Krasne Sally, Stevens Carl D, Kellman Philip J, Niemann James T
Department of Physiology David Geffen School of Medicine University of California Los Angeles CA.
Department of Emergency Medicine David Geffen School of Medicine University of California Los Angeles CA.
AEM Educ Train. 2020 May 5;5(2):e10454. doi: 10.1002/aet2.10454. eCollection 2021 Apr.
Although accurate interpretation of the standard 12-lead electrocardiogram (ECG) is fundamental to diagnosing heart disease, several prior studies report low accuracy rates among medical students, residents, and practicing physicians. The objective of this study was to determine if an online ECG Perceptual and Adaptive Learning Module (ECG PALM) is an efficient instrument to teach ECG interpretation. The ECG PALM consists of 415 unique ECG tracings with associated pretest, posttest, and delayed tests, each using 30 additional ECGs to gauge the effectiveness and durability of training. Between 2013 and 2015, a total of 113 third-year and 156 fourth-year medical students and 34 first-year, 41 second-year, and 37 third-year emergency medicine residents completed the PALM and associated tests. We measured two mastery criteria: accuracy, the percentage of correct interpretations, and fluency, the percentage of images interpreted accurately within 15 seconds. The ECG PALM produced statistically significant improvements (0.0001 <p0.0045) in student and resident performance for both accuracy (effect size = 0.9 to 3.2) and fluency (effect size = 2.5 to 3.1) following training ranging from 46 ± 24 minutes (R3s) to 88 ± 32 minutes (third-year medical students). Medical students and residents performed significantly better on a test the year following training (delayed test) than those without prior ECG PALM training (pretest). The fluency of R3 residents in classifying the 15 diagnostic categories was less than 60% for nine of the 15 diagnoses and greater than 80% for only one. Following PALM training, fluency was higher than 80% for seven of the 15 categories and less than 60% for only two categories. Accuracy in recognizing ST-elevation myocardial infarctions (STEMIs) was high both before and after PALM training for R3s, but fluency was only 64% for anterior STEMIs on the pretest, increasing to 93% following PALM training. These observations suggest that the ECG PALM is an effective and durable supplemental tool for developing mastery in interpreting common ECG abnormalities.
尽管准确解读标准12导联心电图（ECG）是诊断心脏病的基础，但此前多项研究报告称，医学生、住院医师和执业医师的准确率较低。本研究的目的是确定在线心电图感知与适应性学习模块（ECG PALM）是否是一种有效的心电图解读教学工具。ECG PALM包含415份独特的心电图描记图以及相关的预测试、后测试和延迟测试，每项测试还使用30份额外的心电图来评估训练的有效性和持久性。在2013年至2015年期间，共有113名三年级医学生、156名四年级医学生以及34名一年级、41名二年级和37名三年级急诊医学住院医师完成了PALM及相关测试。我们测量了两个掌握标准：准确率，即正确解读的百分比；流畅度，即在15秒内准确解读图像的百分比。经过46±24分钟（三年级医学生）至88±32分钟的训练后，ECG PALM在学生和住院医师的表现上产生了统计学上的显著改善（0.0001＜p＜0.0045），无论是准确率（效应量=0.9至3.2）还是流畅度（效应量=2.5至3.1）。医学生和住院医师在训练后的次年测试（延迟测试）中的表现明显优于未接受过ECG PALM训练的人（预测试）。三年级住院医师对15种诊断类别的流畅度，15种诊断中有9种低于60%，只有1种高于80%。经过PALM训练后，15种类别中有7种流畅度高于80%，只有2种低于60%。三年级住院医师在PALM训练前后识别ST段抬高型心肌梗死（STEMI）时的准确率都很高，但预测试中前壁STEMI的流畅度仅为64%，PALM训练后提高到了93%。这些观察结果表明，ECG PALM是一种有效且持久的补充工具，有助于培养对常见心电图异常解读的掌握能力。
