Wong Hubert E, Kazzi A Antoine, Langdorf Mark I
Department of Emergency Medicine, University of California at Irvine, Orange, CA.
Cal J Emerg Med. 2002 Oct;3(4):59-65.
Electrocardiograph (ECG) interpretation is a vital component of Emergency Medicine (EM) resident education, but few studies have formally examined ECG teaching methods used in residency training. Recently, the Council of EM Residency Directors (CORD) developed an Internet database of 395 ECGs that have been extensively peer-reviewed to incorporate all findings and abnormalities. We examined the efficacy of this database in assessing EM residents' skills in ECG interpretation.
We used the CORD ECG database to evaluate residents at our academic three-year EM residency. Thirteen residents participated, including four first-year, four second-year, and five third-year residents. Twenty ECGs were selected using 14 search criteria representing a broad range of abnormalities, including infarction, rhythm, and conduction abnormalities. Exams were scored based on all abnormalities and findings listed in the teaching points accompanying each ECG. We assigned points to each abnormal finding based on clinical relevance.
Out of a total of 183 points in our clinically weighted scoring system, first-year residents scored an average of 99 points (54.1%) [91-119], second-year residents 111 points (60.4%) [97-126], and third-year residents 130 points (71.0%) [94-150], p = 0.12. Clinically relevant abnormalities, including anterior and inferior myocardial infarctions, were most frequently diagnosed correctly, while posterior infarction was more frequently missed. Rhythm abnormalities including ventricular and supraventricular tachycardias were most frequently diagnosed correctly, while conduction abnormalities including left bundle branch block and atrioventricular (AV) block were more frequently missed.
The CORD database represents a valuable resource in the assessment and teaching of ECG skills, allowing more precise identification of areas upon which instruction should be further focused or individually tailored. Our experience suggests that more focused teaching of conduction abnormalities and posterior infarctions may be beneficial. The CORD database should be considered for incorporation into an ECG curriculum during residency training.
心电图（ECG）解读是急诊医学（EM）住院医师教育的重要组成部分，但很少有研究正式考察住院医师培训中使用的心电图教学方法。最近，急诊医学住院医师主任委员会（CORD）开发了一个包含395份心电图的互联网数据库，这些心电图经过了广泛的同行评审，纳入了所有的检查结果和异常情况。我们研究了这个数据库在评估急诊医学住院医师心电图解读技能方面的效果。
我们使用CORD心电图数据库对我校为期三年的急诊医学住院医师进行评估。13名住院医师参与，包括4名一年级、4名二年级和5名三年级住院医师。使用14条搜索标准选择了20份心电图，这些标准代表了广泛的异常情况，包括梗死、节律和传导异常。根据每份心电图附带的教学要点中列出的所有异常情况和检查结果对考试进行评分。我们根据临床相关性为每个异常发现分配分数。
在我们的临床加权评分系统中，满分183分，一年级住院医师平均得99分（54.1%）[91 - 119]，二年级住院医师111分（60.4%）[97 - 126]，三年级住院医师130分（71.0%）[94 - 150]，p = 0.12。包括前壁和下壁心肌梗死在内的临床相关异常情况最常被正确诊断，而后壁梗死则更常被漏诊。包括室性和室上性心动过速在内的节律异常最常被正确诊断，而包括左束支传导阻滞和房室（AV）阻滞在内的传导异常则更常被漏诊。
CORD数据库是心电图技能评估和教学的宝贵资源，能够更精确地确定应进一步重点关注或个别定制教学的领域。我们的经验表明，对传导异常和后壁梗死进行更有针对性的教学可能会有益处。在住院医师培训期间，应考虑将CORD数据库纳入心电图课程。
