piles of ECGs. I quickly learned that there is nothing better than sitting next to an “ECG expert” one-on-one to begin to appreciate the nuances of this very complex skill. As a practicing electrophysiologist, I spend time with medical students and residents every day, and regularly give ECG conferences. Many of them have taken ECG courses before, but were taught by rote and used textbooks that concentrate mainly on pattern recognition. The problem is that real arrhythmias often don’t look like the pictures in the textbook. I found that incorporating cardiac electrophysiologic principles in my method of teaching ECGs led my students to having a deeper appreciation in the subtleties of rhythm analysis. Once you truly understand how the cardiac conduction system behaves under a variety of circumstances, it becomes much easier to analyze complex arrhythmias.

I decided to create an online course that was like a one-on-one tutorial session with an ECG expert. After publishing a number of sample video tutorials on YouTube, there seemed to be a tremendous thirst out there for basic and advanced ECG knowledge. ECG Academy was created in 2011, and consists of professionally recorded, high-definition video tutorials. The tutorials start with basic electrical theory, cellular physiology, the cardiac conduction system, and progress to cover all aspects of ECGs, including advanced arrhythmias that you will only recognize if you work in an EP lab. These step-by-step video lessons show you exactly what you need to know, without having to read complex printed material from a textbook or other educational website. The content is easy to absorb when presented in video form. The lessons are grouped into sections, which streamlines the learning and allows users to build a logical approach to arrhythmias based on a solid foundation of physiology. Users learn why ECGs look the way they do, and become much more comfortable tackling complex tracings.

Another feature on ECG Academy is the weekly video “ChalkTalk,” which is a short (5- to 6-minute) video lesson based on a single rhythm strip or 12-lead ECG. These help users practice the skills learned in the course. Each ChalkTalk starts with an unknown tracing, and I dissect out all the important clues on your computer screen, provide tips and tricks (always referring back to the physiology behind the tracing), and help you become comfortable with interpreting more difficult ECGs. ChalkTalks come in various degrees of difficulty (rated 1 to 7) and include features such as the “12-Lead Challenge” and “In the Trenches,” in which users learn how electrophysiologists interpret various complex tracings. ECG Academy’s home page includes a link to a number of sample ChalkTalks provided in a library of videos that can be watched for free. ECG Academy contains over 175 archived ChalkTalks at all levels, and users have the ability to search for ChalkTalks at a particular level of difficulty or on a specific topic such as AV block or wide QRS complex tachycardias. (Click on the following links to view sample ChalkTalk 1 and ChalkTalk 2.)

The ECG course is presented in two levels. Level 1 includes basic ECG concepts and all arrhythmias you would see on a rhythm strip. Level 2 picks up where Level 1 leaves off, and consists of topics needed to read a 12-lead ECG. There is also an advanced level series, which consists of videos on topics that are geared mostly towards cardiologists, EP fellows, and EP lab staff who want to really delve into the details. Users can subscribe to whatever level they wish to work on, and have unlimited access to the videos in that level for a monthly or annual subscription fee (subscribers are free to cancel at any time). Nurses, nurse practitioners, and EMS professionals can also earn CE contact hours through ECG Academy’s CE Certificate Courses. The Certificate Courses use the same video tutorials, but provide a more structured environment, with quizzes after each section and a final exam at the end of Level 1 and Level 2. The Level 1 course provides 12 contact hours of CE, and the combined Level 1+2 course is approved for 20 CE contact hours. Cardiac EP and cath labs can use these Certificate Courses to orient new hires or train their entire staff, and institutional discounts are available. 

Many nurses and even medical residents often feel they have a disappointing level of proficiency when it comes to ECGs, and don’t feel comfortable interpreting arrhythmias independently. They feel there is a lack of available resources (personnel or online) that they can turn to while at work, and find it difficult to learn about ECGs from a book. Many healthcare professionals who work on cardiac units can recognize only basic rhythm disturbances. Medical charts on telemetry floors may contain strips that were misinterpreted, which can lead to treatment errors and affect patient outcomes. ECG Academy is an entertaining and engaging solution that is geared to people who may already know the basics but want to be able to look at ECGs in a new light. Once you truly understand ECGs, then you can serve as a resource for your department and colleagues. 

The online video tutorials at ECG Academy have several advantages over more conventional training venues. First, the videos can be viewed over and over, and one can go back and easily review earlier lessons. Since repetition is the key to learning, the videos in ECG Academy were designed to continually refer back to basic physiologic principles throughout the course. The videos are short, so it is easy to grasp the concepts presented and get through the course in small doses. Finally, the online approach can be done at your own pace, and is more likely to be retained than an inservice in your department or an intensive series of live lectures. 

ECG Academy is a fun and easy way to improve your proficiency at basic and advanced ECG interpretation, become an ECG resource at your hospital, and evolve into an invaluable member of the EP lab staff. 

For more information, please visit www.ECGAcademy.com