Physician Training for Electrocardiogram Interpretation: A Systematic Review and Meta-Analysis

Identifying Research Priorities in Digital Education for Health Care: Umbrella Review and Modified Delphi Method Study

BACKGROUND

In recent years, the use of digital technology in the education of health care professionals has surged, partly driven by the COVID-19 pandemic. However, there is still a need for focused research to establish evidence of its effectiveness.

OBJECTIVE

This study aimed to define the gaps in the evidence for the efficacy of digital education and to identify priority areas where future research has the potential to contribute to our understanding and use of digital education.

METHODS

We used a 2-stage approach to identify research priorities. First, an umbrella review of the recent literature (published between 2020 and 2023) was performed to identify and build on existing work. Second, expert consensus on the priority research questions was obtained using a modified Delphi method.

RESULTS

A total of 8857 potentially relevant papers were identified. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, we included 217 papers for full review. All papers were either systematic reviews or meta-analyses. A total of 151 research recommendations were extracted from the 217 papers. These were analyzed, recategorized, and consolidated to create a final list of 63 questions. From these, a modified Delphi process with 42 experts was used to produce the top-five rated research priorities: (1) How do we measure the learning transfer from digital education into the clinical setting? (2) How can we optimize the use of artificial intelligence, machine learning, and deep learning to facilitate education and training? (3) What are the methodological requirements for high-quality rigorous studies assessing the outcomes of digital health education? (4) How does the design of digital education interventions (eg, format and modality) in health professionals' education and training curriculum affect learning outcomes? and (5) How should learning outcomes in the field of health professions' digital education be defined and standardized?

CONCLUSIONS

This review provides a prioritized list of research gaps in digital education in health care, which will be of use to researchers, educators, education providers, and funding agencies. Additional proposals are discussed regarding the next steps needed to advance this agenda, aiming to promote meaningful and practical research on the use of digital technologies and drive excellence in health care education.

Electrocardiography interpretation competency among pediatric and child health residents at Addis Ababa University, Ethiopia

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Designing and evaluating ECG interpretation software for undergraduate nursing students in Iran: a non-equivalent control group pretest-posttest design

BACKGROUND

It is essential for nurses to interpret electrocardiograms accurately in cardiac care and emergency departments. Despite rigorous training, nursing students frequently encounter challenges in mastering electrocardiogram interpretation. The purpose of our study was to evaluate the effectiveness of an electrocardiogram interpretation software specifically designed for Iranian nursing students enrolled in undergraduate programs.

METHODS

A nonequivalent control group pretest-posttest design was conducted at Ramsar University of Medical Sciences in 2020. Using the census sampling method, 75 nursing students from the two educational hospitals were recruited. Participants were divided into two intervention groups and a control group according to their rotations at their respective hospitals. The software contains evidence-based guidelines, interactive learning modules, practice exercises, and real-life examples. Statistical analyses, including chi-square tests and t tests, were conducted using descriptive and inferential statistics.

RESULTS

A comparison of the two groups according to demographic characteristics, such as sex, age, was not statistically significant (p > 0.05). The knowledge and skills of the individuals in the control group significantly improved in comparison to those before the intervention. The use of software enhanced students' ability to interpret electrocardiograms. Moreover, there was no statistically significant difference between the intervention and control groups in terms of knowledge and skills of electrocardiogram interpretation. Nursing students reported higher levels of satisfaction after using the software.

CONCLUSION

Moreover, undergraduate nursing students were able to learn more using electrocardiogram interpretation software combined with traditional teaching methods. Combining these two methods in a blended learning approach can improve learning. This software can be integrated into nursing curricula to assist nursing students in interpreting electrocardiograms.

The spacing effect: Improving electrocardiogram interpretation

BACKGROUND

Accurate electrocardiogram (ECG) interpretation is critical for safe patient care, making this skill a necessary competency for medical school graduation. Improved long-term memory retention with repeated exposure to material is one of the most evidenced-based components of adult learning science. This curricular innovation aimed to determine if implementing spaced repetition and retrieval practice using ECG quizzes during the principal clinical year would improve ECG interpretation skills among medical students enrolled in a Longitudinal Integrated Clerkship (LIC).

APPROACH

The curricular innovation applied the spacing effect and retrieval practice. Cognitive science demonstrates enhanced long-term retention through repeated interval exposure to learned material. Studies of spaced retrieval indicate that memory retention is enhanced through tests involving effortful recall. LIC students in an intervention group were exposed to the spacing effect with periodic ECG quizzes throughout their clinical clerkship year.

EVALUATION

The results of the 17-item post-test for 140 students were analysed: LIC intervention, N = 54; block control, N = 62; and LIC control, N = 24. The ANOVA test was significant (p < 0.001). Games-Howell post hoc testing showed that the mean score in the LIC intervention group was significantly higher compared with the LIC control group (p < 0.001) and the block control group (p < 0.001). There was no significant difference between the LIC control and block control groups (p = 0.59).

IMPLICATIONS

Spaced repetition of material through ECG quizzes improved ECG interpretation skills on an ECG post-test and mitigates the forgetting curve, maintaining student competency in ECG interpretation.

Assessments of Physicians' Electrocardiogram Interpretation Skill: A Systematic Review

PURPOSE

To identify features of instruments, test procedures, study design, and validity evidence in published studies of electrocardiogram (ECG) skill assessments.

METHOD

The authors conducted a systematic review, searching MEDLINE, Embase, Cochrane CENTRAL, PsycINFO, CINAHL, ERIC, and Web of Science databases in February 2020 for studies that assessed the ECG interpretation skill of physicians or medical students. Two authors independently screened articles for inclusion and extracted information on test features, study design, risk of bias, and validity evidence.

RESULTS

The authors found 85 eligible studies. Participants included medical students (42 studies), postgraduate physicians (48 studies), and practicing physicians (13 studies). ECG selection criteria were infrequently reported: 25 studies (29%) selected single-diagnosis or straightforward ECGs; 5 (6%) selected complex cases. ECGs were selected by generalists (15 studies [18%]), cardiologists (10 studies [12%]), or unspecified experts (4 studies [5%]). The median number of ECGs per test was 10. The scoring rubric was defined by 2 or more experts in 32 studies (38%), by 1 expert in 5 (6%), and using clinical data in 5 (6%). Scoring was performed by a human rater in 34 studies (40%) and by computer in 7 (8%). Study methods were appraised as low risk of selection bias in 16 studies (19%), participant flow bias in 59 (69%), instrument conduct and scoring bias in 20 (24%), and applicability problems in 56 (66%). Evidence of test score validity was reported infrequently, namely evidence of content (39 studies [46%]), internal structure (11 [13%]), relations with other variables (10 [12%]), response process (2 [2%]), and consequences (3 [4%]).

CONCLUSIONS

ECG interpretation skill assessments consist of idiosyncratic instruments that are too short, composed of items of obscure provenance, with incompletely specified answers, graded by individuals with underreported credentials, yielding scores with limited interpretability. The authors suggest several best practices.