IMPROVING ECG LEARNING AND COMPETENCE AMONG MEDICAL AND POSTGRADUATE TRAINEES: SCOPING REVIEW OF AVAILABLE EVIDENCE

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O.M. Adebayo^1,2, F.C. Anele³, T.K. Afolabi³, F.O. Inofomoh⁴, A.O. Ajibare^5,6, A. Aje²

1. Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan.
2. Department of Medicine, University College Hospital, Ibadan.
3. College of Medicine, University of Ibadan, Ibadan.
4. Department of Internal Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu.
5. Department of Medicine, Faculty of Clinical Sciences, Lagos State University College of Medicine, Ikeja, Lagos.
6. Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.

Abstract

Background: Electrocardiogram (ECG) is an important non-invasive tool for cardiac disease evaluation, both for routine cardiac evaluation or in life-threatening emergency settings. Cardiovascular diseases remain the most common cause of death worldwide. It is therefore important that medical doctors should be proficient in ECG interpretation. This scoping review therefore sets out to identify approaches to improving ECG learning and competence among medical and postgraduate trainees.

Methods: We performed this review using the preferred reporting items for systematic reviews and meta-analysis guidelines/checklists. The following databases were searched; PubMed, Scientific Electronic Library Online (SciELO), and African Journals Online (AJOL), and all articles investigating the methods of improving ECG learning and competence among medical students and postgraduate trainees published between 1st January 2000 and 31st December 2022 were included. Data was screened and extracted by at least three independent reviewers

Results: A total of 25 articles (19 randomized control trials, one cohort studies and 5 cross-sectional studies were identified. Most studies were from Europe while 20% of them were from the United States. Various modalities of ECG learning were identified which varied from traditional lecture based or electronic learning, formative vs summative methods, multiple integrated/ blended methods, internet versus non-internet methods, computer-simulated program or traditional teaching leads and so on.

Conclusion: We concluded that no single method of ECG learning is superior, however, a combination of conventional and electronic methods works better than either one as a standalone. Therefore, trainers should identify and adopt the most effective methods to enhance ECG competence among their trainees.

Keywords: Echocardiogram, Electrocardiography, Resident doctors, Medical students

Introduction

An electrocardiogram (ECG) remained an important tool for evaluating cardiac patients since it was first introduced over a century ago.1 The ECG is one of the most widely used tools in medicine today – nearly 200 million ECGs are recorded annually worldwide.2 While the ECG tracing itself has remained relatively unchanged since its inception, the ability to leverage the “humble” ECG to detect and diagnose various pathologies continues to evolve.3 ECG is important in the clinical diagnosis of cardiovascular diseases such as coronary syndrome, cardiac arrhythmias, risk stratification of sudden cardiac death and the selection of patients for medical device therapy and implantable cardiac devices etc. and this singular diagnostic tool can make a difference in the management and outcome of such cardiac patients.3 ECG has also remained an important diagnostic tool because of its noninvasive-ness, ease of accessibility, affordability and availability.2

Cardiovascular diseases have remained one of the leading causes of death all over the world. Hence, all healthcare providers must be skilled in making prompt and accurate diagnoses using ECG. The reliance on ECG to identify life-threatening arrhythmias and acute myocardial infarction has become so widespread and critically important that it has become part of the core curriculum for undergraduate and postgraduate medical trainees. This is of utmost importance because misinterpreting the ECG result can lead to misdiagnosis thereby delaying the appropriate treatment. It then becomes important that every healthcare provider is competent with not only performing ECG but also accurate interpretation of its result as this can make a whole lot of difference in the patient’s life. Moreover, improving the competency of ECG interpretation among trainees who work in emergency settings is a potential patient safety issue and could minimize interpretation errors during emergencies.4,5

Notwithstanding that ECG is important during undergraduate and postgraduate medical training, interpretation competence is not optimal and teaching or knowledge transmission is difficult.6-8 Other studies have found poor competency in specific area of ECG knowledge such as ECG of emergencies.9 The rapidly expanding undergraduate and postgraduate medical curriculum also bring to the fore the need for efficient ways to improve ECG learning and attainment of competence and proficiency for trainees.8,10 There are evidence globally to suggest that competence in ECG interpretation is poor in medical students although worse when compared to postgraduate medical trainees, which also further varies among cardiology residents compared to non-cardiology residents.11-13

There is a need for a comprehensive understanding of effective methods to enhance ECG interpretation competence among medical students and postgraduate trainees. By addressing these gaps, this scoping review will provide valuable insights for educators, clinicians, and policymakers to develop targeted strategies for improving ECG interpretation competence among medical trainees, ultimately enhancing patient care, safety, and outcomes.

This scoping review sought to synthesize the available evidence of methods of improving ECG learning and competence among medical students and postgraduate trainees.