Internal Medicine Residency Curriculum Research Articles

Effect of Patient Safety Curriculum for Internal Medicine Residents on a Health Care System.

BackgroundHealthcare organizations seeking to promote a safety culture depend on engaged clinicians. Academic medical centers include a community of physicians-in-training; however, medical residents and fellows are historically less engaged in patient safety (PS) than are other clinicians. Increased attention has been focused on integrating PS into graduate medical education. Nonetheless, developing curricula that result in real-world system changes is difficult.ObjectiveTo develop an interactive PS curriculum for internal medicine (IM) residents that analyzes real-word PS problems.MethodsA multidisciplinary group developed a five-session, case-based PS curriculum for IM residents in the context of a 3-year, longitudinal quality-improvement, PS, and high-value-care curriculum. The curriculum was facilitated by a PS analyst and incorporated mock root cause analysis (RCA) based on actual resident-reported PS events. Each mock RCA developed an action plan, and outcomes were tracked. Pre- and postcurriculum assessments with participating residents were conducted to evaluate the curriculum.ResultsTwenty-eight IM residents completed the curriculum during four iterations from 2017 to 2020. The curriculum identified multiple potential PS risks, led to tangible changes in clinical processes, and enhanced resident confidence in improving systems of care.ConclusionsWe describe an active-learning PS curriculum for IM residents that addressed actual resident-reported PS problems. Through RCA, action items were identified and meaningful system changes were made. Leveraging the expertise of local PS experts in the design and delivery of PS curricula may improve the translation of learner recommendations into real system changes and cultivate a positive PS culture.

Integrating Problem-Based Learning Into an Internal Medicine Residency Curriculum.

Background: Problem-based learning (PBL) is a form of constructivist learning that allows learners to use higher order thinking by promoting learners to construct their own knowledge and understanding. PBL is prevalent in medical school education, but literature on PBL in graduate medical education (GME) is lacking. Because of the limited amount of data on PBL curricula in GME and the need for young physicians to develop critical thinking, lifelong self-directed learning, and problem-solving skills, we sought to incorporate PBL into the curriculum for our internal medicine residency program in a university-based community hospital setting. Methods: The PBL committee created 4 cases derived from actual patient encounters that address common chief complaints encountered in the hospital and served as a crash course curriculum for interns in internal medicine. The success of the PBL curriculum was measured using a 39-question survey created by PBL leadership to assess the learners' satisfaction with case content, likeability/design, feasibility, effectiveness, and motivation/self-learning. Additional questions asked for ways to improve PBL sessions in the future. Results: Overall, interns felt the content was clinically relevant, challenged them to think critically, and aided in the medical management of their patients. They also found PBL to be more effective and more enjoyable than the traditional lecture-style curriculum. Conclusion: Implementing a PBL curriculum in a residency program is possible. Although PBL has associated challenges such as scheduling, it is well received when supported by the program.

Evaluation of an Internal Medicine Residency Curriculum from Trainees' Perspective

Objectives: This study aimed to identify the areas of strength and areas needing improvement in the internal medicine residency curriculum in a developing country - Sudan. Materials and Methods: This qualitative study was conducted at six major teaching hospitals in Sudan. Purposive sampling was used to select 48 residents who participated in six focus group discussions (FGDs). All FGDs were audio taped and lasted between 60 and 90 min. Data collection continued until theoretical saturation took place. The transcribed data were analyzed using the content analysis technique, and codes were generated and categorized into subthemes. Three emerging themes were identified: training curriculum, training in research, and assessment of residents. Results: The residents were generally satisfied with the curriculum at the planning level. They reported that the structure of the program is suitable and the duration of the curriculum appropriate; the number of patients and theoretical training in the research were considered optimum. They suggested that training in research should begin earlier in the curriculum, with time reserved for conducting research, and that assessment needs improvement. Conclusion: This study highlighted the utility of the qualitative approach in identifying residents' perspectives of their educational programs. However, the residents provided suggestions for improvement in the following areas: training curriculum, research training, and assessment. The practical recommendations from this study could be used to improve the quality of postgraduate medical training in Sudan and elsewhere.

Development and Evaluation of Resident-Championed Point-of-Care Ultrasound Curriculum for Internal Medicine Residents.

