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Jacquemyn X, Guerrier K, Harvey E, Tackett S, Kutty S, Wetzel GT. pECGreview: Assessment of a Novel Tool to Evaluate the Accuracy of Pediatric ECG Interpretation Skills. Pediatr Cardiol 2024:10.1007/s00246-024-03556-z. [PMID: 38953950 DOI: 10.1007/s00246-024-03556-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 06/14/2024] [Indexed: 07/04/2024]
Abstract
The skill of interpretation of the electrocardiogram (ECG) remains poor despite existing educational initiatives. We sought to evaluate the validity of using a subjective scoring system to assess the accuracy of ECG interpretations submitted by pediatric cardiology fellows, trainees, and faculty to the Pediatric ECG Review (pECGreview), a web-based ECG interpretation training program. We conducted a retrospective, cross-sectional study of responses submitted to pECGreview. ECG interpretations were assessed independently by four individuals with a range of experience. Accuracy was assessed using a 3-point scale: 100% for generally correct interpretations, 50% for over- or underdiagnosis of minor ECG abnormalities, and 0% for over- or underdiagnosis of major ECG abnormalities. Inter-rater agreement was assessed using expanded Bland-Altman plots, Pearson correlation coefficients, and Intraclass Correlation Coefficients (ICC). 1460 ECG interpretations by 192 participants were analyzed. 107 participants interpreted at least five ECGs. The mean accuracy score was 76.6 ± 13.7%. Participants were correct in 66.1 ± 5.1%, had minor over- or underdiagnosis in 21.5 ± 4.6% and major over- or underdiagnosis in 12.3 ± 3.9% of interpretations. Validation of agreement between evaluators demonstrated limits of agreement of 11.3%. Inter-rater agreement exhibited consistent patterns (all correlations ≥ 0.75). Absolute agreement was 0.74 (95% CI 0.69-0.80), and average measures agreement was 0.92 (95% CI 0.89-0.94). Accuracy score analysis of as few as five ECG interpretations submitted to pECGreview yielded good inter-rater reliability for assessing and ranking ECG interpretation skills in pediatric cardiology fellows in training.
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Affiliation(s)
- Xander Jacquemyn
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, M2315, 1800 Orleans St, Baltimore, MD, 21287, USA
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Karine Guerrier
- Division of Peds Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA
| | - Evan Harvey
- Division of Peds Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA
| | - Sean Tackett
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shelby Kutty
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, M2315, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Glenn T Wetzel
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, M2315, 1800 Orleans St, Baltimore, MD, 21287, USA.
- Division of Peds Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA.
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Olvet DM, Sadigh K. Comparing the effectiveness of asynchronous e-modules and didactic lectures to teach electrocardiogram interpretation to first year US medical students. BMC MEDICAL EDUCATION 2023; 23:360. [PMID: 37217893 DOI: 10.1186/s12909-023-04338-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 05/09/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Medical students are expected to be competent in interpreting electrocardiograms (ECGs) by the time they graduate, but many are unable to master this skill. Studies suggest that e-modules are an effective way to teach ECG interpretation, however they are typically evaluated for use during clinical clerkships. We sought to determine if an e-module could replace a didactic lecture to teach ECG interpretation during a preclinical cardiology course. METHODS We developed an asynchronous, interactive e-module that consisted of narrated videos, pop-up questions and quizzes with feedback. Participants were first year medical students who were either taught ECG interpretation during a 2-hour didactic lecture (control group) or were given unlimited access to the e-module (e-module group). First-year internal medicine residents (PGY1 group) were included to benchmark where ECG interpretation skills should be at graduation. At three time-points (pre-course, post-course, and 1-year follow-up), participants were evaluated for ECG knowledge and confidence. A mixed-ANOVA was used to compare groups over time. Students were also asked to describe what additional resources they used to learn ECG interpretation throughout the study. RESULTS Data was available for 73 (54%) students in the control group, 112 (81%) in the e-module group and 47 (71%) in the PGY1 group. Pre-course scores did not differ between the control and e-module groups (39% vs. 38%, respectively). However, the e-module group performed significantly better than the control group on the post-course test (78% vs. 66%). In a subsample with 1-year follow-up data, the e-module group's performance decreased, and the control group remained the same. The PGY1 groups' knowledge scores were stable over time. Confidence in both medical student groups increased by the end of the course, however only pre-course knowledge and confidence were significantly correlated. Most students relied on textbooks and course materials for learning ECG, however online resources were also utilized. CONCLUSIONS An asynchronous, interactive e-module was more effective than a didactic lecture for teaching ECG interpretation, however continued practice is needed regardless of how students learn to interpret ECGs. Various ECG resources are available to students to support their self-regulated learning.
