A paper published in Archives of Disease in Childhood (Online First) last year highlighted just how bad we are at ECG interpretation.
Why is this an issue?
Anyone who has trained in paediatrics will know that most of us receive pretty much no formal ECG training. In fact, unless we work in ED, we actually won’t be asked to interpret ECGs that often at all. But clearly these are skills that all paediatric trainees need, and being able to identify some common ECG abnormalities is essential.
One study was run by Snyder et al (2005) in the US, where doctors were asked to identify 10 ECGs – junior residents scored 46% correctly; while senior residents faired a bit better at 64%. These results were more or less replicated by Crocetti et al (2010) in a similar assessment of residents.
This study assessed the skills of ECG interpretation in UK paediatric trainees, and then gave them some ECG education.
Who did they ask?
The authors contact 8450 members of the Royal College of Paediatrics and Child Health, UK (this means junior doctors in training) identified by searching through the RCPCH’s member list on their website.
There were 764 who agreed to participate (385 completed the study). 266 of the original participants had received either formal ECG training or previously worked in a paediatric cardiology post.
What were they asked to do?
The participants completed a quiz containing 10 ECGs. Each question had five possible answer options.
The 10 ECGs were: normal neonatal ECG; normal paediatric ECG; atrial fibrillation; complete heart block; Wolff-Parkinson-White syndrome; atrioventricular septal defect with the typical superior left axis; right bundle branch block; prolonged QT interval; myocarditis or pericarditis; and hyperkalaemia.
They were then given one page of ECG teaching to read, and repeated the test (with different ECGs but the same conditions).
Did we pass?
Participants on the pre-education quiz scored 63.5% and on the post-education quiz scored 73.3%. This demonstrated a significant improvement with the educational intervention (p<0.001).
There was no difference between senior and junior trainees and no difference between those with previous ECG/cardiology training and those without.
What about the ones that didn’t complete?
There were 493 people who did the first quiz and didn’t complete the second quiz. Their score on average was 61.5%.
What are the study limitations?
The group is self-selecting out of all UK paediatric trainees. It could be that those who were most worried about their ECG skills, or those who were keenest to learn and improve agreed to participate.
Also, improving test scores in such close proximity to educational intervention doesn’t necessarily teach us much. What matters is whether or not we can retain that information for future practice; and this was not tested by the authors.
What is clear, is that paediatric trainees are not good enough at ECG interpretation. We should all be able to identify these 10 basic and essential ECG patterns. More formal teaching is needed as an integral part of training, but in the meantime we can create more FOAM resources to help.
See how you perform in tomorrow’s ECG quiz….
Jheeta JS, Narayan O, Krasemann T. 215 The Accuracy in Interpreting the Paediatric Electrocardiogram and the Need for Further Training. Archives of Disease in Childhood. 2012 Oct 1;97(Suppl 2):A62-.
Snyder CS, Bricker JT, Fenrich AL, et al. Can pediatric residents interpret electrocardiograms? Pediatr Cardiol 2005;26:396–9.
Crocetti M, Thompson R. Electrocradiogram interpretation skills in pediatric
residents. Ann Pediatr Cardiol 2010;3:3–7.