Introduction: Point-of-care ultrasound (POCUS) is a powerful clinical tool that has seen widespread adoption, including in Internal Medicine (IM), yet standardized curricula designed by trained faculty are scant. To address the demand for POCUS education at our institution, we created a resident-championed curriculum with support from skilled faculty across multiple specialties. Our objective was to teach postgraduate year (PGY)-3 IM residents the basics of POCUS for evaluation of the pulmonary, cardiac, and abdominal systems through resident-developed workshops. The goal of acquisition of these skills was for resident education and to inform decisions to pursue further patient testing. Methods: Three half-day workshops were created to teach residents how to obtain and interpret ultrasound images of the pulmonary, cardiac, and abdominal systems. Workshops were comprised of didactic teaching and practical ultrasound instruction with expert supervision of clinicians within and outside of IM. Residents were asked to complete a written survey before and after each workshop to assess confidence, knowledge, and likelihood of future POCUS use. Results: Across the three workshops (pulmonary, cardiac, and abdominal), 66 sets of pre- and post-workshop surveys (32 pulmonary, 25 cardiac, and 9 abdominal) were obtained and analyzed. Confidence in and knowledge regarding POCUS use increased significantly across all three workshops. Likelihood of future use increased in the cardiac workshop. Conclusions: We implemented a resident-championed POCUS curriculum that led to improved attitudes and increased knowledge of POCUS for PGY-3 IM residents.

Climatizing the internal medicine residency curriculum: A practical guide for integrating the topic of climate and health into resident education

The climate crisis is a threat to human health. Resident physicians in internal medicine need training that addresses the clinical implications of climate change and its effect on health. However, internal medicine residency curricula are already saturated with essential topics in clinical medicine, and often have limited space for additional material. In this guide, we describe how to integrate climate and health training into an internal medicine residency curriculum. Evidence-based topics in climate and health are organized by medical subspecialty and are integrated into pre-existing lectures in the longitudinal, outpatient lecture series. Addition of material to these recurring presentations limits workload by presenters, ensures longevity and adaptability of the course material, and allows exposure of these core topics to the entire residency. Below we highlight learning objectives for these lectures and review pertinent topics in climate and health by medical subspecialty, specifically: pulmonology, cardiovascular disease, nephrology, gastroenterology, infectious diseases, mental health, and women's health. We believe that by “training the trainer,” resident physicians will be better equipped to care for patients affected by climate-mediated disease and advocate for solutions to the climate crisis.

Novel Internal Medicine Residency Ultrasound Curriculum Led by Critical Care and Emergency Medicine Staff.

Point-of-care ultrasound (POCUS) is an integral aspect of critical care and emergency medicine curriculums throughout the country, but it has been slow to integrate into internal medicine residency programs. POCUS has many benefits for internal medicine providers, guiding diagnostic decisions and aiding in procedures. Additionally, POCUS is a convenient and portable resource specifically for internal medicine providers in the military when practicing in deployed or critical care settings. Critical care and emergency medicine clinicians are excellent resources to lead these courses. We sought to develop a new POCUS curriculum for internal medicine residents within the Naval Medical Center Portsmouth Internal Medicine Residency program with the support of emergency medicine and critical care medicine staff to lead and oversee the training. The project's aim was to increase internal medicine resident confidence with POCUS by 20% and proficiency with POCUS as evidenced by pretest and posttest analysis by 10%. The program consisted of a 2-day, 9-hour, introductory course, combining lecture with hands-on scanning taught by emergency medicine physicians who had completed emergency ultrasound fellowship-level training. This was followed by a longitudinal component of hands-on scanning throughout the academic year built into the residents' schedules. Emergency and critical care medicine ultrasound staff reviewed all studies for quality assurance (QA). The residents were given both precourse and post-course knowledge tests and confidence surveys, which utilized a 5-point Likert scale. The knowledge assessments were analyzed with a paired t-test, and the Likert scale data were analyzed using the Wilcoxon signed-rank test. The Naval Medical Center Portsmouth Institutional Review Board deemed this project nonhuman subjects' research. Twenty participants were enrolled, with 10 (50%) of those enrolled completing all course requirements. The average precourse knowledge assessment score was 76.60%, and postcourse assessment score was 80.95% (+4.35%, P = .33). The confidence survey scores were initially 73.33% and improved to 77.67% (+4.34%, P = .74). A curriculum comprised of a 9-hour workshop followed by a longitudinal hands-on experience can provide improvement in internal medicine resident POCUS knowledge and confidence. This model emphasizes the benefit of emergency and critical care cooperation for ultrasound training and provides an emphasis on medicine-relevant scans and longitudinal training.

