Lever Nigel A, Larsen Peter D, Dawes Mathew, Wong Annie, Harding Scott A
Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92024, Auckland 1030, New Zealand.
N Z Med J. 2009 Apr 3;122(1292):9-15.
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).
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.
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.
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.
我们旨在评估医学专业最后一年的学生和住院医务人员识别和解读心电图（ECG）中重要的常见或危及生命的异常情况的技能。
两个研究地点的102名参与者（其中52名是医学专业最后一年的学生）在30分钟内尝试确定15份心电图的心率和心律，并识别和解读其中存在的任何异常情况。
心率的准确测定情况较差，在15份心电图中，正确测定率从0%到89%不等。8份心电图中的正常窦性心律在81%至95%的时间内被识别出来，98%的参与者识别出了室性心动过速。心房颤动（55%）、二度房室传导阻滞（19%）和心室起搏（9%）未被很好地识别。4份心电图显示急性缺血性ST段改变，这些在87%至93%的病例中被正确识别，尽管对这些异常情况的解读准确性较低。长QT间期（7%）和预激（WPW型，11%）未被很好地识别。近一半的参与者认为他们解读心电图的能力不令人满意，而略超过一半的人认为他们接受的心电图教学不令人满意。
总体而言，研究参与者在识别和解读心电图中重要的常见或危及生命的异常情况方面未达到我们认为的适当标准。为解决这一问题，我们需要定义心电图解读的最低标准，改进我们的教学以达到这些标准，并根据这些标准评估我们的毕业生。
