The hierarchical and progressive objectives of standardized training for general practice residents require that third-year residents (R3) develop the ability to manage patients independently. Supervisors provide guidance on complex and critical cases to foster clinical reasoning and enhance diagnostic and management skills among R3. However, community outpatient teaching often relies on limited content and methods, falling short in cultivating systematic recognition and management of critical diseases such as atypical acute coronary syndrome (ACS).

To investigate the application of the PQRST pain assessment method combined with cardiovascular risk assessment in community outpatient teaching, with the aim of improving R3's ability to recognize, diagnose, and manage atypical ACS, thereby optimizing the quality of outpatient teaching.

Case-based learning was employed using a patient presenting with "subxiphoid discomfort for 2 hours after alcohol consumption". The R3 independently conducted the consultation and documented the medical record, while the supervisor observed, supplemented the documentation, and identified problems. The PQRST method was used to systematically collect symptom information, complemented by cardiovascular risk stratification using validated assessment tools. Electrocardiogram (ECG) and cardiac injury markers were utilized to confirm the diagnosis of ACS, followed by prehospital emergency management and referral. Mind map were incorporated into the teaching process to facilitate recording and feedback, reinforcing the R3's clinical reasoning and summarization skills.

Using the PQRST pain assessment method, the patient's symptoms were confirmed to be consistent with atypical chest pain. Cardiovascular risk assessment categorized the patient as being at"very high-risk". ECG and myocardial injury marker findings confirmed ST-segment elevation myocardial infarction (STEMI). Under the supervisor's guidance, the R3 successfully completed rapid assessment, prehospital management, and orderly referral. After the teaching session, the R3 demonstrated significantly improved ability to recognize atypical ACS, enhanced clinical logical reasoning, and greater familiarity with emergency referral procedures.

The combination of the PQRST pain assessment method and cardiovascular risk assessment improves R3's capacity for early recognition and management of atypical ACS. The integration of mind maps for feedback and summarization helps establish a systematic framework for differential diagnosis. This approach is applicable to teaching critical care management in community outpatient teaching and holds promise for broader implementation.