Effectiveness of blended learning versus lectures alone on ECG analysis and interpretation by medical students

Abstract

Background Most medical students lack confidence and are unable to accurately interpret ECGs. Thus, better methods of ECG instruction are being sought. Current literature indicates that the use of e-learning for ECG analysis and interpretation skills (ECG competence) is not superior to lecture-based teaching. We aimed to assess whether blended learning (lectures supplemented with the use of a web application) resulted in better acquisition and retention of ECG competence in medical students, compared to conventional teaching (lectures alone). Methods Two cohorts of fourth-year medical students were studied prospectively. The conventional teaching cohort (n=67) attended four hours of interactive lectures, covering the basic principles of Electrocardiography, waveform abnormalities and arrhythmias. In addition to attending the same lectures, the blended learning cohort (n=64) used a web application that facilitated deliberate practice of systematic ECG analysis and interpretation, with immediate feedback. All participants completed three tests: pre-intervention (assessing baseline ECG competence at start of clinical clerkship), immediate post-intervention (assessing acquisition of ECG competence at end of six-week clinical clerkship) and delayed post-intervention (assessing retention of ECG competence six months after clinical clerkship, without any further ECG training). Diagnostic accuracy and uncertainty were assessed in each test. Results The pre-intervention test scores were similar for blended learning and conventional teaching cohorts (mean 31.02±13.19% versus 31.23±11.52% respectively, p=0.917). While all students demonstrated meaningful improvement in ECG competence after teaching, blended learning was associated with significantly better scores, compared to conventional teaching, in immediate (75.27±16.22% vs 50.27±17.1%, p<0.001; Cohen’sd=1.58), and delayed post-intervention tests (57.70±18.54% vs 37.63±16.35%, p<0.001; Cohen’s d=1.25). Although diagnostic uncertainty decreased after ECG training in both cohorts, blended learning was associated with better confidence in ECG analysis and interpretation. Conclusion Blended learning achieved significantly better levels of ECG competence and confidence amongst medical students than conventional ECG teaching did. Although medical students undergo a significant attrition of ECG competence without ongoing training, blended learning also resulted in better retention of ECG competence than conventional teaching. Web applications encouraging a stepwise approach to ECG analysis and enabling deliberate practice with feedback may, therefore, be a useful adjunct to lectures for teaching Electrocardiography.

Evaluating the Efficacy of an Online Learning Tool for EEG Teaching

“…36 The significant reduction in the number of "I am unsure" responses between pre-and postcourse tests also suggested a decrease in diagnostic uncertainty following the educational intervention. 13 Although our study did not directly assess delayed retention of acquired knowledge, previous studies into online ECG training have shown sustained retention 37,38 and it seems likely that EEG, which requires comparable aptitude for pattern recognition, would show similarly sustained knowledge retention.…”

Clinically contextualised ECG interpretation: the impact of prior clinical exposure and case vignettes on ECG diagnostic accuracy

“…This implies that ECG training should not rely on experiential learning alone for teaching electrocardiography. Instead, ECG training should be supplemented by other formal methods of instruction [ 45 , 59 , 60 ].…”

Evaluating a Blended Learning Model for Medical Student ECG Teaching

“…The ECG is a vital diagnostic tool when assessing patients with cardiopulmonary conditions, and accurate assessment can save lives by ensuring an accurate diagnosis. Combining multiple modalities can enhance learning across a variety of settings (blended methods), including ECG interpretation 13,14 . A previous effective blended learning ECG curriculum used Web applications and in-person didactics 13 .…”

“…11 Blended learning is a pedagogical tool that combines different modes of information delivery, models of teaching, and learning styles combining face-to-face learning sessions with online learning (Web-based, e-learning, modules). [12][13][14] Blended learning has proven to be an effective strategy to teach ECG competency when combining online modules with didactic lectures. 13 Online modules are difficult to integrate into busy clinical clerkships, however.…”