First year internal medicine residents\u2019 self-report point-of-care ultrasound\xa0knowledge and skills: what (Little) difference three years make

BackgroundWith increasing availability of point-of-care ultrasound (POCUS) education in medical schools, it is unclear whether or not learning needs of junior medical residents have evolved over time.MethodsWe invited all postgraduate year (PGY)-1 residents at three Canadian internal medicine residency training programs in 2019 to complete a survey previously completed by 47 Canadian Internal Medicine PGY-1 s in 2016. Using a five-point Likert scale, participants rated perceived applicability of POCUS to the practice of internal medicine and self-reported skills in 15 diagnostic POCUS applications and 9 procedures.ResultsOf the 97 invited residents, 58 (60 %) completed the survey in 2019. Participants reported high applicability but low skills across all POCUS applications and procedures. The 2019 cohort reported higher skills in assessing pulmonary B lines than the 2016 cohort (2.3 ± SD 1.0 vs. 1.5 ± SD 0.7, adjusted p-value = 0.01). No other differences were noted.ConclusionsPOCUS educational needs continue to be high in Canadian internal medicine learners. The results of this needs assessment study support ongoing inclusion of basic POCUS elements in the current internal medicine residency curriculum.

Resident-Reported Impact of a Novel Oncology Curriculum for Internal Medicine Residents.

The Accreditation Council of Graduate Medical Education mandates that all internal medicine residents gain exposure to internal medicine subspecialties including hematology and oncology. While many residents meet this criterion through inpatient oncology rotations, the current structure of many inpatient oncology rotations leaves little opportunity for formal education. We therefore designed a novel oncology curriculum consisting of one-page oncology teaching sheets to increase the number, breadth, and quality of formal teaching sessions on our resident inpatient oncology services. In order to evaluate the curriculum, we conducted pre- and post-intervention surveys of residents. From these surveys, we found that 72.2% of residents used the teaching sheets on their inpatient oncology rotation and that the teaching sheets led to an increase in the number of formal oncology teaching sessions (mean 3.4 ± 2.1 post-implementation vs 2.6 ± 2.0 pre-implementation, p = 0.008), the breadth of oncology topics taught (% reporting ≥ 5 topics; 26.1% vs 16.3%, p = 0.035), the proportion of residents reporting improvement in overall oncology knowledge (80.2% vs 62.4%, p = 0.012), and the proportion of residents reporting improvement in their ability to care for patients (70.8% vs 48.9%, p = 0.013). These results demonstrate that formal oncology teaching can be improved on inpatient oncology rotations through a simple and easily replicable oncology curriculum.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13187-021-02055-6.

Teaching Telehealth During a Pandemic and Beyond: an Intern's Survival Guide for Virtual Medicine.

BackgroundThe rapid transition to telemedicine at the onset of the COVID-19 pandemic required many providers to learn telemedicine “on the fly.” As virtual care will likely remain a mainstay of outpatient medicine, it is imperative that telemedicine training be incorporated into graduate medical education.AimDesign a telemedicine curriculum for internal medicine residents based on principles of experiential learning.SettingVA-based internal medicine primary care clinic.ParticipantsSixteen first-year internal medicine residents participated in the curriculum.Program DescriptionThe curriculum included a didactic session followed by four simulated patient encounters focused on troubleshooting technical issues, performing the virtual physical exam, coordinating team-based care, and tackling emergencies.Program EvaluationParticipants reported minimal previous experience with telemedicine. After completing the training, resident confidence in conducting video visits increased from an average score of four to seven (on a 10-point scale). Residents were more likely to agree that video visits would allow them to build bonds and effectively address their patients’ needs. This increased confidence persisted at 3 months after training.DiscussionUsing experiential learning, we identified strategies which increased the confidence of internal medicine trainees in conducting telemedicine visits. Further research is needed to validate our findings across different practice settings.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07009-8.

Focused Cardiac Ultrasound Curriculum for Internal Medicine Residents.

