The acquisition and retention of ECG interpretation skills after a standardized web-based ECG tutorial–a randomised study

Abstract

BackgroundElectrocardiogram (ECG) interpretation is of great importance for patient management. However, medical students frequently lack proficiency in ECG interpretation and rate their ECG training as inadequate.Our aim was to examine the effect of a standalone web-based ECG tutorial and to assess the retention of skills using multiple follow-up intervals.Methods203 medical students were included in the study. All participants completed a pre-test, an ECG tutorial, and a post-test. The participants were also randomised to complete a retention-test after short (2–4 weeks), medium (10–12 weeks), or long (18–20 weeks) follow-up.Intragroup comparisons of test scores were done using paired-samples t-test. Intergroup comparisons of test scores were performed using independent-samples t-test and ANOVA, whereas demographic data were compared using ANOVA and Chi-squared test.ResultsThe overall mean test score improved significantly from 52.7 (SD 16.8) in the pre-test to 68.4 (SD 12.3) in the post-test (p < 0.001). Junior and senior students demonstrated significantly different baseline scores (45.5 vs. 57.8 points; p < 0.001), but showed comparable score gains (16.5 and 15.1 points, respectively; p = 0.48).All three follow-up groups experienced a decrease in test score between post-test and retention-test: from 67.4 (SD 12.3) to 60.2 (SD 8.3) in the short follow-up group, from 71.4 (SD 12.0) to 60.8 (SD 8.9) in the medium follow-up group, and from 66.1 (SD 12.1) to 58.6 (SD 8.6) in the long follow-up group (p < 0.001 for all). However, there were no significant differences in mean retention-test score between the groups (p = 0.33). Both junior and senior students showed a decline in test score at follow-up (from 62.0 (SD 10.6) to 56.2 (SD 9.8) and from 72.9 (SD 11.4) to 62.5 (SD 6.6), respectively). When comparing the pre-test to retention-test delta scores, junior students had learned significantly more than senior students (junior students improved 10.7 points and senior students improved 4.7 points, p = 0.003).ConclusionA standalone web-based ECG tutorial can be an effective means of teaching ECG interpretation skills to medical students. The newly acquired skills are, however, rapidly lost when the intervention is not repeated.

Is computer-assisted instruction more effective than other educational methods in achieving ECG competence amongst medical students and residents? A systematic review and meta-analysis

“…It remains important to review whether these novel teaching and learning methods are effective 26. Previous studies have shown that students’ knowledge of, and skills in the analysis and interpretation of ECGs improve with computer-assisted instruction (CAI) 27–34. However, these studies did not compare CAI to other methods of instruction and thus it cannot be concluded that CAI is better than traditional methods of ECG teaching.…”

Performance of the BMJ learning training modules for ECG interpretation in athletes

“…This study reports descriptive statistics from an online training course taken by a large group of self-selected multinational and multidisciplinary healthcare professionals and was not designed to be a randomised controlled trial. Retention of information was also not assessed, an important caveat given some evidence suggests ECG interpretation test scores reduce 2–4 weeks post-education 20. In addition, other factors that may have influenced individual performance, such as prior experience in ECG interpretation in athletes, other educational courses completed or how long participants took to complete a module, are unknown.…”

The essential skill of ECG interpretation: How do we define and improve competency?

“…More recent research has explored and compared various teaching techniques, including self-directed learning (eg, online courses or modules), lecture-based or workshop-based formats and small-group peer teaching 4 5. Although no single method has emerged as superior, it is clear that newly acquired ECG interpretation skills must be continually reinforced for content retention 6–8. Thus, medical educators are not only challenged to deliver effective teaching methods, but they are also tasked with finding an educational approach that will help ensure enduring, sustainable progress.…”

“…Ideally, ECG interpretation training methods should be efficient, flexible, sustainable, and capable of taking learners from a novice to an advanced interpreter level. In the modern era of technology-based medical education, online training or ‘e-learning’ has emerged as a promising and increasingly popular educational format 6. Online self-directed learning methods are often referred to as a ‘flipped-classroom’ approach, in which online modules are completed on the learner’s own time and then later reinforced through clinical application.…”