Utility of the CORD ECG Database in Evaluating ECG Interpretation by Emergency Medicine Residents

OBJECTIVES: Electrocardiograph (ECG) interpretation is a vital component of Emergency Medicine (EM) resident education, but few studies have formally examined ECG teaching methods used in residency training. Recently, the Council of EM Residency Directors (CORD) developed an Internet database of 395 ECGs that have been extensively peer-reviewed to incorporate all findings and abnormalities. We examined the efficacy of this database in assessing EM residents' skills in ECG interpretation. METHODS: We used the CORD ECG database to evaluate residents at our academic three-year EM residency. Thirteen residents participated, including four first-year, four second-year, and five third-year residents. Twenty ECGs were selected using 14 search criteria representing a broad range of abnormalities, including infarction, rhythm, and conduction abnormalities. Exams were scored based on all abnormalities and findings listed in the teaching points accompanying each ECG. We assigned points to each abnormal finding based on clinical relevance. RESULTS: Out of a total of 183 points in our clinically weighted scoring system, first-year residents scored an average of 99 points (54.1%) [9 1- 1191, second-year residents 11 1 points (60.4%) [97-1261, and third-year residents 130 points (7 1.0%) [94- 1501, p = 0.12. Clinically relevant abnormalities, including anterior and inferior myocardial infarctions, were most frequently diagnosed correctly, while posterior infarction was more frequently missed. Rhythm abnormalities including ventricular and supraventricular tachycardias were most frequently diagnosed correctly, while conduction abnormalities including left bundle branch block and atrioventricular (AV) block were more frequently missed. CONCLUSION: The CORD database represents a valuable resource in the assessment and teaching of ECG skills, allowing more precise identification of areas upon which instruction should be further focused or individually tailored. Our experience suggests that more focused teaching of conduction abnormalities and posterior infarctions may be beneficial. The CORD database should be considered for incorporation into an ECG curriculum during residency training

Monetary Resident Incentives: Effect on Patient Satisfaction in an Academic Emergency Department

Patient satisfaction most be a priority in emergency departments (EDs). The care provided by residents forms much of the patient contact in academic EDs

Patients’ vs. Physicians’ Assessments of Emergencies: The Prudent Layperson Standard

Objective: To compare perception of the need for emergency care by emergency department (ED) patients vs. emergency physicians (EPs). Methods: Mailed survey to EPs and a convenience sample of ED patients. Survey rated urgency of acute sore throat, ankle injury, abdominal pain, and hemiparesis, as well as the best definition of “emergency.” Responses were compared with chi-square (p < .05). Results: 119/140 (85%) of EPs and 1453 ED patients responded. EPs were more likely to judge acute abdominal pain (79.8% vs. 43.4%, p < 0.001, odds ratio (OR) 5.16, 95% confidence interval (CI) 3.19-8.40) and hemiparesis (100% vs. 82.6%, p < 0.001, OR 24.9, 95% CI 3.75-94.4) as an emergency. Similar proportions of ED patients and EPs considered sore throat (12.2% vs. 7.6%, p = 0.18, OR 0.59, CI 0.27-1.23) and ankle injury (46.9% vs. 38.6%, p = 0.10, OR 0.71, CI 0.48-1.06) an emergency. EPs (35%) and ED patients (40%) agreed to a similar degree with the “prudent layperson” definition, “a condition that may result in death, permanent disability, or severe pain.” (p = .36, OR 1.22, CI 0.81-1.84). EPs were more likely to add, “the condition prevented work,” (27% vs. 16%, p = 0.003, OR 0.51, CI 0.33-0.81). Patients more often added, “occurred outside business hours” (15% vs. 4%, p = 0.002, OR 4.0, CI = 1.5-11.3). Conclusion: For serious complaints, ED patients’ thresholds for seeking care are higher than judged appropriate by EPs. Stroke is not uniformly recognized as an emergency. Absent consensus for the “correct” threshold, the prudent layperson standard is appropriate