ECG as an Entrustable Professional Activity: CDIM Survey Results, ECG Teaching and Assessment in the Third Year

EYE-ECG: An RCT of the influence of student characteristics and expert eye-tracking videos with cued retrospective reporting on students' ECG interpretation skills

Objectives

Teaching of ECG interpretation frequently relies on visual schemas. However, subsequent student ECG interpretation skills are often poor. Expertise research shows that expert looking patterns frequently deviate from the steps taught in schema learning. The present study made a cardiology expert's gaze interpreting ECGs visible - through eye-tracking videos with cued retrospective reporting (CRR) - and investigated the potential as an additional expert-driven route to improve medical students' ECG interpretation skills.

Methods

N=91 Medical students participated in the RCT of an ECG e-learning session aimed at medical students' ECG interpretation skills gain, either receiving the newly developed eye-tracking video with CRR audio commentary materials (n=47) or studying via four clinical cases only (n=44). Three outcome scores relating to different aspects of ECG interpretation skills were derived from pre-post MCQ ECG tests. The effect of the EYE-ECG training and additional characteristics (e.g., prior experience, interest) on student ECG interpretation skills were evaluated using t-tests and multivariate linear regression.

Results

A small, non-significant advantage of the EYE-ECG training signifying a tendency for greater knowledge gain was observed, compared to training as usual. In multivariate regression models, the predictive value of clinical case 1 was an unexpected finding warranting further exploration.

Conclusion

Additional gains after an only 9-minute intervention using videos of expert's real-time gaze pattern in combination with hearing their thought processes during ECG interpretation is a promising finding. Furthermore, a number of specific performance characteristics enabling students to best benefit from ECG training were identified and possible modifications to the learning intervention suggested.

Comparing the effectiveness of asynchronous e-modules and didactic lectures to teach electrocardiogram interpretation to first year US medical students

BACKGROUND

Medical students are expected to be competent in interpreting electrocardiograms (ECGs) by the time they graduate, but many are unable to master this skill. Studies suggest that e-modules are an effective way to teach ECG interpretation, however they are typically evaluated for use during clinical clerkships. We sought to determine if an e-module could replace a didactic lecture to teach ECG interpretation during a preclinical cardiology course.

METHODS

We developed an asynchronous, interactive e-module that consisted of narrated videos, pop-up questions and quizzes with feedback. Participants were first year medical students who were either taught ECG interpretation during a 2-hour didactic lecture (control group) or were given unlimited access to the e-module (e-module group). First-year internal medicine residents (PGY1 group) were included to benchmark where ECG interpretation skills should be at graduation. At three time-points (pre-course, post-course, and 1-year follow-up), participants were evaluated for ECG knowledge and confidence. A mixed-ANOVA was used to compare groups over time. Students were also asked to describe what additional resources they used to learn ECG interpretation throughout the study.

RESULTS

Data was available for 73 (54%) students in the control group, 112 (81%) in the e-module group and 47 (71%) in the PGY1 group. Pre-course scores did not differ between the control and e-module groups (39% vs. 38%, respectively). However, the e-module group performed significantly better than the control group on the post-course test (78% vs. 66%). In a subsample with 1-year follow-up data, the e-module group's performance decreased, and the control group remained the same. The PGY1 groups' knowledge scores were stable over time. Confidence in both medical student groups increased by the end of the course, however only pre-course knowledge and confidence were significantly correlated. Most students relied on textbooks and course materials for learning ECG, however online resources were also utilized.

CONCLUSIONS

An asynchronous, interactive e-module was more effective than a didactic lecture for teaching ECG interpretation, however continued practice is needed regardless of how students learn to interpret ECGs. Various ECG resources are available to students to support their self-regulated learning.

Utilizing Supplemental Online Modules for Physician Assistant Student Electrocardiogram Interpretation Training

PURPOSE

The literature suggests that graduating medical and physician assistant (PA) students lack competency in electrocardiogram (ECG) interpretation. This project aimed to determine whether use of perceptual adaptive learning modules (PALMs) would improve PA students' ECG interpretation, alter self-perceptions of their ECG education, or both.

