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

Abstract

To assess the accuracy of interpreting the athlete's ECG both pre and post a series of online training modules among a range of healthcare professionals. 10 512 healthcare professionals from 138 different nations commenced the online course. These were primarily doctors (43%), nurses (18.4%) and other healthcare professionals (3.9%). The users came from 102 different specialities, with General Practice/Family Medicine (24.5%), Cardiology (10.6%), Emergency Medicine (8.7%) and Sports Medicine (6.6%) predominating. Among the 2023 users who completed both the pre-course and post-course test, there was an overall improvement of 15.3% (95% CI 13.9% to 16.6%; p<0.001). 930 completed all four other modules, and these users fared significantly better (18.7% increase; 95% CI 17.3 to 20.0) than those completing no additional modules (11.7% increase; 95% CI 3.3 to 17.7, p=0.036). Demographic analysis showed that while the starting pre-test scores varied significantly between profession/specialty groups (57.8%-82.6%), post-test scores were largely consistent (80.8%-84.6%). Although users showed the most improvement when interpreting primary electrical diseases (12.4% increase), it was also an area of notable weakness compared with the modules of normal training-related findings and cardiomyopathies. With the evolving criteria for ECG interpretation eliciting ever improving levels of specificity and sensitivity in the detection of conditions associated with sudden cardiac death among athletes, training is required to ensure the infrastructure and personnel is in place to uphold these standards. The BMJ Learning course presented is a valuable first step and demonstrates that such an online tool can be effective in aiding ECG interpretation among healthcare professionals globally.

Accuracy of Physicians’ Electrocardiogram Interpretations

“…In this systematic review and meta-analysis, of the 1138 articles initially identified, 78 studies (enrolling a total of 10 056 participants) reported accuracy data (Figure 1). For 2 studies, data were reported in several different publications; in each case, we abstracted 1 report (the most complete). The eTable in the Supplement summarizes the key features of study designs and tests.…”

“…Forty-one studies involved medical students (n = 4256 participants), 42 studies involved postgraduate physicians (n = 2379), 11 studies involved noncardiologist practicing physicians (n = 1074), and 10 studies involved cardiologists or cardiology fellows (n = 2094); 4 mixed-participant studies did not report training level–specific sample sizes (n = 253). Twenty-six studies were randomized trials, 11 studies were 2-group nonrandomized comparisons, 19 studies were single-group pre-post comparisons, and 22 studies were cross-sectional (single time point). Twenty-two studies were identified as surveys .…”

“…Twenty-two studies were identified as surveys . Of the 47 studies reporting posttraining data, the training interventions included face-to-face lectures or seminars (22 studies), computer tutorials (20 studies), independent study materials (7 studies), clinical training activities (4 studies), and 7 other miscellaneous activities (some studies used >1 intervention type). On further quality appraisal, all studies reported an objective outcome of learning (ie, accuracy), 54 studies had high (≥75%) follow-up, 16 studies involved more than 1 institution, and 66 studies…”

Cardiovascular screening in Olympic athletes: time to achieve a uniform standard

“…Several ECG interpretation guidelines have evolved with each successive rendition affording an improved specificity (lower false positive rate) without compromising sensitivity to detect at-risk conditions. Freely available online training modules also have assisted the interpretation of the athlete’s ECG among healthcare professionals worldwide 14. The latest ‘International criteria’ provide a clear guide to the appropriate interpretation and secondary investigation of ECG abnormalities 15…”

Heartbeat: The worldwide burden of atrial fibrillation

“…In a study of how a BMJ Learning training module improved interpretation of ECG tracings in athletes, Riding and Drezner5 found that ECG interpretation was much more consistent and accurate after training, despite significant baseline differences depending on medical specialty. Research into educational approaches, such as demonstrated in this study, is important to improve the efficacy and efficiency of medical training; which ultimately translates into better care of our patients and improved population health.…”