Background: The electrocardiogram (ECG) is the most important procedure to examine the cardiac rhythm and conduction system abnormalities. The common problem of ECG misinterpretation can lead to inappropriate diagnoses and clinical decisions. There is a limited number of studies identifying the size of the problem in Saudi Arabia. We aimed to assess the frequency of ECG misreading, address the nature of errors, and analyze the determinants of ECG interpretation accuracy among sixth-year medical students and interns of Taif University, Taif, Saudi Arabia.Methods: Participants were given a quiz of 10 multiple-choice questions of commonly encountered ECG interpretations. Each correct answer was given a 1-point score. The overall score for each participant was calculated out of 10 points.Results: A total of 297 participants took part in this study and achieved a median (IQR) overall score of 6.0 (4). The most frequent score was 9 (13.5%), followed by 8 (12.8%) and 4 (12.5%). Second degree AV block, type II was misread by 60.6% of the participants, 2nd-degree AV block, type I was misread by 50.2% while other abnormalities were less frequently misread. Academic year and gender showed no significant influence on ECG interpretation. On the other hand, interest in ECG reading and previous participation in ECG courses were associated with significantly better performance (p<0.001 and p=0.001, respectively).Conclusions: Overall performance of medical students and interns was moderate. Self-learning and providing organized educational courses on ECG can positively improve ECG interpretation and allow adequate diagnosis and management of heart diseases.

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