SCST Diploma Day: A Reflection

Myself and OliGS recently sat the SCST Electrocardiography Diploma and Practical Examination, so I thought I’d jot down some of my experiences in the run up, and my retrospective thoughts on the day itself.

If you’re thinking of doing it, or have your PTP finals looming, then read on, as this will give you an idea of what to expect.

I’ll start by saying this: Oli and I have NEVER been so stressed in our entire lives.

This exam was a nightmare for which to prepare; I have extensive experience in taking exams, and it is my view that they’re 50% what you know, and 50% what the examiners want you to tell them. Without having met these examiners or seen a previous paper, it was very difficult to know what to really nail, in the revision stage. The syllabus was long, detailed, and contained what seemed like an entire career’s-worth of things to learn, so we already knew it was going to be a slog, but nothing prepared us for the written paper…

Read these. Lots.

We studied, sometimes sleeplessly, for weeks. Tested each other on rare arrhythmias, read textbooks cover-to-cover (repeatedly), and watched each other’s once sunny outlooks and youthful (ahem) features rapidly wither as the examination date draw closer. It consisted of 20 multiple choice questions, 10 arrhythmia analysis and knowledge questions, and 4 full ECG analysis recordings. Some of these were almost instantly recognisable, but others were brutally difficult to analyse. The MCQs (often the most looked-forward to section of any exam) were equally tough. Those 3 hours lasted a lifetime…

We left the exam battered and bruised, but glad it was over.

But it wasn’t over. It was far from over. As well as the written paper that had almost ruined us, we had the practical exam to do as well.

We had made sure that during our post-ECG placements we still got ourselves in the clinic so as to keep everything fresh, as performing a perfect ECG is not like riding a bicycle.

 

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The last attempt before test day

It turns out that this was the correct call, as was practicing on one another in the hotel the evening before the exam; the margin for error in the exam is 2mm(!) Anyone who’s had an informal assessment, or had their Direct Observed Practice scrutinised whilst training knows that it’s very easy to second-guess when it comes to electrode placement, and despite having 20 minutes to complete the whole thing, this timeframe becomes devastatingly short once you’re in there. It’s a clinical assessment, so one needs to complete the necessary ID checks, explain the procedure to the patient AND to the examiners (i.e. in two different ways), perform it whist answering questions, and then complete a verbal examination.

Three hours after we had finished the written paper, we were called to attempt our practical exam. There were ashen faces all around. Some were on those still waiting for their number to be called as ours had just been, others had been told that their 2 attempts had been unsuccessful. Neither of us were looking forward to this. Now, given that I’ve already stated that each electrode is allowed to deviate only 2mm from the precise, gold standard location, the internet-purchased electrodes pictured in the above image would be somewhat unfair, right? It seems that the examination board concur, as they provide some rather cool, transparent electrodes complete with crosshairs. They doesn’t make it easier, per se, but they certainly go some way eliminate that lingering trepidation when it comes to deciding you’re happy with your placement and ready for judgement.

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Crosshair emblazoned electrodes(!)

I opted for the “all at once” technique: I explained everything to the patient before I started, gained consent, then explained everything I was doing as I went along. Once was put simply to the patient, then once to the examiners, using correct terminology. I paid extra special attention to V1, V2 and V4, as my patient had a particularly wide sternum, so I wanted to be totally sure that I had the sternal border, especially given the electrodes were rather far apart when placed and looked slightly odd to me. After I took a step back and looked at my work, I was incredibly tempted to move the aforementioned electrodes, but either due to fear, fatigue, or a combination of the two, I decided to leave them as they were, opting to go with my initial judgement. After that, I waited.

I’m not entirely sure how the placements are measured, as candidates are asked to leave the room whilst they are checked by two examiners. I heard someone mentioning special rulers, but I didn’t get a look at them (it’s all very cloak and dagger), in any event, you’re called back into the room and, in my case at least, informed of your passing or failing grade. I’m pleased to report that I passed on the first attempt, which as I’m sure you can imagine, was a tremendous relief; I lost my cool somewhat, and expressed my joy rather loudly, as I was informed I wouldn’t have to do it again. Oli soon found me in the waiting area and, grinning wildly, slapped me on the back and hissed “YESSSSS!” before promptly throwing himself into a chair. It was over, and we were victorious.

We didn’t speak too much about it, on the way home, but in the couple of days that have passed since the exam, we both feel a tremendous sense of pride that we actually did it, and did it successfully. If I were to give you all some advice, it would be the following:

  1. Be prepared for anything and everything, including waiting around for a long while
  2. Practice analysing ECGs until you hate them
  3. Practice performing ECGs until you hate them
  4. Go with your gut as much as you can during the practical exam
  5. Bring lunch
  6. Don’t under ANY circumstances, stay at the Ibis Hotel in Birmingham’s Chinatown district (I can’t stress this enough because it backs onto a nightclub that doesn’t stop playing the most bass-heavy music until the wee hours of the morning)

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7 Epic Fails to Avoid During Your Medical Fellowship

by Robin Dale

A cardiology fellowship will give you the opportunity to be fully prepared for the field and can go as long as four years. It will help you to hone your clinical skills and have cutting edge skills in surgery. A mix of research, public lectures, clinical experience, and classroom-based learning all combined enable one to be very well versed in the field at hand. Fellowships in Cardiology range from Cardiac Surgery Training, Cardiac Critical Care and Paediatric Cardiology, Vascular and Interventional Radiology, and Vascular Surgery and Endovascular Therapy Fellowships.

Several institutions offer what are considered the best Cardiology Fellowship Programs. To choose and get accepted into the best cardiology fellowships programs successfully, requires much more than an exceptional personal statement; applying to a residency, especially a cardiology one, is challenging and requires a lot of work. The existing places for such mentorships are extremely limited and contested, so you have an obligation to be unique and to stand out in order to be accepted.