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Affiliation(s)
- Doreen M Olvet
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA.
| | - Kaveh Sadigh
- Department of Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, 11794, USA
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Oh SY, Cook DA, Van Gerven PWM, Nicholson J, Fairbrother H, Smeenk FWJM, Pusic MV. Physician Training for Electrocardiogram Interpretation: A Systematic Review and Meta-Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:593-602. [PMID: 35086115 DOI: 10.1097/acm.0000000000004607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Using electrocardiogram (ECG) interpretation as an example of a widely taught diagnostic skill, the authors conducted a systematic review and meta-analysis to demonstrate how research evidence on instruction in diagnosis can be synthesized to facilitate improvement of educational activities (instructional modalities, instructional methods, and interpretation approaches), guide the content and specificity of such activities, and provide direction for research. METHOD The authors searched PubMed/MEDLINE, Embase, Cochrane CENTRAL, PsycInfo, CINAHL, ERIC, and Web of Science databases through February 21, 2020, for empirical investigations of ECG interpretation training enrolling medical students, residents, or practicing physicians. They appraised study quality with the Medical Education Research Study Quality Instrument and pooled standardized mean differences (SMDs) using random effects meta-analysis. RESULTS Of 1,002 articles identified, 59 were included (enrolling 17,251 participants). Among 10 studies comparing instructional modalities, 8 compared computer-assisted and face-to-face instruction, with pooled SMD 0.23 (95% CI, 0.09, 0.36) indicating a small, statistically significant difference favoring computer-assisted instruction. Among 19 studies comparing instructional methods, 5 evaluated individual versus group training (pooled SMD -0.35 favoring group study [95% CI, -0.06, -0.63]), 4 evaluated peer-led versus faculty-led instruction (pooled SMD 0.38 favoring peer instruction [95% CI, 0.01, 0.74]), and 4 evaluated contrasting ECG features (e.g., QRS width) from 2 or more diagnostic categories versus routine examination of features within a single ECG or diagnosis (pooled SMD 0.23 not significantly favoring contrasting features [95% CI, -0.30, 0.76]). Eight studies compared ECG interpretation approaches, with pooled SMD 0.92 (95% CI, 0.48, 1.37) indicating a large, statistically significant effect favoring more systematic interpretation approaches. CONCLUSIONS Some instructional interventions appear to improve learning in ECG interpretation; however, many evidence-based instructional strategies are insufficiently investigated. The findings may have implications for future research and design of training to improve skills in ECG interpretation and other types of visual diagnosis.
