McLearning and 12-Lead ECG interpretation

I've been giving a lot of thought lately to paramedic education and the problem of 12-lead ECG interpretation.

Specifically, the reasons why paramedics aren't taught to actually read a 12-lead ECG and are instead given a crash course in "STEMI recognition" which does not prepare the student to differentiate between the ST-elevation of acute STEMI and other causes of ST-elevation.

This TED Talk by Dan Meyer about high school math education struck a chord with me. I highly recommend the entire talk, but the most relevant part for this discussion starts at 01:50.

Here's the part that really resonated with me:

"David Milch, creator of Deadwood and other amazing TV shows [...] swore off creating contemporary drama -- shows set in the present day -- because he saw that when people filled their minds with 4 hours a day of, for example, 2 1/2 Men, it shapes the neuro-pathways in such a way that they expect simple problems. He called it an "impatience with irresolution". You're impatient with things that don't resolve quickly. You expect sitcom-sized problems that wrap up in 22 minutes, 3 commercial breaks and a laugh track.

I'll put it to all of you -- what you already know. No problem worth solving is that simple."

Doesn't that exactly describe the paramedic approach to 12-lead ECG interpretation?

EKGs for Dummies, 12-Leads Made Easy, Rapid STEMI ID, etc. etc. etc.

Just the "need to know" information without all the difficulty of axis determination, bundle branch blocks, electrolyte derangements, differential diagnosis of tachycardias, primary and secondary ST-T wave abnormalities, identifying acute STEMI in the presence of STE-mimics, and other things that we have no patience for because we can't learn it in 22 minutes.

As if we can jump straight to the finish line and enjoy the fruits of victory without ever preparing for the race.

The problem is compounded by policy makers who "don't know what they don't know" (thank you Don Rumsfeld). They consider it a foregone conclusion that comprehensive 12-lead ECG knowledge is not practical for paramedics.

I say that it's indispensable.


Anonymous said...

Having earned my paramedic back when we DID learn how to interpret 12-leads fully, I'd say the main problem has been the resistance in the rest of the professions in allowing full use of the skills. We could interpret -- but no one would listen. Just bring the strip. Just get them here. Just shut up and let us start all over at the beginning when you get here...So it is no wonder that they did not continue to spend the hours necessary to keep that level of expertise in the classroom education.

Tom B said...

Where are you from, Anonymous?

Ron said...

One thing I found interesting in the video and related to EMT class was the test questions aren't like those math questions. One of the things that make the tests in EMT-B class hard is there is extraneous information in the question. The answers are not clear cut. They are really testing you to look at the whole problem and figure out what you actually need to know.

That's not really how EMTB curriculum is set up to be taught. Because it is so structured, it is very mechanical and then you get to the test and are taken totally off guard.

EMT GFP said...

I believe Anonymous made a good point, that today we are in the unfortunate stance that may of the people that we meet in the hospital believe that Paramedics are there to pass a patient off. Its amazing to see how many people, even in the medical profession, do not realize how much training paramedics do get.

However, I believe it is also do in part to our own short falls. Some people want to learn. Some don't. Its easier to train at a "lower level" so that more people can work in the profession. That is a culture that we as a profession must change.

Also, back to ER's, I know that many doctors feel that we overreact in situations, thus feeling that since they have more knowledge than we do, its okay to ignore us. Again, this may be due to true encounters with over reacting EMS providers, but that then leads into us needing to working on more training for ourselves. Its a rather vicious cycle. Both sides need better education about what the other does before we will find a nice middle ground.

Ditch Doctor Gabe said...

It is sad that there are many paramedic programs that are "McEMT Factories." I'm not trying to stand on a soap box but I do force my students to learn how to read a 12 lead since the "doc in the box" interpretation has been wrong. I think there needs to be a decent revision of the entire education program. Sure it's a huge task but everyone needs to come together and be on the same page.