EKG reading: It's shocking what medical residents don't know

“Dr. Fisher, can you teach our residents EKG lecture series?”

Naively, I said “Sure!”

What I didn’t realize is how hard this is to do today.

Much of this is not residents’ fault. They only have so many hours in so many days to attend lectures while caring for patients. Thanks to residency work-hour restrictions, those hours have become even fewer. To make matters much worse, through the year residents are torn to different rotations at different times and different hospitals. Since topics for EKG interpretation span over many lectures, it is impossible for residents to attend every lecture over the academic residency year. Just like when a student misses half the lectures for a college course, it’s hard to get an A.

Yesterday, I stood before a crowded room of about 35-40 residents and interns for their first of many EKG classes. There they sat, with their nicely pressed florescent-white lab coats ready to learn. They were quiet and respectful as they sized up their middle-aged physician attending who apologetically arrived 5 minutes late after seeing an urgent consult in the emergency room. They had no idea what to expect. I some ways, neither did I.

I plugged in the obligatory USB thumb drive to the obligatory computer to display the obligatory PowerPoint presentation, then stopped. Up came the image on the screen. They turned toward it, oblivious how uninterested I was in the contents of the slide. I asked them a question.

“How many of you don’t know the first thing about an EKG?”

Their heads swung back to me, silently. Much of the room smiled, not certain where I was going. Hesitantly, a few hands rose in the air.

I had never seen this before. As their soon-to-be instructor, I could not help but ask myself silently what the heck these kids have spent at least $200,000 of their parents’ money learning in medical school. How on earth can any student leave four years of medical school education and not know the first thing about an EKG?

I pressed on.

“How many of you know something about an EKG and its basics but realize you need to know more?”

Relieved, I saw many more hands go up.

EKG reading is one of those basic skills that every physician should at least have a rudimentary knowledge. Medical school’s controlled classroom-like environment lends itself better to instruction of the basics rather than hurried clinical rotations. Clinical rotations are where residents should fine-tune their skills in this area. How and why some medical students are not even exposed to this basic skill before entering their internship is one question, but what these young doctors are receiving for their huge costs of education is even a more important one.

As pressures continue to mount on physician salaries in the years ahead and their corresponding debts mount, perhaps we should ask ourselves why our young doctors continue to pay huge sums for their medical education of when the quality of the instruction has been allowed to slip to this level.