Asteroids® and Electrocardiograms: Proof of Concept of a Simulation for Task-Switching Training

Aziz, Farhad H.; Yeh, Bryan; Emerson, Geremiha; Way, David P.; Miguel, Christopher San; King, Andrew

doi:10.5811/westjem.2018.10.39722

Cited by 2 publications

(16 citation statements)

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“…not report training level-specific sample sizes (n = 253). Twentysix studies 12,27,29,31,35,36,39,[56][57][58][59]62,64,65,71,72,74,75,77,[80][81][82]85,86,96,98 were randomized trials, 11 studies 21,23,24,34,42,43,48,52,53,73,97 were 2-group nonrandomized comparisons, 19 studies 25,30,32,41,50,66,69,70,78,79,84,[87][88][89][90][92][93][94][95] were single-group pre-post comparisons, and 22 studies…”

Section: Key Pointsmentioning

confidence: 99%

“…The number of test items ranged from 1 to 100 (median, 10; IQR, 9-20). The ECG diagnoses represented in the test were reported in 53 studies (68%) 12,21,25,26,30,31,33,34,[36][37][38]40,[43][44][45][46][47][49][50][51][52][53][54][55]57,59,61,63,64,[66][67][68][69][70][71]75,76,78,80,[83][84][85][86][87][88][89][90][91][92][94][95][96]98; these studies included normal ECGs (26 studies 31,33,34,37,38,40,45,47,49,51,52,54,63,66,68,69,75,76,78,84,87,90-92, 94,96) and abnormalities of rhythm...…”

Section: Features Of Ecg Testsmentioning

confidence: 99%

“…The ECG complexity or difficulty was intentionally set or empirically determined in 32 studies. 21,24,26,28,[30][31][32][33]36,38,[43][44][45]49,51,53,54,56,[59][60][61]63,66,67,69,75,[90][91][92]94,95,98 Among these, the ECGs reflected a simple interpretation (single diagnosis) in 20 studies, 26,31,33,38,[43][44][45]49,51,53,54,59,61,66,67,75,92,94,95,98 several straightforward diagnoses in 2 studies, 28,…”

Section: Features Of Ecg Testsmentioning

confidence: 99%

“…We planned subgroup analyses according to item difficulty. Nineteen pretraining assessments 26,31,33,38,[43][44][45]49,51,53,54,59,61,66,67,92,94,95,98 included only ECGs with 1 diagnosis (less difficult), and 10 assessments 21,24,30,32,36,60,63,69,90,91 included ECGs with multiple diagnoses or empirically determined high difficulty. In analyses limited to these 29 studies, 21,24,26,[30][31][32][33]36,38,[43][44][45]49,51,53,54,[59][60][61]63,66,67,69,[90]…”

Section: Accuracy Of Physicians' Ecg Interpretationsmentioning

confidence: 99%

“…We also conducted subgroup analyses according to response format. Twenty-three pretraining assessments 21,23,30,32,33,36,[38][39][40][44][45][46][49][50][51]55,59,61,68,70,90,94,97 used free-text response, with a median accuracy of 54% (IQR, 43%-65%). Twenty assessments 12,47,53,54,62,66,67,69,71,76,77,79,84,87,[91][92][93]95,96,98 used a predefined list of answers, with a median accuracy of 60% (IQR, 48%-68%).…”

Section: Accuracy Of Physicians' Ecg Interpretationsmentioning

confidence: 99%

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Accuracy of Physicians’ Electrocardiogram Interpretations