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Affiliation(s)
- So-Young Oh
- S.-Y. Oh is assistant director, Program for Digital Learning, Institute for Innovations in Medical Education, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0002-4640-3695
| | - David A Cook
- D.A. Cook is professor of medicine and medical education, director of education science, Office of Applied Scholarship and Education Science, research chair, Mayo Clinic Rochester Multidisciplinary Simulation Center, and consultant, Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2383-4633
| | - Pascal W M Van Gerven
- P.W.M. Van Gerven is associate professor, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; ORCID: https://orcid.org/0000-0002-8363-2534
| | - Joseph Nicholson
- J. Nicholson is director, NYU Health Sciences Library, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Hilary Fairbrother
- H. Fairbrother is associate professor, Department of Emergency Medicine, Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Frank W J M Smeenk
- F.W.J.M. Smeenk is professor, Department of Educational Development and Research, Maastricht University, Maastricht, and respiratory specialist, Catharina Hospital, Eindhoven, The Netherlands
| | - Martin V Pusic
- M.V. Pusic is associate professor of pediatrics and associate professor of emergency medicine, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-5236-6598
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Vetter VL, Khanna S, Iyer VR. Reply. J Pediatr 2020; 217:218-219. [PMID: 31732134 DOI: 10.1016/j.jpeds.2019.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Victoria L Vetter
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sahil Khanna
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Rutgers Robert Wood Johnson Medical School, Currently Feinberg School of Medicine at Northwestern Memorial Hospital, Chicago, Illinois
| | - V Ramesh Iyer
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Sodhi JK, Hussain SS. Correct interpretation of pediatric electrocardiograms. J Pediatr 2020; 217:217-218. [PMID: 31708157 DOI: 10.1016/j.jpeds.2019.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/08/2019] [Accepted: 10/10/2019] [Indexed: 11/25/2022]
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The effectiveness of a nationwide interactive ECG teaching workshop for UK medical students. J Electrocardiol 2020; 58:74-79. [DOI: 10.1016/j.jelectrocard.2019.11.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/16/2019] [Accepted: 11/19/2019] [Indexed: 11/20/2022]
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Electrocardiogram interpretation and arrhythmia management: a primary and secondary care survey. Br J Gen Pract 2016; 66:e291-6. [PMID: 27025557 DOI: 10.3399/bjgp16x684781] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/16/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND There is increasing desire among service commissioners to treat arrhythmia in primary care. Accurate interpretation of the electrocardiogram (ECG) is fundamental to this. ECG interpretation has previously been shown to vary widely but there is little recent data. AIM To examine the interpretation of ECGs in primary and secondary care. DESIGN AND SETTING A cross-sectional survey of participants' interpretation of six ECGs and hypothetical management of patients based on those ECGs, at primary care educational events, and a cardiology department in Leeds. METHOD A total of 262 primary care clinicians and 20 cardiology clinicians were surveyed via questionnaire. Answers were compared with expert electrophysiologist opinion. RESULTS In primary care, abnormal ECGs were interpreted as normal by 23% of responders. ST elevation and prolonged QT were incorrectly interpreted as normal by 1% and 22%, respectively. In cardiology, abnormal ECGs were interpreted as normal by 3%. CONCLUSION ECG provision and interpretation remains inconsistent in both primary and secondary care. Primary care practitioners are less experienced and less confident with ECG interpretation than cardiologists, and require support in this area.
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Al-Fayyadh M, Alwadai A, Al Huzaimi A, Al Halees Z. Near missed reversible cardiomyopathy: The value of the electrocardiogram. Int J Pediatr Adolesc Med 2015; 2:29-33. [PMID: 30805433 PMCID: PMC6372371 DOI: 10.1016/j.ijpam.2015.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/17/2015] [Accepted: 02/25/2015] [Indexed: 11/26/2022]
Abstract
Dilated cardiomyopathy is a devastating disease affecting the myocardium that is characterized by cardiac chamber dilatation with contractile function impairment in the absence of structural heart disease. The majority of cases are idiopathic; these patients have a poor outcome. However, identifying a reversible etiology and instituting appropriate intervention could reverse the disease process and result in complete recovery. An electrocardiogram is a simple, non-invasive and quick test that should be performed in each patient presenting with dilated cardiomyopathy. Failure to perform this test or misinterpreting its result could result in a tragic misdiagnosis of idiopathic cardiomyopathy, depriving the patient of a potentially curative intervention. Here, we report two cases of dilated cardiomyopathy caused by clinical conditions with recognizable ECGs. In both cases, the diagnosis was missed initially, delaying corrective interventions. These cases draw attention to the importance of performing and correctly interpreting ECGs in patients with dilated cardiomyopathy.
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Affiliation(s)
- Majid Al-Fayyadh
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Saudi Arabia
| | - Abdualah Alwadai
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Saudi Arabia
| | - Abdulah Al Huzaimi
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Saudi Arabia
| | - Zohair Al Halees
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Saudi Arabia
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