Mastering the ECG Teaching Station: A PLAB 2 Mock Scenario

examiner mla
Jun 15
2 min read

Summary:

This station involves teaching a junior colleague, in this case a newly enrolled nursing student, about ECG interpretation. The FY2 doctor, is required to assess the learner’s baseline knowledge, explain core ECG concepts, and introduce interpretation techniques while demonstrating effective teaching and communication skills.

Key Points:

Cardiovascular System – ECG Basics

ECG is the graphical representation of the heart's electrical activity.
It displays characteristic waves: P wave (atrial depolarization), QRS complex (ventricular depolarization), and T wave (ventricular repolarization).
PR interval: time from onset of atrial depolarization to onset of ventricular depolarization, used to detect heart blocks.

Teaching Strategy and Structure

Start with rapport building and assessing prior knowledge: Ask what the learner knows about ECGs.
Clearly outline objectives: Explain ECG basics, wave identification, and basic rhythm interpretation.
Structure the teaching into clear, digestible segments (e.g., waves → rate → rhythm → axis).
Provide resources for further self-study (e.g., online ECG tutorials).

ECG Interpretation Components

Rate: Count R-R intervals, divide 300 by number of large squares. Heart rate can be calculated using the number of small boxes between R-R intervals (divide 300 by the number of large squares between R-R)
Rhythm: Determine if rhythm is regular or irregular, and whether every P wave is followed by a QRS.
Axis: Use leads I and aVF to determine normal or abnormal axis (e.g., right or left axis deviation).
Mentioned Enthoven triangle to explain axis with limb leads (I, II, III, aVR, aVL, aVF).

Important Considerations:

Avoid overloading information; match content to learner's level.
Use appropriate visual aids or ECG strips.
Check for understanding periodically.
Clarify misconceptions (e.g., QRS is depolarization, not relaxation).
Safety netting: Offer to follow up or provide further guidance.

Diagnostic Approach:

Check patient's heart rate using ECG (R-R interval method).
Identify PQRST waves and intervals.
Analyze rhythm consistency and axis direction using limb leads.

Management:

For learners: recommend starting with normal ECGs before progressing to pathological ones.
Emphasize common patterns like atrial fibrillation: absence of P waves, irregularly irregular rhythm.

Communication Skills:

Establish rapport with learner (e.g., ask name, preferred form of address).
Encourage active participation and summarization.
Use clear, simple language; avoid jargon.
Provide reassurance and positive reinforcement.

Ethical Considerations:

Respect learner’s level and pace.
Ensure an inclusive and supportive teaching environment.
Uphold professionalism and avoid patronizing tones.

Additional Resources:

GMC Good Medical Practice: Teaching and mentoring responsibilities
ECG interpretation guides (e.g., Life in the Fast Lane, ECG Made Easy)
Online tutorials and simulations for ECG reading
NICE and Resuscitation Council UK guidelines for arrhythmias