METHODS

PALMs were incorporated into the PA curriculum after lecture-based ECG learning. Students' pretest, posttest, and delayed-posttest scores were then compared. Students' ability to correctly interpret ECGs (accuracy) and the percentage of ECGs accurately interpreted within 15 seconds or less (fluency) also were evaluated. Finally, students' perceptions of PALMs and overall ECG training were assessed.

RESULTS

PALM training improved ECG interpretation accuracy and fluency (p < .0001), as well as delayed-posttest accuracy and fluency (p < .0001). The majority of student respondents felt supplemental training enhanced their learning.

CONCLUSION

These perception results combined with data on ECG interpretation improvement supports continued use of supplemental PALMs in ECG interpretation training.

An algorithm to assist novices with electrocardiogram interpretation: Validation with the Delphi Method

PURPOSE

Electrocardiograms (ECG) are often poorly interpreted by novices and this can delay time-sensitive, critical intervention. This study aimed to assess, improve and validate a stepwise ECG algorithm designed to assist with ECG interpretation by novices by soliciting the opinions of an international cohort of expert cardiologists.

METHODS

The Delphi Method was used, and an online questionnaire was sent to an international panel of cardiologists. Experts were required to evaluate each step of the algorithm and offer comments. Feedback was analysed by the investigators, changes to the algorithm were made and these were sent back to the experts until a consensus was reached. Two rounds of the Delphi Method were required to achieve consensus.

RESULTS

Overall, 55 responses were achieved (round one = 33, round two = 22). The average agreement in round one was 90.2% with 25 changes from 124 comments. Round two achieved 93.4% agreement with 12 changes from 57 comments. The threshold for consensus was set at 90% and was confirmed as being reached by all four investigators of this study. A final algorithm was therefore established. The ECG algorithm was validated through a rigorous two-stage development and review process.

CONCLUSIONS

The algorithm was validated as a safe, informative tool for novices to use to improve ECG interpretation. Real-world user validation is now required to further improve the algorithm.

Clinically contextualised ECG interpretation: the impact of prior clinical exposure and case vignettes on ECG diagnostic accuracy

BACKGROUND

ECGs are often taught without clinical context. However, in the clinical setting, ECGs are rarely interpreted without knowing the clinical presentation. We aimed to determine whether ECG diagnostic accuracy was influenced by knowledge of the clinical context and/or prior clinical exposure to the ECG diagnosis.

METHODS

Fourth- (junior) and sixth-year (senior) medical students, as well as medical residents were invited to complete two multiple-choice question (MCQ) tests and a survey. Test 1 comprised 25 ECGs without case vignettes. Test 2, completed immediately thereafter, comprised the same 25 ECGs and MCQs, but with case vignettes for each ECG. Subsequently, participants indicated in the survey when last, during prior clinical clerkships, they have seen each of the 25 conditions tested. Eligible participants completed both tests and survey. We estimated that a minimum sample size of 165 participants would provide 80% power to detect a mean difference of 7% in test scores, considering a type 1 error of 5%.

RESULTS

This study comprised 176 participants (67 [38.1%] junior students, 55 [31.3%] senior students, 54 [30.7%] residents). Prior ECG exposure depended on their level of training, i.e., junior students were exposed to 52% of the conditions tested, senior students 63.4% and residents 96.9%. Overall, there was a marginal improvement in ECG diagnostic accuracy when the clinical context was known (Cohen's d = 0.35, p < 0.001). Gains in diagnostic accuracy were more pronounced amongst residents (Cohen's d = 0.59, p < 0.001), than senior (Cohen's d = 0.38, p < 0.001) or junior students (Cohen's d = 0.29, p < 0.001). All participants were more likely to make a correct ECG diagnosis if they reported having seen the condition during prior clinical training, whether they were provided with a case vignette (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.24-1.71) or not (OR 1.58, 95% CI 1.35-1.84).

CONCLUSION

ECG interpretation using clinical vignettes devoid of real patient experiences does not appear to have as great an impact on ECG diagnostic accuracy as prior clinical exposure. However, exposure to ECGs during clinical training is largely opportunistic and haphazard. ECG training should therefore not rely on experiential learning alone, but instead be supplemented by other formal methods of instruction.

