ECGs for A&E
Authors: Gillian Kelly
Publication date: 16 Apr 2009
Who is it for?
All doctors working in an acute setting. The website advertises the course as most suitable for foundation year one doctors to specialist trainee year 3 doctors, but anyone who looks at electrocardiograms (ECGs) will benefit, and there are usually a few emergency department consultants (who keep their job title very quiet) on each course.
When did you do it?
I did the course in my first year as an emergency medicine specialist registrar.
Why did you do it?
I went into emergency medicine from a surgical background and had thought I was confident in ECG analysis. As a middle grade in the emergency department I found I was frequently being asked questions about ECGs by juniors and peers to which I couldn’t respond with a level of confidence with which I was comfortable. I needed to know that I could confidently analyse an ECG in the middle of a busy shift and move on to the next task knowing I had made the right decision.
How much effort did it entail?
There is no formal pre-course work—the tutors state that if you can identify the ST segment on an ECG, you are fit to start the course. A comprehensive handbook is provided at registration, and teaching is in tutorial style with the group size being capped at 40. No one escapes questioning by the tutors, who have perfected the art of non-confrontational, non-intimidating teaching. There is a lot covered in one day, but still plenty of time to ask questions and go through examples.
These topics are covered:
Acute coronary syndrome—ST elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction (NSTEMI), unstable angina, and their management
Arrhythmias—bradycardias, tachycardias, and their management
Arrhythmias in young patients—hypertrophic cardiomyopathy (HCM), Brugada, long QT, and the effect of drugs
ECGs in context—pulmonary embolism, electrolyte imbalances.
Is there an exam?
There is a standardised test at the end of the day consisting of 16 ECGs, some of which are really quite difficult. This is marked by the tutors and everyone is given their scores. The average score from my course was 13/16, which I understand is usual for most courses.
What was the course like and how much does it cost?
The course is held at UCL in London and at the Manchester Conference Centre. The fee includes tutorials from 9 am to 5 pm and a buffet lunch.
The day is divided into a series of interactive tutorials starting with the basics and working up to analysis and management of more complex ECGs.
It costs £150 if booked a month in advance and £195 if booked less than four weeks before the course. There is also a “five for the price of four,” offer which several emergency departments have taken advantage of to use as part of their induction programme.
Do some revision before you go and know what your specific weaknesses are. I went with a list of areas that I am not confident in, determined to have these problem areas resolved by the end of the day—and they were.
Was it worth it?
Definitely. This is by a long stretch the best course I have ever been on. Discussion and interaction are the hallmarks of the day. You really do start with the most basic ECGs before working up to examples that would stretch many registrars. No one gets left behind.
I did not know anyone on the course and really appreciated my anonymity. This enabled me to ask those questions that we all have and all feel we should know the answer to, so never ask. There are many ECGs over which there will always be debate but the course gave me confidence to interpret ECGs and manage the underlying pathology. If you have ever squinted over an ECG then this course is for you.
firstname.lastname@example.org; 0207 234 2288
Gillian Kelly specialist registrar in emergency medicine
Great Western Hospital, Swindon