Interpretation of the emergency electrocardiogram by junior hospital doctors.

Abstract

Objective-To assess the ability ofa cohort of junior hospital doctors to interpret ECGs which have immediate clinical relevance and influence subsequent management of patients Methods-57 junior hospital doctors were interviewed and asked to complete a standard questionnaire which included eight ECGs for interpretation and a supplementary question relating to the administration of thrombolytic treatment. Each doctor was assessed over a 48 h period while they performed their daily clinical duties. Results-The major abnormality of anterior myocardial infarction was recognised by almost all doctors. There was difficulty in the interpretation of posterior myocardial infarction and second degree heart block. Most myocardial infarctions would have been given satisfactory thrombolysis, but there was a reluctance to use this treatment in patients with posterior myocardial infarction and left bundle brach block. A few patients without myocardial infarction would have received thrombolytic treatment. Conclusions-There is varying ability among junior hospital doctors in the interpretation of the emergency electrocardiogram. The results are of concern as poor interpretation of the ECG can result in inappropriate management. As a result of the findings of this study it is proposed to introduce more formal training in the interpretation of clinically relevant ECG abnormalities for junior hospital doctors.

Conventional Electrocardiographic Interpretation by Non-Cardiologist Medical Doctors: A Need for Improvement in the Teaching Techniques or a Necessity for Better Learning Skills?

“…Moreover, many doctors are unaware of their limitations and believe that their ECG interpretation knowledge is good enough. However, several studies showed otherwise [13][14][15][16][17]. The results of these investigations highlight the fact that the current ECG interpretation knowledge is undoubtedly poor.…”

Expertise in Interpretation of 12-Lead Electrocardiograms of Staff and Residents Physician: Current Knowledge and Comparison between Two Different Teaching Methods

“…In the present study, AMI was missed by 13.4%, VT was missed by 44.1%, and 2 nd degree AV block was missed by 64.6% of the residents in the IT. In a study by Gillespie et al [12] more than 50% of residents failed to recognize AV block and posterior MI when interpreting ECGs. It is notable that although residents improved their results, the score of FT remained poor.…”

Training and Assessment of ECG Interpretation Skills: Results From the 2005 CDIM Survey

“…[2][3][4] Even correct identification of minor ECG abnormalities, such as fascicular blocks and conduction delays, can have important prognostic implications. 5 Prior studies have demonstrated less than optimal interpretation skills in medical students, 6-10 internal medicine, family medicine, and emergency medicine residents, [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] noncardiologist physicians, 3,4,22,[26][27][28][29] and anesthesiologists. 30 Resident physicians in both emergency medicine and internal medicine have recognized their knowledge deficits and feel that their ECG training during medical school and postgraduate years was inadequate.…”