Illustrated ECG. A Step by step approach to learn ECG Med Educ Online [serial online] 1999;4,1. Available fromURL ttp://www.utmb.edu/meo/

1

Illustrated ECG, A Step by Step Approach to Learn ECG

Tarek Abdelhamid, MD, David E. Richmond, MD & Stephen Wealthall, MD

First Edition 1998, Medical Education Development Company Ltd.,P.O.Box 15-241 New Lynn, Auckland, New Zealand. ISBN 0-473-05483-3

Reviewed by Curtis J. Rosebraugh, MD

Introduction: This is the first of I hope many reviews in Medical Education Online ofbooks addressing health education. I would like to thank Tarek Abdelhamid, MD forproposing the idea of a book review section and submitting his textbook for review. Ihave enjoyed getting to know Dr. Abdelhamid and look forward to working with himon future projects. I would also like to thank my friend and former colleague CurtisRosebraugh, MD for conducting a thoughtful review. Additional information and se-lected examples from Illustrated ECG, A Step by Step Approach to Learn ECG isavailable electronically at: http://www.medical-education.co.nz/index.htm. I hope youfind this review and the new section of the journal useful and welcome your commentsand suggestions. David J. Solomon, PhD, Editor, Medical Education Online.

There have been many attempts to fill thevoid that exists in medical education for thedefinitive ECG textbook. The perfect textbookwould be simplistic enough for the novice tounderstand, while providing enough compre-hensive material that the novice could gain theskills to interpret the majority of ECG’s thatthey will encounter in the future. Ideally itwould employ a graduated teaching design thatwould allow novices and more advanced learn-ers alike, opportunities to enhance their skills.This would allow learners with different levelsof experience to remain engaged with the text,while not being too over or underwhelmed. Asystematic, retainable, approach is essential andkey concepts should be illuminated with visualexamples. The author that would take on thistask has the challenge to write an ECG textbookthat would appeal to a wide range of learnerswith a wide range of abilities. The textbookmust also appeal to a wide range of educatorsthat mentor these learners, each of whom havethere own unique approaches to teaching andtheir own expectations. To fulfill all of this is adifficult assignment indeed.

Dr. Abdehamid’s textbook “Illustrated ECG,A Step by Step Approach to Learn ECG” is an-

other attempt by a skilled medical educationalistto fill this textbook void. Dr. Abdelhamid’seffort is outstanding in several of its sectionsand is a quick read for an experienced ECGreader. My favorites are his approach to ECGchanges associated with Bundle Branch Blocksand the mechanism underlying ST segmentchanges in ischemia. These sections are clearlywritten, easy to understand and effectively an-swer questions that consistently confuses nov-ices. I found his approach to these areas so il-luminating that I would consider personally in-corporating them into my own teachings.

His early chapters however, suffer from thebane that plagues most ECG textbooks con-fusing limb lead graphics and inadequate expla-nations of how to interpret these graphics. Also,in these sections is a general use of terminology,medical conditions and concepts, that a novicelearner may find frustrating. The heart rhythmand rate sections are superficial, unfocused andlack the same systematic approach that is shownin later sections. In the final section, I wouldlike to see the practice ECG’s and their answerson separate pages. This would remove thetemptation of looking prematurely at the answer.The quality of the print throughout the book is

Illustrated ECG. A Step by step approach to learn ECG Med Educ Online [serial online] 1999;4,1. Available fromURL ttp://www.utmb.edu/meo/

2

very primitive and occasionally hard to read.

In summary, Dr. Abdelhamid’s textbookresembles others that are currently published. Itis brilliant in some sections and but lacks a clearsystematic approach with depth and clarity, inothers. I would rank his textbook at the samelevel as those that enjoy popularity now, andwould recommend its use as a supplement, butnot as the definitive educational ECG textbook.Sadly, the void still exists.

A Reply from the Author

“I learn from those who tell me my positivepoints, but I learn more from those who tell meabout the negative ones.”

I would like first to thank all those whoshared in reviewing my book Illustrated ECG.The comments were very constructive and use-ful. I do agree that most of ECG books (includ-ing mine) need more detailed information aboutthe electrophysiologic background of the Limbleads. Probably, the authors find it a compli-cated subject for beginners. I believe thereshould be some way to simplify its concepts, andI will try to work out a way to achieve this.

I agree also that the first chapters were rela-tively superficial and shallow compared to thosefollowing. One of my challenges in this bookwas how to start it. Ideally, each chapter shouldbe complete; however, memory studies haveshown that too much information can be a hin-drance to memorizing data because of an “in-terference phenomenon” (see Houston, 1991).For this reason, I decided to start the first chap-ters (which contain the basic concepts of theECG) with relatively little information, so as toavoid the interference phenomenon as much aspossible so the basic ECG concepts becomemore memorable. In other words, some infor-mation was intentionally relocated from the firstchapters to other chapters to facilitate the overallprocess of learning and memory. This may ex-plain why the first chapters appear shallow orsuperficial compared to the others.

Finally, my challenge now is to write “theultimate ECG book”. It is not an easy job, but itis possible. I am preparing a revised edition andwill consider these highly constructive com-ments to further improve my book.

I am very grateful to all that shared in this re-view.

Tarek Abdelhamid, M.D.

Houston,J. P. Fundamentals of learning andmemory (4th ed.). Florida: Harcourt Brace Jo-vanovich, 1991.

Dr. Rosebraugh may be reached for commentvia e-mail at Rosebra@aol.com.

Dr. Abdelhamid may be reached for commentvia e-mail at tarek@medical-education.co.nz