Recognition and Management of Cardiac Arrhythmias: A Teaching Module for Physician Assistant Students

Background: Electrocardiogram (ECG) diagnosis of arrhythmias is a core skill for medical trainees. The ideal method of instruction is not yet known. Prior studies have shown that trainees fare poorly on arrhythmia recognition and often rate their training as inadequate. We assessed the efficacy of a multimodality didactic and case-based teaching module on arrhythmia diagnosis and management amongst physician assistant (PA) students. Methods: A case-based, self-study module outlining evidence-based criteria for the diagnosis and management of cardiac arrhythmias was developed. Over 300 cases at the George Washington University Hospital were reviewed for inclusion to select 26 ECGs and telemetry events that best illustrated common supraventricular and ventricular arrhythmias, atrioventricular conduction abnormalities, and arrhythmias related to common medical conditions. All arrhythmias had been confirmed by electrophysiology studies. Additional examples were compiled into a databank used to administer pre- and post-tests to 48 PA students as a prospective validation trial. After the pre-test, students received a module-based lecture and self-study module for two weeks of independent study prior to the post-test. The primary endpoint was improvement in correct diagnosis. The secondary endpoint was improvement in correct next-step management. A sample size of 42 students was needed to achieve a 90% power and type 1 error rate of 5%. The paired t-test was used to compare pre- and post-test scores. Results: Correct diagnosis was made for 60 ± 1.9% of arrhythmias at baseline, which improved to 68 ± 1.4% on post-test (p=0.01). Correct management was identified for 46± 1.5% of arrhythmias at baseline and improved to 53 ± 1.3% on post-test (p=0.008). Conclusion: Our results demonstrate poor baseline competency in diagnosis and management of common cardiac arrhythmias that significantly improved using our teaching module. A case and evidence-based multi-modality teaching module that incorporates didactics and independent-study improves ECG skills amongst trainees

Therapeutic approaches in hypertriglyceridemia-induced acute pancreatitis: A literature review of available therapies and case series

Hypertriglyceridemia-induced acute pancreatitis (HGAP) is the third most common etiology of acute pancreatitis. HGAP can be attributed to genetic disturbances in triglyceride metabolism or multiple secondary causes. Here, we presented three cases for HGAP and explored different therapeutic approaches for treating HGAP. A case series of three patients who presented with HGAP and underwent different therapeutic approaches was conducted. The first patient was a 37-year-old male who presented with nonsevere HGAP; he was treated with conservative therapy with insulin and heparin infusion, which resulted in clinical and laboratory improvement. The second patient was a 64-year-old male with human immunodeficiency virus on multiple highly active antiretroviral therapy. He presented with severe HGAP and multiorgan failure. After initiation of therapeutic plasma exchange, his HGAP resolved. The third patient was a 28-year-old male who presented with recurrent episodes of HGAP; his conservative therapy failed and was eventually escalated to therapeutic plasma exchange (TPE). HGAP can be attributed to genetic disturbances of lipid or secondary etiologies. A nonsevere form of HGAP can be managed with conventional therapy including insulin and heparin; however, severe HGAP may require TPE