Discussion
The purpose of this study was to assess the impact of a short period of
intensive ECG teaching on ECG knowledge and confidence in ECG
interpretation. A single session of intensive ECG teaching was provided
to students who had completed their teaching and clinical practice
curriculum, a cohort reflective of junior doctors in training. The
teaching was provided by Cardiology trainees rather than consultant
Cardiologists. This was designed to reflect the doctors providing the
majority of bedside teaching within hospitals. The method of testing in
our study was also different to previous similar studies. Our test
involved the interpretation of 10 ECGs taken from clinical practice with
a short clinical scenario attached. Instead of multiple choice answers
the participants were required to provide a free hand answer. This is
more reflective of ECG interpretation in clinical practice.
This study found an improvement in both ECG knowledge and ECG
interpretation after a 2 hour session of teaching. The improvement in
examination results was modest but statistically significant. The
standard of knowledge tested was high and the marking scheme was strict.
The examination was brief but deliberately covered a broad spectrum of
ECG knowledge. Therefore it is unsurprising that there was a wide range
of examination results. The free hand answering format also impacted on
the scores. For instance, when interpreting the ECG in normal sinus
rhythm many participants answered “regular rhythm”. This was
considered an incorrect answer. If provided with multiple choice
questions it is possible many of these participants would have answered
correctly. Similarly, the questions on STEMI asked for identification of
the STEMI territory rather than identification of a STEMI. In clinical
practice, identification of an ECG concerning for a STEMI would lead to
specialist cardiology involvement and the non-cardiology doctor’s
inability to identify the territory involved is unlikely to
significantly impact on the clinical course for the patient. Incorrect
answers of this nature are unlikely to reflect a risk to patient safety
in clinical practice.
Participants with a lower baseline knowledge had a more significant
improvement than students with a higher baseline knowledge, who in fact
had a disimprovement in their scores. On subcategory analysis, there was
a greater improvement in the basic skills of ECG interpretation e.g.
rate and rhythm assessment, compared to complex concepts e.g. conduction
abnormalities. There was a highly variable level of ECG knowledge prior
to attending this session despite all students having completed their
teaching curriculum. This style of teaching was most effective at
improving basic ECG principles and was less effective with complex
concepts. Therefore, participants who scored poorly in the basic
principles were more likely to improve on the post-teaching examination.