Background: Focused cardiac ultrasound (FCU) is a safe and efficient diagnostic intervention for internal medicine physicians. FCU is a highly teachable skill, but is used in routine cardiac assessment in only 20% of surveyed training programs.We developed an FCU curriculum for internal medicine residents and an assessment tool to evaluate the impact of the curriculum on trainee knowledge and confidence. Methods: Internal medicine residents rotating through clinical cardiology services underwent 30 minutes of didactic and 60 minutes of hands-on teaching on acquisition and interpretation of FCU. A 20 item pre and post-curriculum online survey was administered (November 2018-December 2019) to assess confidence and knowledge in FCU. Results: 79 of 116 (68%) residents completed the pre-survey and 50 completed the post-survey, of whom 34 received the curriculum. The mean change in confidence score in those who received versus did not receive the curriculum was 0.99 versus 0.39 (p=0.046) on a 5-point Likert scale. Among 33 residents who had paired pre- and post-surveys the mean change in confidence score was 1.2 versus 0.85 (p<0.001) in those who received versus did not receive the curriculum. The mean increase in knowledge score was 13% versus 7% respectively (p<0.0001). Conclusions: We instituted a novel curriculum for internal medicine residents to gain experience in image acquisition and interpretation. Both confidence and knowledge in FCU improved following the curriculum, indicating that this is a highly teachable skill. Additional analysis of the of the FCU study images will be useful for informing future interventions.

A Case-Based Critical Care Curriculum for Internal Medicine Residents Addressing Social Determinants of Health.

IntroductionGraduate medical education on social determinants of health (SDOH) is limited. Residents often directly care for vulnerable populations at safety-net hospitals, yet curricula thus far are based in the ambulatory setting.MethodsWe developed a case-based curriculum integrating SDOH with critical care topics to standardize knowledge and improve skills and attitudes of internal medicine residents working with these patients. We conducted a needs assessment, identified systematic social risk domains, and modified a published curriculum to develop the content. Case-based discussions were conducted weekly in the medical intensive care unit, while knowledge, attitudes, and skills were assessed daily during multidisciplinary rounds. A 360-degree assessment was completed with pre- and postcurriculum surveys and self-reflection.ResultsEleven residents completed postcurriculum surveys. Both pre- and postcurriculum, residents reported confidence in identifying and describing how SDOH affect care. After the curriculum, residents could name more resources for patients experiencing health disparities due to substance abuse (pre: 47%, post: 73%) and financial constraints (pre: 50%, post:64%). This curriculum was recognized as the first training many residents received (pre: 31%, post: 91%) with formal feedback (pre: 16%, post: 64%).DiscussionImplementing a curriculum of social risk assessment in critically ill patients was difficult due to competition with clinical care. Participating residents said they “loved the open dialogue” to reflect on their experiences; this became an avenue to “debrief on specific patient encounters and [how] SDOH brought [patients] to the ICU.” Future directions include qualitative analysis of reflections and assessment of curricular impact on trainee resiliency.

Implementing a telemedicine curriculum for internal medicine residents during a pandemic: the Cleveland Clinic experience

Telemedicine training was not a substantial element of most residency programmes prior to the COVID-19 pandemic. Social distancing measures changed this. The Cleveland Clinic Internal Medicine Residency Programme (IMRP) is...

Healing Through History: a qualitative evaluation of a social medicine consultation curriculum for internal medicine residents

BackgroundSocial context guides care; stories sustain meaning; neither is routinely prioritized in residency training. Healing Through History (HTH) is a social medicine consultation curriculum integrating social determinants of health narrative into clinical care for medically and socially complex patients. The curriculum is part of an internal medicine (IM) residency outpatient clinical rotation at a Veterans Health Administration hospital. Our aim was to explore how in-depth social medicine consultations may impact resident clinical practice and foster meaning in work.MethodsFrom 2017 to 2019, 49 categorical and preliminary residents in their first year of IM training were given two half-day sessions to identify and interview a patient; develop a co-produced social medicine narrative; review it with patient and faculty; and share it in the electronic health record (EHR). Medical anthropologists conducted separate 90-min focus groups of first- and second-year IM residents in 2019, 1–15 months from the experience.Results46 (94%) completed HTH consultations, of which 40 (87%) were approved by patients and published in the EHR. 12 (46%) categorical IM residents participated in focus groups; 6 PGY1, and 6 PGY2. Qualitative analysis yielded 3 themes: patient connection, insight, and clinical impact; clinical skill development; and structural barriers to the practice of social medicine.ConclusionsHTH offers a model for teaching co-production through social and narrative medicine consultation in complex clinical care, while fostering meaning in work. Integration throughout training may further enhance impact.

