Mintesnot Helen, Tadele Henok, Ahmed Hayat, Moges Tamirat, Gedlu Etsegenet
Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
BMC Med Educ. 2024 Dec 30;24(1):1548. doi: 10.1186/s12909-024-06614-5.
Electrocardiography (ECG) interpretation competency is vital to ensure the timely initiation of life-saving treatment for emergent ECG conditions. This competency has not been well-studied among pediatric and child health residents. Hence, the study aimed to determine the competency in ECG interpretation and its predictors among residents at the National University of Ethiopia.
This cross-sectional study employed standard ECG Wave-Maven strips, a web-based ECG self-assessment tool. The association between dependent and independent variables was tested using a chi-square test and Fisher's exact test.
The study included 95 residents with male dominance, 61.1%. The median age of study participants was 29 years (IQR: 28-30). The median service years before residency enrollment was 2 years (IQR:1-3). More than half, 51.6%, received 1-3 hours of ECG lectures. ECG training insufficiency was reported by 75.8% of participants. Residents were not confident in their ECG readings,65.3%. The majority,67.3%, partially or totally relied on computer-generated ECG (C-ECG) reports during ECG interpretation. The majority ordered up to 5 ECGs per month, 75.8% and sought consultation for ECG reading most of the time, 58.9%. Common emergent ECG conditions were rarely diagnosed correctly: long QTC syndrome, 42.1%; Complete heart block (CHB), 10.5%; supraventricular tachycardia (SVT), 9.5%; ventricular tachycardia, 8.4% and hyperkalemia, 4.2%. Young residents, 29 years or less, diagnosed sinus rhythm correctly, p = 0.017. Year I and II residents correctly diagnosed sinus arrhythmia, p = 0.001. CHB diagnosis was associated with the use of C-ECG reports, p = 0.011. SVT diagnosis was associated resident's juniority, p = 0.018 and the number of monthly ECG orders, p = 0.018. Atrial fibrillation diagnosis was associated with the service years before residency enrollment, p = 0.046. The diagnosis of acute pericarditis was associated with monthly resident's ECG orders, p = 0.034.
In this study, three-fourths of pediatric and child health residents reported insufficient ECG training during their residency. They were not confident in their ECG readings. ECG diagnosis of common life-threatening conditions was missed. Resident's age, year of residency, monthly ECG orders, service years before residency enrollment and reliance on C-ECG reports predicted the correct diagnosis of an ECG abnormality or rhythm. Well-designed and structured urgent ECG training sessions are required to fill this gap among the residents.
心电图（ECG）解读能力对于确保及时启动针对紧急心电图情况的救命治疗至关重要。在儿科和儿童健康住院医师中，这种能力尚未得到充分研究。因此，本研究旨在确定埃塞俄比亚国立大学住院医师的心电图解读能力及其预测因素。
本横断面研究采用标准心电图波形专家条带，这是一种基于网络的心电图自我评估工具。使用卡方检验和费舍尔精确检验来检验因变量和自变量之间的关联。
该研究纳入了95名住院医师，男性占主导，为61.1%。研究参与者的中位年龄为29岁（四分位间距：28 - 30岁）。住院医师入学前的中位服务年限为2年（四分位间距：1 - 3年）。超过一半（51.6%）的人接受了1 - 3小时的心电图讲座。75.8%的参与者报告心电图培训不足。65.3%的住院医师对自己的心电图解读没有信心。大多数人（67.3%）在心电图解读过程中部分或完全依赖计算机生成的心电图（C - ECG）报告。大多数人每月开出多达5份心电图检查单（75.8%），并且大部分时间（58.9%）寻求心电图解读方面的咨询。常见的紧急心电图情况很少被正确诊断：长QT综合征，42.1%；完全性心脏传导阻滞（CHB），10.5%；室上性心动过速（SVT），9.5%；室性心动过速，8.4%；高钾血症，4.2%。年龄在29岁及以下的年轻住院医师正确诊断窦性心律，p = 0.017。第一年和第二年的住院医师正确诊断窦性心律失常，p = 0.001。CHB的诊断与使用C - ECG报告有关，p = 0.011。SVT的诊断与住院医师的资历有关，p = 0.018以及每月心电图检查单的数量有关，p = 0.018。房颤的诊断与住院医师入学前的服务年限有关，p = 0.046。急性心包炎的诊断与住院医师每月的心电图检查单数量有关，p = 0.034。
在本研究中，四分之三的儿科和儿童健康住院医师报告在住院期间心电图培训不足。他们对自己的心电图解读没有信心。常见的危及生命情况的心电图诊断被遗漏。住院医师的年龄、住院年份、每月心电图检查单数量、住院医师入学前的服务年限以及对C - ECG报告的依赖可预测心电图异常或心律的正确诊断。需要精心设计和组织紧急心电图培训课程来填补住院医师之间的这一差距。