Cook

Pusic³

2020

JAMA Intern Med

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STUDY SELECTION Of 1138 articles initially identified, 78 studies that assessed the accuracy of physicians' or medical students' ECG interpretations in a test setting were selected.DATA EXTRACTION AND SYNTHESIS Data on study purpose, participants, assessment features, and outcomes were abstracted, and methodological quality was appraised with the Medical Education Research Study Quality Instrument. Results were pooled using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES Accuracy of ECG interpretation.RESULTS Of 1138 studies initially identified, 78 assessed the accuracy of ECG interpretation. Across all training levels, the median accuracy was 54% (interquartile range [IQR], 40%-66%; n = 62 studies) on pretraining assessments and 67% (IQR, 55%-77%; n = 47 studies) on posttraining assessments. Accuracy varied widely across studies. The pooled accuracy for pretraining assessments was 42.0% (95% CI, 34.3%-49.6%; n = 24 studies; I 2 = 99%) for medical students, 55.8% (95% CI, 48.1%-63.6%; n = 37 studies; I 2 = 96%) for residents, 68.5% (95% CI, 57.6%-79.5%; n = 10 studies; I 2 = 86%) for practicing physicians, and 74.9% (95% CI, 63.2%-86.7%; n = 8 studies; I 2 = 22%) for cardiologists. CONCLUSIONS AND RELEVANCEPhysicians at all training levels had deficiencies in ECG interpretation, even after educational interventions. Improved education across the practice continuum appears warranted. Wide variation in outcomes could reflect real differences in training or skill or differences in assessment design.

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Section: Key Pointsmentioning

confidence: 99%

Section: Features Of Ecg Testsmentioning

confidence: 99%

Section: Features Of Ecg Testsmentioning

confidence: 99%

Section: Accuracy Of Physicians' Ecg Interpretationsmentioning

confidence: 99%

Section: Accuracy Of Physicians' Ecg Interpretationsmentioning

confidence: 99%

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Accuracy of Physicians’ Electrocardiogram Interpretations

Cook

Pusic³

2020

JAMA Intern Med

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Assessments of Physicians’ Electrocardiogram Interpretation Skill: A Systematic Review

Cook

Pusic

2022

Academic Medicine

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PurposeTo identify features of instruments, test procedures, study design, and validity evidence in published studies of electrocardiogram (ECG) skill assessments. MethodThe authors conducted a systematic review, searching MEDLINE, Embase, Cochrane CENTRAL, PsycINFO, CINAHL, ERIC, and Web of Science databases in February 2020 for studies that assessed the ECG interpretation skill of physicians or medical students. Two authors independently screened articles for inclusion and extracted information on test features, study design, risk of bias, and validity evidence. ResultsThe authors found 85 eligible studies. Participants included medical students (42 studies), postgraduate physicians (48 studies), and practicing physicians (13 studies). ECG selection criteria were infrequently reported: 25 studies (29%) selected single-diagnosis or straightforward ECGs; 5 (6%) selected complex cases. ECGs were selected by generalists (15 studies [18%]), cardiologists (10 studies [12%]), or unspecified experts (4 studies [5%]). The median number of ECGs per test was 10. The scoring rubric was defined by 2 or more experts in 32 studies (38%), by 1 expert in 5 (6%), and using clinical data in 5 (6%). Scoring was performed by a human rater in 34 studies (40%) and by computer in 7 (8%). Study methods were appraised as low risk of selection bias in 16 studies (19%), participant flow bias in 59 (69%), instrument conduct and scoring bias in 20 (24%), and applicability problems in 56 (66%). Evidence of test score validity was reported infrequently, namely evidence of content (39 studies [46%]), internal structure (11 [13%]), relations with other variables (10 [12%]), response process (2 [2%]), and consequences (3 [4%]). Conclusions ECG interpretation skill assessments consist of idiosyncratic instruments that are too short, composed of items of obscure provenance, with incompletely specified answers, graded by individuals with underreported credentials, yielding scores with limited interpretability. The authors suggest several best practices.

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Asteroids® and Electrocardiograms: Proof of Concept of a Simulation for Task-Switching Training

Cited by 2 publications

References 11 publications

Accuracy of Physicians’ Electrocardiogram Interpretations

Accuracy of Physicians’ Electrocardiogram Interpretations

Assessments of Physicians’ Electrocardiogram Interpretation Skill: A Systematic Review

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