Mastering Electrocardiogram Interpretation Skills Through a Perceptual and Adaptive Learning Module

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 < p < 0.0045) 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.

Working with entrustable professional activities in clinical education in undergraduate medical education: a scoping review

BACKGROUND

Entrustable professional activities (EPAs) are increasingly used in undergraduate medical education (UME). We conducted a scoping review to summarize the evidence for the use of EPAs in clinical rotations in UME.

METHODS

We searched multiple databases for scoping reviews based on the PRISMA guidelines for articles reporting qualitative and quantitative research, as well as conceptual and curriculum development reports, on EPAs in UME clinical rotations.

RESULTS

We identified 3309 records by searching through multiple databases. After the removal of duplicates, 1858 reports were screened. A total of 36 articles were used for data extraction. Of these, 47% reported on EPA and EPA-based curriculum development for clerkships, 50% reported on implementation strategies, and 53% reported on assessment methods and tools used in clerkships. Validity frameworks for developing EPAs in the context of clerkships were inconsistent. Several specialties reported feasible implementation strategies for EPA-based clerkship curricula, however, these required additional faculty time and resources. Limited exposure to clinical activities was identified as a barrier to relevant learning experiences. Educators used nationally defined, or specialty-specific EPAs, and a range of entrustability and supervision scales. We found only one study that used an empirical research approach for EPA assessment. One article reported on the earlier advancement of trainees from UME to graduate medical education based on summative entrustment decisions.

CONCLUSIONS

There is emerging evidence concerning how EPAs can be effectively introduced to clinical training in UME. Specialty-specific, nested EPAs with context-adapted, entrustment-supervision scales might be helpful in better leveraging their formative assessment potential.

EE-6S: an integrated approach for introducing early clinical exposure in the new Egyptian medical curriculum

The electrocardiogram (ECG) is the primary diagnostic tool in cardiovascular diseases. Hence its interpretation is a core competency in medicine, where obvious deficiencies have been reported among learners. The aim of this study was to introduce the fundamentals of ECG knowledge and interpretation through early clinical exposure (ECE) based on a six-step approach for preclinical students (n = 110) and to study its influence on their knowledge and interpretation skills thereafter. The first step employed a blended learning format using didactic lectures on normal and pathological ECGs, each preceded by preinstructional videos. The second step focused on psychomotor skills and utilized laboratory exercises for ECG recording and interpretation. The third step focused on vertical integration, where the clinical relevance of the procedure was established with integrated lectures. The fourth step used the Moodle platform, where opportunities for peer interactions and clarifications by clinical faculty were made available. The fifth step incorporated clinical and diagnostic reasoning through cardiology ward visits and interpretation of patient ECGs. The sixth step was designed for critical thinking and problem solving through case-based discussions with peers and faculty. Students were assessed with multiple-choice questions and objective structured practical examination. Learner perceptions of the approach were evaluated with a feedback questionnaire and focus group discussion. Statistical analysis showed that ECE through a six-step approach significantly enhanced knowledge and interpretation of ECG as evidenced by the pre- and posttest scores. Analysis of the focus group data revealed that learner engagement and skills of critical thinking were enhanced along with diagnostic and clinical reasoning.

Determining electrocardiography training priorities for medical students using a modified Delphi method

BACKGROUND

Although electrocardiography is considered a core learning outcome for medical students, there is currently little curricular guidance for undergraduate ECG training. Owing to the absence of expert consensus on undergraduate ECG teaching, curricular content is subject to individual opinion. The aim of this modified Delphi study was to establish expert consensus amongst content and context experts on an ECG curriculum for medical students.

METHODS

The Delphi technique, an established method of obtaining consensus, was used to develop an undergraduate ECG curriculum. Specialists involved in ECG teaching were invited to complete three rounds of online surveys. An undergraduate ECG curriculum was formulated from the topics of ECG instruction for which consensus (i.e. ≥75% agreement) was achieved.