Partnering With Patients in a Quality Improvement Curriculum for Internal Medicine Residents.

Patient experience is a core component of the Institute for Healthcare Improvement Triple Aim for health care improvement. Although resident physicians must meet quality improvement (QI) competencies prior to graduation, QI training during residency may not adequately prepare residents to improve patient and family experience. We describe an active learning QI curriculum engaging 3 Patient and Family Advisors as partners alongside 15 resident physicians. This partnership proved to be a meaningful experience for both groups, with the development of mutual respect and insight into the contributions that patients and families bring to solving problems in health care quality.

"Make the Implicit Explicit": Measuring Perceptions of Gender Bias and Creating a Gender Bias Curriculum for Internal Medicine Residents.

BackgroundGender bias in clinical training has been well established; however, little is known about how perceptions differ between men and women. Furthermore, few curricular options have been developed to discuss gender bias.ObjectiveTo measure the prevalence of gender bias, examine qualitative differences between men and women, and create a gender bias curriculum for internal medicine residents.MethodsWe surveyed 114 residents (response rate of 53.5%) to identify the prevalence and types of gender bias experienced in training. We compared estimates between genders and organized qualitative results into shared themes. We then developed a curriculum to promote and normalize discussions of gender bias.ResultsAmong surveyed residents, 61% reported personal experiences of gender bias during training, with 98% of women and 19% of men reporting experiences when stratified by gender. We identified two domains in which gender bias manifested: role misidentification and a difficult working environment. Residents identified action items that led to the development of a gender bias curriculum. The curriculum includes didactic conferences and training sessions, a microaggression response toolkit, dinners for men and women residents, participation in a WhatsApp support group, and participation in academic projects related to gender bias in training.ConclusionWe confirmed a wide prevalence of gender bias and developed a scalable curriculum for gender bias training. Future work should explore the long-term impacts of these interventions.

1118. Development of a Curriculum for Internal Medicine Residents on Latent and Active Pulmonary TB: A Targeted Needs Assessment

BackgroundInternal medicine (IM) residents have previously been found to have significant knowledge and practice gaps in tuberculosis (TB) diagnosis, but it is unknown whether these gaps vary based on geography or TB incidence. San Francisco has the highest incidence of TB of any US city. UCSF IM residents encounter TB throughout their clinical training; however, the residency program does not have a dedicated TB curriculum. Following the Kern model of curriculum development, the aim of this project was to conduct a targeted needs assessment of UCSF IM residents regarding the need for and format of a TB curriculum.MethodsAn anonymous survey was sent to residents in February 2020 to assess their confidence in multiple domains in the diagnosis and management of latent and active pulmonary TB and gauge their preferences for the format and timing for delivery of a TB curriculum. All questions used a five-point Likert scale. Chi-squared test was used to compare confidence levels between interns and residents. The study received UCSF IRB approval.ResultsSeventy-five IM residents completed the survey (41% of residency; 32% interns and 68% residents). More than 50% of respondents reported that they were quite or extremely confident in only 1 of 14 domains assessed. Residents demonstrated significantly increased confidence compared to interns in only 4 of 14 domains. IM residents felt that a TB curriculum of a short video series, online videos interspersed with questions, or a house-staff handbook would be most useful, with more than 50% stating that these formats would be quite or extremely useful. While lectures and Powerpoint slides are common teaching methods, residents felt these formats were less useful. IM residents also felt they would be more likely to access a TB curriculum during ID elective or while caring for patients on wards and less likely on own time.ConclusionIM residents demonstrated lack of confidence in multiple domains in the diagnosis and management of latent and active pulmonary TB. Confidence did not markedly improve between interns and residents despite increased experience in a high TB incidence clinical setting, highlighting the need for a TB curriculum to address this gap. This curriculum should avoid lecture format and be integrated within relevant clinical time to maximize utility.Disclosures All Authors: No reported disclosures

A Novel Contraception Counseling and Shared Decision-Making Curriculum for Internal Medicine Residents

