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New Online Resource Offers Multimedia EKG Training

In This Article

  • Medical training relies largely on long-form didactic lectures, dense slide presentations and other methods that are not ideal for modern learners
  • Most learners cannot sustain attention for more than five or six minutes on any one given task, and the human brain learns better when it uses both auditory and visual methods
  • Excaliper is a new, free, multimedia platform that uses short videos and quizzes to help trainees and other medical professionals learn how to read electrocardiograms (EKGs)
  • The site's browse and search functions also make the platform a reference tool for clinical care

A Massachusetts General Hospital cardiologist has developed and launched a novel online platform to help trainees and other providers improve their electrocardiogram (EKG) interpretation skills. The open-access website, called Excaliper, contains a robust collection of case-based EKG modules featuring short-form videos and self-assessment quizzes, which is supported by a personalized learning management system to allow users to explore EKGs for different diagnoses at their own pace and in their preferred way.

"If you compare how medical education was delivered in the early 1900s to how it is delivered today, much of what we do is unchanged. By and large, we continue to rely on passive and unidirectional forms of learning in which teachers lecture to large groups of students without engaging them in the learning process—a teacher-centered learning approach," says Jonathan Salik, MD, MS-HPEd, assistant inpatient education director in the Mass General Cardiology Division. "But decades of research has shown that learning needs to be active in order to be sticky. By building educational experiences that allow learners to set their own goals and learning outcomes, we can make education more learner-centered and impactful."

Dr. Salik applied evidence-based principles of educational theory and technology-enhanced learning to create Excaliper. It is targeted to trainees but may be useful to many other types of medical professionals, including attending physicians, pharmacists, advanced practice providers and emergency medical technicians, he says.

EKG Training via Short, Interactive Videos

The modern learner, explains Dr. Salik, is a person of any age who is generally facile with technology, highly visual in orientation and capable of processing data quickly. Modern learners prefer to learn through short, multimedia-based formats that engage multiple senses and can be done on the go.

"Humans process information through two channels—an auditory channel and a visual channel," he says. "By engaging both channels, we can improve learners' ability to retain information. Yet at the same time, there are good data demonstrating that, even on dynamic multimedia platforms such as YouTube, the average learner can't sustain attention for more than five or six minutes. So it is critical to keep these learning experiences short and concise."

His platform currently hosts 50 EKG modules, each containing a self-assessment quiz and a brief interactive, annotated video (more videos are in development). The modules train learners to recognize a variety of EKG findings, from basic diagnoses such as left bundle branch block, to more complex diagnoses, such as EKG changes associated with long QT syndrome. Dr. Salik personally established the site, wrote each script, recorded each video, and edited and produced each module. He worked with Gnar Inc., a Boston-based software consultancy, to design the website.

"I built the easier modules, which are labeled 'Essentials,' using a deductive approach to learning—the video begins with a short overview of the diagnosis in question, followed by an explanation of the specific EKG contained within the module," he says. "For the more challenging modules, which are labeled 'Advanced,' I did the opposite and used an inductive approach. In these cases, the specific EKG featured in the module is reviewed first, followed by a broader discussion of the overall diagnosis. This format is more holistic in its orientation and thus better suited for experienced learners."

Excaliper allows users to engage with the site in multiple ways. In the "Quiz Yourself" mode, users can practice reading EKGs at random or by selecting from distinct categories, such as structural abnormalities, ischemia and arrhythmia. As a user works through the site's modules, the system provides real-time feedback about performance. The user can then apply the data to decide which EKG modules to complete next.

In addition to serving as a forum to practice EKG reading, the site can be used as a reference tool to facilitate patient care. "Say you're an intern and just admitted a patient with hyperkalemia, but you don't know much about the specific EKG changes associated with hyperkalemia. Rather than reviewing Excaliper's EKG modules anonymously in the Quiz Yourself mode, you can search for specific topics in the 'Browse by Topic' mode," Dr. Salik says. "In this manner, the site can be used not just as a way to practice reading EKGs, but also as a portable reference manual."

Open-Access, Interactive Online Medical Education

Dr. Salik's site is unique because it is grounded in evidence-based educational principles, incorporates multimedia elements, and is free for all learners. To use Excaliper, a person must simply create an account to log in. Progress is then saved in the user's profile.

Upon launch, Excaliper will be incorporated into the Mass General cardiovascular disease fellowship. As per guidelines set by the Accreditation Council for Graduate Medical Education (ACGME), fellows are required to read a minimum of 3,500 EKGs over the course of their fellowship. To help meet these requirements, Mass General fellows will be asked to complete Excaliper's modules and work with Dr. Salik to write new cases as part of their mandatory EKG training.

The tool also is meant for the larger medical community. "It's an important health equity issue. For too long, multimedia EKG sites have been erected behind paid firewalls. With Excaliper, I hope to democratize EKG education to ensure that all students, trainees, and healthcare providers have access to high-quality educational resources no matter their practice setting or financial means."

Mass General supported the site's development thanks to a gift from an anonymous foundation.

The Future of Excaliper

Dr. Salik has a special interest in cardiovascular medical education, particularly technology-enhanced learning and medical simulation. He recently received a Master of Science in Health Professions Education (MS-HPEd) from the Boston University School of Medicine. He also serves as director of the Harvard Medical School Continuing Education Channel, a compendium of continuing medical education (CME) videos by experts at Harvard Medical School.

Following the launch of Excaliper, Dr. Salik plans to invite co-creators to write new modules. He would also like to apply for CME accreditation and conduct research to assess whether the platform leads to improvements in self-perceived confidence or competence among users of the site.

Excaliper is beginning to build a presence on social media via Twitter (@excaliperEKG), which will feature and promote the site's "Case of the Month." In addition, Dr. Salik hopes to institute a gamified "Weekly EKG Challenge" to provide learners with additional opportunities to hone their EKG skills in a fun and socialized manner.

Visit the Excaliper website

Refer a patient to the Corrigan Minehan Heart Center

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