RESULTS

The panellists (n = 131) had a wide range of expertise (42.8% Internal Medicine, 22.9% Cardiology, 16% Family Medicine, 13.7% Emergency Medicine and 4.6% Health Professions Education). Topics that reached consensus to be included in the undergraduate ECG curriculum were classified under technical aspects of performing ECGs, basic ECG analysis, recognition of the normal ECG and abnormal rhythms and waveforms and using electrocardiography as part of a clinical diagnosis. This study emphasises that ECG teaching should be framed within the clinical context. Course conveners should not overload students with complex and voluminous content, but rather focus on commonly encountered and life-threatening conditions, where accurate diagnosis impacts on patient outcome. A list of 23 "must know" ECG diagnoses is therefore proposed.

CONCLUSION

A multidisciplinary expert panel reached consensus on the ECG training priorities for medical students.

Worked examples for teaching electrocardiogram interpretation: Salient or discriminatory features?

CONTEXT

Cognitive load theory states that one way to optimise learning is to decrease extraneous cognitive load, defined as information not relevant to task completion. Worked examples, which show the learner the logic behind the solving of a problem, can decrease extraneous load. However, there is little research to guide the optimal formatting of worked examples.

METHODS

In a crossover design, first-year medical students were randomised to worked examples of bradycardias with salient features first and tachycardias with discriminatory features second (n = 33) or worked examples of bradycardias with discriminatory features first and tachycardias with salient features second (n = 32). After each learning phase, participants completed a testing phase. Diagnostic accuracy and reported cognitive load were compared between the two worked example formats, as well as with data for a group of historical controls, consisting of medical students interpreting electrocardiogram rhythms without worked examples. Each module concluded with a questionnaire in which the learner was asked to rate his or her perceptions of the difficulty of the core content, the clarity with which the information was presented, and perceived learning.

RESULTS

Worked examples highlighting salient and discriminatory features were associated with similar levels of diagnostic accuracy (56% and 60%, respectively; P = .32). Both worked example conditions were associated with higher diagnostic accuracy than was found in historical controls (P < .0001). There was no difference in the extraneous load experienced between worked examples highlighting salient features and those highlighting discriminatory features (12.5 ± 6.1 and 11.9 ± 6.1, respectively; P = .52). Participants reported greater intrinsic load in the worked examples highlighting salient rather than discriminatory features (17.1 ± 4.9 and 15.5 ± 4.6, respectively; P = .01).

CONCLUSIONS

Discriminatory feature-based worked examples were associated with less intrinsic cognitive load, but this did not translate into any meaningful difference in diagnostic performance. Instruction with worked examples improved diagnostic performance regardless of whether salient or discriminatory features were highlighted.

An evaluation study on gamified online learning experiences and its acceptance among medical students

Objective

The successful application of gamification in different educational settings shows that the use of gamification in medical education may be an effective solution. Even though many studies have been conducted to investigate the efficacy of the integration of gamification to different education curriculums, few studies have examined the reactions, behaviors, and attitudes of learners toward the use of gamification in medical education. Hence, this study aimed to evaluate the medical students' learning experience and acceptance of the use of gamification for the delivery of electrocardiogram lessons.

Materials and Methods

A qualitative research method was used to generate findings in this study. The data collection methods included focus group discussions and interviews. Triangulation methods were used to ensure the validity and reliability of the qualitative data analyzed in this study. The thematic analysis of the data collected in this study helped to garner insights into the perception of participants and experts about the use of GaMed@™ for the delivery of ECG lessons.

Results

A total number of 32 medical students and four experts in the fields of user experience, communication, social psychology, and game design participated in this study. The findings showed that in spite of the negative reports about the user experience and application of GaMed@™, the participants and experts affirmed its positive impact on the increased motivation and engagement of users.

Conclusions

The impact of this concept can be maximized by tailoring the game design to foster-positive learning attributes, behaviors, and outcomes in students. However, further research studies must be conducted to investigate the impact of gamification designs on specific learning outcomes in students.