IntroductionMany women of reproductive age with complex medical conditions receive primary care through an internal medicine (IM) physician rather than an obstetrician/gynecologist. Long-acting reversible contraception methods are the most effective form of contraception; however, IM residents are not routinely trained in them. Infrequent training in, inadequate knowledge of, and discomfort with contraception counseling limit the counseling performed by IM residents. Shared decision-making (SDM) is a method of patient-centered communication that can improve communication about patient preferences and increase patient satisfaction with and adherence to contraception. We developed a curriculum to teach contraception counseling under the framework of SDM for IM residents.MethodsThe curriculum focused on contraception counseling through the lens of SDM designed for IM and medicine/pediatrics residents (PGY 2-PGY 4). We adapted an existing seven-step model of SDM to fit elements of contraception counseling. The curriculum consisted of a didactic teaching session with integration of an instructional video and structured interactive discussion. The session lasted 60 minutes.ResultsFifty-eight residents participated in the curriculum. On pre- and postcurriculum surveys, residents reported improvement in contraception knowledge (overall mean precurriculum = 57%, postcurriculum = 70%, p < .001) and comfort with contraception counseling (overall mean precurriculum = 3.2, postcurriculum = 3.6, p < .01). Residents expressed strong support for SDM before and after the curriculum.DiscussionBased on the survey results, the curriculum successfully addressed gaps in residents’ comfort with contraception counseling and knowledge of contraception side effects and efficacy.

Implementation of a Hospital Medicine Rotation and Curriculum for Internal Medicine Residents.

IntroductionHospital medicine is a growing field that focuses not only on expertise in inpatient medicine but also on knowledge of nonclinical health system topics. The traditional model for resident education does not lend itself to learning these topics. We developed a unique ward rotation with a dedicated curriculum called the Resident Inpatient Training Experience (RITE) to address this deficiency.MethodsThe RITE rotation was initially implemented in the 2013–2014 academic year. The curriculum accompanying the rotation contained four case-based modules that included content on patient safety, quality improvement, cost-conscious care, hospital metrics/reimbursement, physician billing and coding, and transitions of care. Prior to RITE, residents received an email orientation to the service. To evaluate the rotation and curriculum, residents completed a pre- and postrotation online survey. Forty-six upper PGY 2 residents each rotated on the service for 1 month. An experienced hospitalist attended on the service and facilitated a weekly discussion on each module. This publication includes an updated version of the email orientation, the four modules, and the surveys.ResultsThere was a 72% response rate for completion of the pre- and postrotation survey. Confidence in managing hospitalized patients and knowledge of module content taught during the rotation improved.DiscussionWe found that implementation of a hospital medicine rotation and curriculum improved resident independence and knowledge of the module topics and was a successful way to alleviate current deficiencies in resident education.

Women's Leadership and Gender Bias Curriculum for Internal Medicine Residents.

Women's Leadership and Gender Bias Curriculum for Internal Medicine Residents.

A Resident-Authored, Case-Based Electrocardiogram Email Curriculum for Internal Medicine Residents.

IntroductionThe interpretation of electrocardiograms (ECGs) is a critical competency for internal medicine trainees, yet time and resources to foster proficiency are limited.MethodsThis resident-authored ECG email curriculum for first-year residents involved 129 first-year internal medicine residents at three major academic university hospitals. Residents either received the resident-authored ECG email curriculum (intervention group) or continued standard training (control group). The curriculum involved 10 multiple-choice ECG cases emailed biweekly over the 6-month study period. All participants were asked to complete a pre- and postintervention test to assess ECG interpretation competency and attitudes. The primary outcome was improvement in ECG test performance.ResultsAmong the 129 first-year residents participating, 21 of the 65 (32%) randomized to the intervention group and 13 of the 64 (20%) randomized to the control group completed both the pre- and posttests for analysis. While all participants’ ECG test scores improved over the study period (p < .001), improvement did not differ between groups (p = .860). We found that the effect of the intervention on ECG test performance varied significantly by the number of cardiology rotations an intern experienced (p = .031), benefiting naïve learners the most. All intervention group participants who completed the posttest reported they would recommend it to a colleague.DiscussionWhile it did not improve resident performance on an ECG posttest, this resident-authored ECG email curriculum offers a scalable way to provide trainees additional practice with ECG interpretation, with particular benefit to trainees who have not yet rotated on cardiology.