Instructions and FAQ

O’Keefe ECG User Instructions and FAQ

O’Keefe ECG is designed to help you excel on electrocardiogram (ECG) portion of the American Board of Internal Medicine (ABIM) Cardiovascular Certifying Examination (CV Boards). This study guide will teach you what you need to know to ace the ECG section on the CV Boards. Indeed, if you are diligent about using the O’Keefe ECG cases, the ECG section can be one of the easiest portions of the CV Boards to master.

The O’Keefe ECG online program simulates the format and score sheet used on the ECG portion of the CV Board Exam. There are just 89 specific ECG diagnoses that you need to worry about for CV Boards, but you need to know “by heart” the criteria for making each of these diagnoses. On the score sheet you can click on the “i” icon following each of the 89 items and it will bring up its specific criteria required to make that ECG diagnosis, and it will also display one or more ECG snippets as examples of the finding. To select any of the diagnosis from the score sheet as an answer, just click on the corresponding box.

Underneath each unknown ECG is the score sheet which lists the 89 potential ECG diagnoses. The answer options on the O’Keefe ECG score sheet are virtually identical to the recently updated ABIM Cardiovascular Disease Certifying Exam (Boards) ECG scoresheet.

Read the patient description at the top of each ECG, identify the relevant electrocardiographic findings, select the appropriate answer option(s) on the score sheet that correspond to your findings. Correct diagnoses may come from several different sections, including more than one diagnosis from any of the sections, and/or none from many sections. Only choose the options that are the correct answers for any given ECG.

The goal is not to identify minutiae or clinically irrelevant details. Also try to avoid redundancy, such as coding left axis deviation in the setting of left anterior fascicular block, or ST-T changes suggesting acute myocardial injury in the setting of acute MI. If you feel that there is insufficient data or the findings are equivocal for any specific ECG feature, do not include that diagnosis among your answers on the scoresheet.

This self-assessment exam includes 300 ECGs which will in aggregate cover in detail each and every one of the 89 diagnoses you need to know for the ECG section of the CV Boards. For each unknown ECG, a brief summary of the patient clinical presentation will be provided on the top of the tracing. As on the CV Board Exam, this clinical lead-in will often convey important clues that will help you come up with the correct answers for each ECG.

You can zoom the ECG by clicking the Zoom icon or deploy the electronic calipers by clicking the Calipers icon, which will allow you to measure parameters such as QRS, QT, PR, and RR intervals. As you analyze the ECG, you can scroll down to see the ECG diagnoses score sheet.

Note that the score sheet has a Clinical Disorders section. For many cases you will need to recognize that the findings on the ECG are consistent with one of these clinical diagnoses. Choose a clinical diagnosis only when the findings are strongly suggestive of a specific clinical disorder such as hypokalemia, acute pericarditis, Brugada syndrome, etc. The CV Boards typically includes many ECGs that are examples of these clinical disorders.

To see how your answers compare with the experts, click the “SUBMIT ANSWERS” button at the bottom of the scoresheet for each ECG unknown. The scoring system used on O’Keefe ECG will provide you with immediate feedback to improve your ECG interpretation skills.

Each tracing has been thoroughly vetted by our cardiologists who are experts at ECG interpretation. Your score for each ECG will be determined by how many of the correct answers you selected—for which you will receive positive credit (+ points), and how many incorrect answers you chose—for which you will receive negative credit (- 1 point for each incorrect diagnosis). Each ECG has anywhere from 1 to 10 correct diagnoses; the maximum number of points possible for each ECG ranges from 4 to 15.

Because the ABIM Cardiovascular Diseases Board Exam ECG scoring system is proprietary, the O’Keefe ECG scoring is based upon our own time-tested and well-established criteria. If you have disagreements regarding our scoring on any particular ECG, please email us and we will consider your comments and decide whether the answers for that ECG needs to be revised.

Once you have read the explanation for the correct answers, and are ready to move onto the next case, click the “Take a Test ECG” button again. O’Keefe ECG is also a superb resource for anyone looking to improve their ECG interpretation skills. The convenient online format allows you to access this program whenever and wherever you want to study for CV Boards and/or sharpen your ECG diagnostic acumen.

Frequently Asked Questions

Can I redo an ECG after I have submitted my answer?

Yes, for any particular ECG you can swipe left to right left (or click the back arrow in the upper left-hand corner) to go back to the unknown ECG/scoresheet and revise your answers; when ready to resubmit, click the “SUBMIT ANSWERS” button again. You can also retake the entire O’Keefe ECG exam after you have completed all the unknown ECGs or at any point in the test. When ready to start over, go to “ALL ECGS/YOUR RESULTS” page and hit the “Clear All ECG Results” button. This will give you a clean start.  If you want to take the ECGs in sequential order, click the “ALL ECGS/YOUR RESULTS” tab on home page.

How much time should I allow for interpretation of each ECG?

ABIM CV Boards have typically allowed approximately 3 minutes to view and score each tracing in the ECG portion of the test.

How do I use the calipers?

You may display ECG calipers by clicking on the Caliper icon. Use the mouse to click and drag the two sides of the calipers to create your desired caliper width; the interval will be displayed in milliseconds (msec) at the bottom of the ECG.

Is O’Keefe ECG the on-line version of Complete Guide to ECGs, 4th Edition?

No, the tracings and teaching materials in O’Keefe ECG are entirely new, with no duplication of any ECGs from the Complete Guide to ECGs. Thus, these two resources (O’Keefe ECG and Complete Guide to ECGs) are two independent resources to improve ECG interpretation skills.


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