Quantifying the medical student learning curve for ECG rhythm strip interpretation using deliberate practice

Objectives: Obtaining competency in medical skills such as interpretation of electrocardiograms (ECGs) requires repeated practice and feedback. Structured repeated practice and feedback for ECGs is likely not provided to most medical students, so skill development is dependent on opportunistic training during clinical rotations. Our aim was to describe: the amount of deliberate practice completed for learning ECG rhythm strip diagnoses in first year medical students, the learning curve for rhythm strip diagnosis, and student experiences with deliberate practice. Methods: First year medical students from two medical schools were provided with online rhythm strip practice cases. Diagnostic accuracy was measured throughout practice, and students were provided feedback for every case they completed. Total cases practiced and time spent practicing were correlated with their performance during practice and on an exam. Results: 314 of 384 (82%) students consented. The mean number of ECGs each student practiced was 59 (range 0-280), representing 18,466 total instances of deliberate practice. We generated mathematical models that accurately correlated both the number of cases practiced and time spent practicing, with diagnostic accuracy on an exam (p<0.001). For example, students would need to spend on average of 112 minutes and complete 34 practice cases to obtain 75% on an ECG rhythm strip exam. Student satisfaction was high using the online cases. Conclusions: We succeeded in delivering deliberate practice for ECG rhythm strip interpretation to a large cohort of students at 2 medical schools. We quantified a learning curve that estimates the number of cases and practice time required to achieve pre-determined levels of diagnostic accuracy. This data can help inform a competency-based approach to curriculum development.

Why Medical Students Choose to Use or Not to Use a Web-Based Electrocardiogram Learning Resource: Mixed Methods Study

BACKGROUND

Electrocardiogram (ECG) interpretation is a core competence and can make a significant difference to patient outcomes. However, ECG interpretation is a complex skill to learn, and research has showed that students often lack enough competence. Web-based learning has been shown to be effective. However, little is known regarding why and how students use Web-based learning when offered in a blended learning situation.

OBJECTIVE

The aim of this paper was to study students' use of Web-based ECG learning resources which has not previously been studied in relation to study strategies.

METHODS

A qualitative explanatory design using mixed methods was adopted to explore how medical students reason around their choice to use or not to use a Web-based ECG learning resource. Overall, 15 of 33 undergraduate medical students attending a course in clinical medicine were interviewed. Data on usage of the resource were obtained via the learning management system for all students. At the final examination, all the students answered a questionnaire on study strategies and questions about internet access and estimated their own skills in ECG interpretation. Furthermore, study strategies and use patterns were correlated with results from an ECG Objective Structured Clinical Examination (OSCE) and a written course examination.

RESULTS

In total, 2 themes were central in the students' reasoning about usage of Web-based ECG: assessment of learning needs and planning according to learning goals. Reasons for using the Web resource were to train in skills, regarding it as a valuable complement to books and lectures. The main reasons for not using the resource were believing they already had good enough skills and a lack of awareness of its availability. Usage data showed that 21 students (63%) used the Web resource. Of these, 11 were minimal users and 10 were major users based on usage activity. Large variations were found in the time spent in different functional parts of the resource. No differences were found between users and nonusers regarding the OSCE score, final examination score, self-estimate of knowledge, or favoring self-regulated learning.

CONCLUSIONS

To use or not to use a Web-based ECG learning resource is largely based on self-regulated learning aspects. Decisions to use such a resource are based on multifactorial aspects such as experiences during clinical rotations, former study experiences, and perceived learning needs. The students' own judgment of whether there was a need for a Web-based resource to achieve the learning goals and to pass the examination was crucial for their decisions to use it or not. An increased understanding of students' regulation of learning and awareness of variations in their ECG learning needs can contribute to the improvement of course design for blended learning of ECG contexts for medical students.

Scoping Review of Entrustable Professional Activities in Undergraduate Medical Education

PURPOSE

Entrustable professional activities (EPAs) are a hot topic in undergraduate medical education (UME); however, the usefulness of EPAs as an assessment approach remains unclear. The authors sought to better understand the literature on EPAs in UME through the lens of the 2010 Ottawa Conference Criteria for Good Assessment.

METHOD

The authors conducted a scoping review of the health professions literature (search updated February 2018), mapping publications to the Ottawa Criteria using a collaboratively designed charting tool.

