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Can Electrocardiogram (ECG) Interpretation Be Taught to Pediatric Residents?

Friday, October 19, 2012
Room 275-277 (Morial Convention Center)
Amine Daher, PGYII, Pediatric, resident1, Steven B. Ritz2, William Graessle3 and Arsenia M. Asuncion3, (1)Pediatrics, Cooper University Hospital, Collingswood, NJ, (2)Nemours, (3)Cooper University Hospital

Purpose: Accurate electrocardiogram (ECG) interpretation is paramount to patient care and may prevent unnecessary delay in care delivery and unwarranted referrals. We established a curriculum to enhance pediatric residents’ ECG interpretation skills.

Methods: The curriculum consisted of a lecture reviewing ECG interpretation methods, common pediatric arrhythmias and characteristic ECG morphologic findings.  A weekly ECG unknown (n=17) was distributed to 25 pediatric residents followed later by an annotated interpretation with a systematic review of pertinent findings and case review.  A test consisting of 15 different ECGs for interpretation (perfect score=30) and 5 technical measurements (perfect score=5) was administered to residents at baseline and six months later.  Residents were surveyed regarding their use of the “ECG of the Week” educational tool and perceived efficacy.

Results: An improvement of at least 10% in total score was seen in 60% of all residents (PGY1 30.0%; PGY2 85.7%; PGY3 75.0%, p=0.04). The PGY1 class improved in technical measurements, from mean of 2.0 to 3.4 (p=0.02). The PGY2 and PGY3 classes improved in interpretation skills from mean score of 11.4 to 18.7 (p=0.01), and 14.3 to 19.9 (p=0.3), respectively.

The pre-test diagnoses most missed were right ventricular hypertrophy, long QTc, and sinus arrhythmia (84%, 80%, and 76% respectively).  The diagnosis most frequently identified correctly was pericarditis (80% pre, 88% post).  Improved correct recognition was seen in at least 40% of residents for diagnoses of sinus arrhythmia, right bundle branch block, ventricular tachycardia, and long QT.

14/15 residents who reported participating consistently in the “ECG of the Week” showed improvement in total scores (93.3%) in contrast to only 40% of the rest (p<0.01).

84.0% of all participants reported the weekly activity useful and 96.0% felt it should be repeated every year.

Conclusion: This study demonstrates improvement in ECG technical skills in PGY1 residents and improvement in interpretation skills in PGY2 and PGY3 residents participating in the educational intervention.  Acceptance of the intervention was high among participants.  These data suggest areas of focus for future educational interventions to target identified weaknesses in ECG interpretation.