Timeframe: from first patient contact until diagnosis or exclusion of a specific rhythm disorder (then continued in specific EPAs), or other cause

Setting: outpatient setting, inpatient setting, and emergency department

Including:

initial assessment based on clinical history and physical examination

using modalities of heart rhythm monitoring

Excluding: performing actual therapy of rhythm disorders (see specific EPAs)

• Medical expert

• Communicator

• Collaborator

• Professional

• Describe the arrhythmic and non-arrhythmic causes of palpitation

• Describe the electrocardiographic features of the different arrhythmias

• Recall the high-risk features on the resting ECG in a patient with a suspected arrhythmia

• Explain the significance of structural heart diseases in a patient presenting with a suspected arrhythmia

• Discuss the role of the 12-lead ECG and different modalities (invasive and non-invasive) of heart rhythm monitoring in patients with palpitations

• Discuss the limitations of consumer devices for heart rate and rhythm monitoring

• Outline the circumstances in which additional investigation, including echocardiography and blood testing, is appropriate for a patient with palpitation

• Take a relevant history and perform an appropriate physical examination

• Differentiate the types of arrhythmia from the 12-lead ECG

• Perform and interpret electrocardiographic monitoring including 12-lead electrocardiogram, Holter, patient activated and implantable or wearable devices, and emergency interrogation of pacemakers and implantable cardioverter-defibrillators

• Acknowledge the anxiety associated with palpitation, even when the cause is shown to be benign

• Recognize that palpitation is an insensitive and non-specific symptom of an arrhythmia

• Avoid over-investigation

• Recognize that palpitation can be normal and that some rhythm disturbances are best managed with reassurance

• Explain that self-monitoring devices are prone to over diagnosis and causing inappropriate anxiety

• Direct observation/WBA (e.g. DOPS, Mini-CEX, fieldnotes)

• CbD (case-based discussion)/EbD (entrustment-based discussion)

• 5. Able to teach (no supervision)