RESULTS

Of the 1,089 publications found, 71 (6.5%) met inclusion criteria. All were published after 2013. Forty-five (63.4%) referenced the 13 Core Entrustable Professional Activities for Entering Residency developed by the Association of American Medical Colleges (AAMC). Forty (56.3%) were perspectives, 5 (7.0%) were reviews, and 26 (36.6%) were prospective empirical studies. The publications mapped to the Ottawa Criteria 158 times. Perspectives mapped more positively (83.7%) than empirical studies (76.7%). Reproducibility did not appear to be a strength of EPAs in UME; however, reproducibility, equivalence, educational effect, and catalytic effect all require further study. Inconsistent use of the term "EPA" and conflation of concepts (activity vs assessment vs advancement decision vs curricular framework) limited interpretation of published results. Overgeneralization of the AAMC's work on EPAs has influenced the literature.

CONCLUSIONS

Much has been published on EPAs in UME in a short time. Now is the time to move beyond opinion, clarify terms, and delineate topics so that well-designed empirical studies can demonstrate if and how EPAs should be implemented in UME.

Entrustable professional activities

Medical education is currently undergoing a paradigm shift from process-based to competency-based education, focused on measuring the desired competence of a physician. In an attempt to improve the assessment framework used for medical education, the concept of entrustable professional activities (EPAs) has gained traction. EPAs are defined as professional activities that can be entrusted to an individual in a clinical context. The Association of American Medical Colleges (AAMC) defined a set of 13 such EPAs to define the core of what all students should be able to do on day 1 of residency, regardless of specialty choice. The AAMC is currently piloting these EPAs with 10 medical schools to determine if EPAs can be used as a way to observe, measure, and entrust medical students with core clinical activities by the end of the clinical immersion experiences of the third year. The specialty of pediatrics is piloting the use of specialty-specific EPAs at 5 medical schools to assess readiness for transitions from medical school into pediatric residency training and practice. To date, no neurology-specific EPAs have been published for use in neurology clerkships or neurology residencies. This article introduces the concept of EPAs in the context of competency-based medical education and describes how EPAs might be relevant and applicable in neurologic education across the continuum. The Undergraduate Education Subcommittee of the American Academy of Neurology advocates for a proactive approach to incorporating core EPAs in undergraduate medical education and to considering an EPA-based specialty-specific assessment framework for neurology.

Is computer-assisted instruction more effective than other educational methods in achieving ECG competence among medical students and residents? Protocol for a systematic review and meta-analysis

INTRODUCTION

Although ECG interpretation is an essential skill in clinical medicine, medical students and residents often lack ECG competence. Novel teaching methods are increasingly being implemented and investigated to improve ECG training. Computer-assisted instruction is one such method under investigation; however, its efficacy in achieving better ECG competence among medical students and residents remains uncertain.

METHODS AND ANALYSIS

This article describes the protocol for a systematic review and meta-analysis that will compare the effectiveness of computer-assisted instruction with other teaching methods used for the ECG training of medical students and residents. Only studies with a comparative research design will be considered. Articles will be searched for in electronic databases (PubMed, Scopus, Web of Science, Academic Search Premier, CINAHL, PsycINFO, Education Resources Information Center, Africa-Wide Information and Teacher Reference Center). In addition, we will review citation indexes and conduct a grey literature search. Data extraction will be done on articles that met the predefined eligibility criteria. A descriptive analysis of the different teaching modalities will be provided and their educational impact will be assessed in terms of effect size and the modified version of Kirkpatrick framework for the evaluation of educational interventions. This systematic review aims to provide evidence as to whether computer-assisted instruction is an effective teaching modality for ECG training. It is hoped that the information garnered from this systematic review will assist in future curricular development and improve ECG training.

ETHICS AND DISSEMINATION

As this research is a systematic review of published literature, ethical approval is not required. The results will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement and will be submitted to a peer-reviewed journal. The protocol and systematic review will be included in a PhD dissertation.

PROSPERO REGISTRATION NUMBER

CRD42017067054; Pre-results.