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.