Thursday, 27 March 2014

Life in the Slow Lane


I love my collection of ECG books but I’m always struck by words such as “easy”, “simplified” and “rapid” in the titles. I guess the reasons for this might be marketing ones. After all who wants to buy a book that states interpreting ECGs can be incredibly difficult and might take you rather a long time? Most authors will, however, endeavour to explain their work to you and how it should be applied in the preface. Needless to say twenty three years ago I was told to read one of these books and back then I couldn’t even get past the first couple of pages.

Even though my formal training was four years long, only a fraction of classroom time was dedicated to this subject. My education in this respect then consisted of gradually picking up snippets of information either from text books or from well-meaning work colleagues. Over many years, and mainly through experiential learning, I managed to construct a fairly decent understanding of ECGs. However, for me, it was only through teaching others that I was eventually able to plug the remaining gaps in my knowledge. I then began to wonder why I ever found any of it confusing and why it had been such a long drawn out process. Don't get me wrong, although I believe I now have a good understanding of the subject, I still look at the odd ECG or read someone else's blog and that old familiar feeling of inadequacy rears its ugly head when I realise I still don't know enough!

One of the reasons I believe this subject is difficult to learn (and to teach) is because so many of us in the medical profession are required to attain this skill. Take my ECG classes for example. In any given group there are a considerable mixture of professions and abilities. These range from healthcare support workers to doctors, and everything in between. Therefore, if you are a teacher or an author of a blog or text book, finding the right level for everyone can be a nightmare. On the one hand you don’t want to oversimplify the subject matter otherwise the learner gains no understanding other than simply pattern recognition. On the other, you don’t want to launch into something like action potentials when the learner is still struggling with recognising positive and negative waveforms. Too little challenge and the student doesn’t progress; too much and the student retreats.

I was browsing through some ECG case studies on the internet a short while back; many learners engaged in one particular discussion eager to put forward their interpretations. Due to the fact that many of them stated the wrong answer (it was meant to be a learning exercise) someone posted rather unkindly that it was "amateur hour!" I can only imagine that this poor guy was treated abominably as a student. However, these kinds of remarks are neither supportive nor educational to our fellow colleagues - luckily though they are few and far between. It is far better to learn by your mistakes in an online or classroom environment than making blunders at work.

The problem is that as learners we desperately want to get the “right” answer. Understandably new students believe it’s the teacher’s job to impart unambiguous information, and learning is simply a matter of information exchange. Granted, some ECG concepts are fairly black and white, but there are a lot of grey areas whereby an ECG only forms part of a diagnosis. Take ST elevation, for example. There are a number of different causes for this finding, but unless you put it into some sort of clinical context you may never know the correct answer. Therefore, in this respect I believe the process of interpretation and the context is as important, if not more so, than simply trying to label an ECG straight off the bat. You might not arrive at the "right" answer straight away, but you can achieve a lot in trying to get there. It doesn’t help that cardiology is also laden with a lot of confusing terminology. Thus I find a fair amount of my teaching time consists of explaining out all the unnecessary jargon.

With the rise of the internet we have instantaneous access to a lot more information than we used to. I love the fact that I can plug a few words into a search engine and not have to haul myself off to the library anymore. But, I wonder if this makes it even more confusing for the learner. I certainly still have trouble sifting through good and bad material because whatever mode of education you use it is all susceptible to inaccuracies, assumptions, and misunderstandings. Not to mention that as students we seem to accept anything that is passed down “from above”. But, some things change, so whatever you were told in 1991 (presumably by someone who was told the exact same thing in 1975) might not be applicable today.

Reading a text book, trawling the internet, or attending a seminar is a great start, but it doesn’t automatically make you proficient. They definitely have their place and I wouldn't be without my books, but my advice is to use them as a basis for developing your own knowledge through your own working practices, and perhaps more importantly take your time and question everything. I have many books on how to speak Spanish. Does that make me fluent? Does it heck! Why? Because I don’t practice!

But surely things have changed since I was a student? And, perhaps I’ve unintentionally painted a rather gloomy picture. Certainly, in my profession degree courses have become more structured, and students are assigned mentors or required to keep log books. A work colleague of mine, who trained at the same time as me, has nothing but good things to say about her ECG training. However, even after all these years there is still that look of fear on some of my students’ faces at the beginning of every seminar. I see them visibly relax when they realise they’re not the only desperate souls out there struggling with this subject. Perhaps we just have to accept that whatever our profession, it might be a long road to ECG competency, if we ever really get there. Once we realise this we can stop being so hard on ourselves. A medical student recently showed me his e-learning cardiology resources – on the first slide the tutor tells him to read an ECG book – I just smiled.  

These are just my own opinions and experiences. Please feel free to comment as would love to hear all your views…good, bad, and ugly. Below are some useful links. Many thanks for reading. Mx

My favourite websites

The two Jasons, Dawn & Ken -  all have ECG superpowers!

Love these guys!

My cardiology crush!

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