Your cardiology fellowship personal statement is an opportunity whereby you can say why you feel you are the most deserving of being enrolled in the program. Elevating yourself above the bar will determine whether you are accepted or rejected. Here you will find the help to writing a personal statement for fellowship in cardiology, as well as some dos and don’ts.

Fellowship goes above and beyond a good resume. A good resume can only go a long way. You can be the most qualified and have the best CV, but this will not guarantee you a spot in the fellowship program. As a candidate, do research on your options, enhance your exposure on volunteer work, conduct clinical research projects, and get publications.  Ensure that you have filled the gaps in your resume and took the time to address all of them practically. Most candidates limit their options depending on where the hospitals are situated. This approach is detrimental, however, and prevents them from having a varied list and therefore options pertaining to the top-notch institutions. As a candidate, you can polish up your resume with a clearly defined and well put together personal statement.

The AMA or the American College of Physicians. Most candidates are not part of any corporate entity that advocates for their medical practice. With the continuous cutting of funds in the national budget, it is getting harder and harder to provide any services. This, in turn, has reduced the number of applicants able to be accepted and therefore numerous candidates find themselves being turned down. Joining the AMA will help you get a fair trial and increase your chances of getting approved.

Application to highly competent residency. Programs in radiology, dermatology and cardiology are highly competitive, and the stakes are high. Some of these students’ performances in their former medical school are usually not up to standard and sometimes place few schools on their ranking list.

Expansion of classification list. Students tend to limit their options and apply to a few residency programs. However, it is encouraged that a student lists down at least five hospitals to increase their chances of getting accepted. These choices can either be within their chosen specialty or even selecting a different specialty.

Transitional slot. A student can contact their medical school and ask for an interim slot or see a research fellowship. With this, the candidate will be able to become more competitive in the field and increase their chances of approval. An additional degree is also a supplement to a candidate’s resume and consideration.

Ill-preparedness. Two or more years of postdoctoral training whereby there is formal coursework in the fundamental sciences pertinent to the investigator’s area of expertise; this increased chances of attaining a fellowship.

Medical residency interview. It’s like a pass mark for all residents. Most programs won’t absorb candidates they have not interviewed. It is crucial that you take this interview seriously as it will not only determine if you will get accepted but also where you will get accepted.


r-dale

Robin Dale is a junior doctor and her passion is guest post writing. She is fond of writing useful posts for students to make their learning lives easier and more effective. Her own life credo is “Keep calm, study hard, and become a doctor”.

 

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Review: simECG: ECG Simulator v1.186

Download for Windows/Linux: Free

Developers: Antonio Cardoso Martins, Paulo Dias Costa, Joao Miguel Marques

 

I’ve been searching for a half-decent ECG simulator since last year, but hadn’t found one that costs less than “more than I have”, so I was pleasantly surprised to find the rather unnecessarily named simECG: ECG Simulator for free, on Windows and Linux.

simECG offers a number of functions in its current version. The operator can select from a series of common arrhythmias at the click of a button, and observe the associated waveform on the display. Unfortunately, only a handful of options are actually selectable, at present, with the others showing as greyed out, presumably, as with many Open Source programs, until they are finalised by the development team.

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The custom settings tab provides the means to alter each area of the trace individually, adjusting heart rate, P wave amplitude/duration and more, and watching the displayed trace change in real time. The program hints at future save/load functions for your altered settings, too, which will be a nice inclusion for educators to make use of.

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All of the aforementioned are easy to use and clearly marked, even if there aren’t currently all that many of them.

The option exists to change the background between ECG paper and a monitor screen, although the ECG paper skin is purely cosmetic. It would have been nice if the paper option was more in correlation with the amplitudes and durations selectable in the readout options. Greyed out sections of the “preferences” tab hint that calibration will soon be able to be changed by the user, so it would be preferable for beginners and students if these proposed calibration options had a realistic background to use in conjunction with the created trace.

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I couldn’t find an option to reset the trace at all, even in a greyed out form, and as a result, returning to the default custom settings is something of a chore. Hopefully this is something the developers will consider including in future iterations.

By now you may have noticed the appearance of the waveforms in the above trace. The trace waveform was one of the first things I noticed, as the whole thing doesn’t look right. The P and T waves look malformed, with the latter presenting almost as though the patient was displaying hyperkalaemia despite this being labeled as a normal sinus ECG.

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The assessment quiz tab gives the user an opportunity to identify 10 rhythms in 60 seconds. It’s fun, sure, but given the odd appearance of the waveforms, it becomes a case of memorising the traces present in this program alone, as they aren’t all applicable to real life.

I’ll be honest, it’s hard to criticise something that the developers admit will “never be finished” due to its Open Source status, but the nature of this website and Open Source in general means it pays to remain objective. In actuality, whilst I have highlighted a few issues, the fact that this tool is ever-evolving and totally free, means I can only commend the development team for their ethos and hard work.

Martins, Costa and Marquez state their belief that education shouldn’t be a corporate tool, or purchasable commodity, rather it should be accessible to all. The more people there are to flag issues, the better an idea the team can have of what functionality to add, what bugs to fix, and what other changes are felt to be necessary by users. Despite being generally incomplete at present, it’s not only one to watch for in the future, but one I’d ask every cardiac physiologist to download and play around with.

Due to this version still being in the 1.n phase, I have high hopes for the future of this software, as it has great potential as a learning tool. With the addition of more options in the preset tab, further wave/interval customisation, and more accurate waveforms in general, simECG could help physiology students consolidate their knowledge without carting loads of textbooks around, making it an essential bit of kit.

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