Electrocardiogram competency of Canadian emergency medicine residents: curriculum gaps and opportunities for improvement

Objective Electrocardiogram (ECG) interpretation is crucial for emergencies, alongside point-of-care ultrasound (PoCUS). A prior survey of Emergency Medicine program directors identified “must know” ECG diagnoses. But whether ECG interpretation is adequately promoted by the Royal College, included in structured curriculum, and learned by residents is unknown. We sought to identify curriculum gaps and opportunities for improvement. Methods Using constructive alignment framework, we conducted a multi-modal evaluation of Canadian Emergency Medicine residency program ECG education. For intended learning outcomes, we reviewed the college’s Entrustable Professional Activities, comparing ECG with PoCUS. For teaching and learning activities, we administered a national cross-sectional survey of program directors. For assessment, we surveyed residents on self-reported efficacy in interpreting “must know” ECG diagnoses. Results There is no Royal College Entrustable Professional Activities for ECGs, and only 1 milestone compared with 9 for PoCUS. A majority (60%) of program directors reported no structured ECG curriculum, and most (57.4%) residents reported < 1 h of ECG self-study per month. There were 60% of program directors and 92% of residents who agreed they would benefit from structured teaching. Self-reported efficacy increased through residency, from 60% for PGY-2 to 90% for PGY-5. But there were gaps with low efficacy (e.g., for bifascicular block, failure to capture, Brugada pattern, and myocardial infarction in the presence of bundle branch block). PGY-5 residents reported autonomy for ventricular tachycardia, hyperkalemia, and acute myocardial infarction, despite known limitations from the literature of Emergency physicians. Conclusion ECG curriculum gaps include lower emphasis from Royal College Entrustable Professional Activities compared with PoCUS, limited structured ECG curriculum, and little self-study. While self-reported efficacy increases through residency, there are perceived gaps for many “must know” diagnoses, and unperceived gaps with confidence that exceeds known practice variation. The majority of survey responses agree they would benefit from structured training.