Are our medical graduates in New Zealand safe and accurate in ECG interpretation?

AIM

We aimed to assess the skills of final year medical students and resident medical officers in recognising and interpreting important common or life-threatening abnormalities in the electrocardiogram (ECG).

METHODS

102 participants at two study sites (52 of whom were final year medical students) attempted to determine the heart rate and rhythm and identify and interpret any abnormalities present in 15 ECGs in a 30-minute time period.

RESULTS

Accurate determination of heart rate was poor, ranging from 0% to 89% correct across the 15 ECGs. Normal sinus rhythm in 8 ECGs was identified 81% to 95% of the time, and ventricular tachycardia was identified by 98% of participants. Atrial fibrillation (55%), second degree heart block (19%) and ventricular pacing (9%) were not well identified. Four ECGs showed acute ischaemic ST segment changes, and these were correctly identified in 87% to 93% of cases, although interpretation of these abnormalities was less accurate. Long QT interval (7%) and pre-excitation (WPW pattern, 11%) were not well recognised. Nearly half of the participants rated their ability to interpret ECGs as less than satisfactory while just over half rated the ECG teaching they had received as less than satisfactory.

CONCLUSIONS

Overall study participants did not achieve what we would consider an adequate standard in recognising and interpreting important common or life-threatening abnormalities in the ECG. To address this we need to define minimum standards in ECG interpretation, to improve our teaching to meet these standards, and to assess our graduates against these.