ECG Stampede is designed to instruct junior-level residents; however, some of the content is quite advanced and has been successfully used for senior-level residents.
ECG Stampede is a novel educational program designed to standardize emergency medicine (EM) resident training in electrocardiogram (ECG) interpretation and triage. Practicing emergency physicians are tasked with rapidly and accurately determining the acuity of ECGs obtained on arriving patients – generally with little more information than the patient’s age, (potentially) their chief complaint, and a historical ECG for comparison.1 With this data, they must determine whether the patient can safely wait for evaluation, if they require a bed for immediate evaluation, or if a ST-elevation myocardial infarction (STEMI) is identified and requires appropriate resource activation. Unfortunately, many EM residents do not receive specific training in this task which requires both a strong foundation and unique application of ECG knowledge.2–4 ECG Stampede combines a novel video-based curriculum and engaging game aimed at preparing EM trainees for this core competency. The game and curriculum can be accessed, free of charge, at ecgstampede.com.
Upon completion of the ECG Stampede curriculum, learners will be able to rapidly interpret and identify potentially life-threatening conditions that are identifiable on ECG, and triage appropriately. This goal will be realized by achieving the following objectives: (1) Identify a standard approach to ECG interpretation, (2) distinguish the anatomic location of STEMIs, (3) explain conduction disturbances and their electrocardiographic findings, (4) identify ischemia mimics including (but not limited to) pericarditis, early repolarization, left ventricular aneurysm, and Brugada syndrome, (5) diagnose subtle findings of ischemia and non-traditional indications for emergent and/or urgent reperfusion, (6) generate an approach to ECG interpretation of a patient presenting with syncope, (7) describe the variable electrocardiographic findings of pulmonary embolism, (8) compare alternative explanations for T wave inversions including (but not limited to) Wellens’ syndrome, cerebral T waves, and left ventricular hypertrophy, (9) diagnose and manage bradydysrhythmias, (10) evaluate ECGs for electrolyte disturbances including (but not limited to) hypokalemia, hyperkalemia, and hypocalcemia, (11) diagnose and manage narrow and wide-complex tachydysrhythmias, and (12) analyze paced rhythms, and identify and manage pacemaker failures.
ECG Stampede is a unique educational program comprised of a comprehensive, video-based curriculum with accompanying student and instructor guides. ECG Stampede also features an engaging game accessible via modern browsers and dedicated mobile applications for iOS and Android devices. The gamified model presents learners with a batch of ECGs for which they must assign one of four triage acuities.
The entire curriculum was delivered longitudinally during the 2018-19 emergency medicine didactic conferences at the McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth) and survey data was collected. The gamified model has been available online and through a mobile application since January 2018.
The curriculum was well-received. To date, over 30 residency programs have signed up to use the curriculum, and the gamified model has been played over 40,000 times on the mobile application alone. The ECG stampede curriculum was delivered in its entirety to the McGovern Medical School at UTHealth emergency medicine interns during the 2019-2020 academic year orientation month, and more detailed data are being collected on its efficacy.
Learner feedback prompted the creation of videos to be viewed asynchronously and the recommendation for small-group (rather than large-group) discussion.
ECG, cardiology, STEMI, bundle branch block, fascicular block, bifascicular block, trifascicular block, syncope, Brugada syndrome, long QT, Wolf-Parkinson-White syndrome, early repolarization, pericarditis, deWinter T waves, Wellen’s syndrome, cerebral T waves, hypokalemia, hyperkalemia, hypocalcemia, atrioventricular heart block, supraventricular tachycardia, atrial fibrillation with rapid ventricular response, sodium channel blocker, paced rhythm, failure to capture, failure to sense, failure to pace.