Electrocardiography interpretation training in emergency medicine: methods, resources, competency assessment, and national standardization

Objective(s). The aim of this study was to evaluate the status of electrocardiography (ECG) training in emergency medicine residency programs in Turkey, and the attitude of the program representatives towards standardization of such training.

Methods. This investigation was planned as a cross-sectional study. An 18-item questionnaire was distributed to directors of residency programs. Responses were evaluated using SPSS (v.16.0), and analyzed using the chi-square test.

Results. Thirty-nine program directors (out of 42) responded to the questionnaire. Twenty-eight of them stated they did not have a formal ECG training curriculum. The most preferred ECG education method was clinical education in the Emergency Department; the most common education resource was ECG textbooks; and the most common evaluation method was case scenarios. Only thirteen of the programs had an obligation to prove competency. The most common competency-assessment method was obtaining a passing grade based on an instructor’s observation. The majority of program directors are of the opinion that there should be a formal ECG teaching curriculum, and that a national ECG training program and national ECG database should be formed.

Conclusions. The majority of programs do not have a formal ECG interpretation curriculum, which is an obligation to prove competency. As a result, their training methods, resources, and assessment tools were determined to be subjective.

emergency medicine, electrocardiography, education

1. Brady WJ, Whetstone D, Ghaemmaghami CA. The ECG and clinical decision making in the emergency department. In: Mattu A, Barish RA, Tabas JA, editors. Electrocardiography in emergency medicine. 1st ed. Dallas: ACEP Bookstore; 2007.

p. 1-12.

2. Hollander JE. Acute coroner syndromes: Acute myocardial infarction and unstable angina. In: Tintinalli JE, Stapczynski JS, Cline DM, editors. Emergency medicine: A comprehensive study guide. 8th ed. New York: McGraw-Hill; 2011. p. 370-4.

3. Fisch C, Ryan TJ, Williams SV, Achord JL, Akhtar M, Crawford MH, et al. Clinical competence in electrocardiography. A statement for physicians from the

ACP/ACC/AHA task force on clinical privileges in cardiology. J Am Coll Cardiol 1995;25:1465-9.

4. Speake D. The first ECG has a low sensitivity for myocardial infarction in patients with chest pain. BestBets. Accessed 2010 Sep 15;

Available at: http://www.bestbets.org/bets/bet.php?id=75 .

5. Brady WJ, Perron AD, Martin ML, Beagle C, Aufderheide TP. Cause of ST segment abnormality in ED chest pain patients. Am J Emerg Med 2001;19:25-8.

6. Benner JP, Borloz MP, Adams M, Brady WJ. Impact of the 12-lead electrocardiogram on ED evaluation and management. Am J Emerg Med

2007;25:942-8.

7. Snoey ER, Housset B, Guyon P, Elhaddad S, Valty J, Hericord P. Analysis of emergency department interpretation of electrocardiograms. J Accid Emerg Med 1994;11:149-53.

8. Rusnak RA, Stair TO, Hansen K, Fastow JS. Litigation against emergency physicians: common features in cases of missed myocardial infarction. Ann Emerg Med 1989;18:1029-34.

9. Sever M, Karcıoğlu Ö, Aslan Ö, Sever F, Parlak İ, Ersel M. An analysis of accuracy and reliability of emergency department ECG interpretations. Turk J Emerg Med 2007;7:56-63.

10. Eken C, Başarıcı İ, Eray O, Belgi A, Hakbilir O. Likelihood classification of patients presented with chest pain to the emergency department. Turk J Emerg

Med 2006;6:41-8.

11. Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, et al. Missed diagnoses of acute cardiac ischemia in the emergency medicine. N Engl J Med 2000;342:1163-70.

12. Sharkey SW, Berger CR, Brunette DD, Henry TD. Impact of the electrocardiogram on the delivery of thrombolytic therapy for acute myocardial infarction. Am J Cardiol 1994;73:550-3.

13. Masoudi FA, Magid DJ, Vinson DR, Tricomi AJ, Lyons EE, Crounse L, et al. Implications of the failure to identify high-risk electrocardiogram findings for the quality of care of patients with acute myocardial infarction. Results of the emergency department quality in myocardial infarction study. Circulation

2006;114:1565-71.

14. Karcz A, Korn R, Burke MC, Caggiano R, Doyle MJ, Erdos MJ, et al. Malpractice claims against emergency physicians in Massachusetts: 1975-1993. Am J Emerg Med 1996;14:341-5.

15. Karcz A, Holbrook J, Auerbach BS, Blau ML, Bulat PI, Davidson A, et al. Preventability of malpractice claims in emergency medicine: a closed claims study. Ann Emerg Med 1990:19:865-73.

16. Hazinsky MF, Samson R, Schexnayder S. Handbook of Emergency Cardiovascular Care for Healthcare Providers 2010. Dallas: American Heart Association, 2010.

17. Initial management of acute coronary syndromes. In: European Resuscitation Council Guidelines for Resuscitation 2005. European Resuscitation Council Web site. Accessed2010 Sep 20; Available at:

https://www.erc.edu/index.php/docLibrary/en/viewDoc/down%3D6/ .

18. Kadish AH, Buxton AE, Kennedy HL, Knight BP, Mason JW, Schuger CD, et al. ACC/AHA clinical competence statement on electrocardiography and ambulatory electrocardiography: A report of ACC/AHA/ACP-ASIM task force on clinical competence (ACC/AHA committee to develop a clinical competence statement on electrocardiography and ambulatory electrocardigraphy) endorsed by the international society for holter and noninvasive electrocardiography. J Am Coll Cardiol 2001;38:2091-100.

19. Ginde AA, Char DM. Emergency medicine residency training in electrocardiogram interpretation. Acad Emerg Med 2003;10:738-42.

20. Pines JM, Perina DG, Brady WJ. Electrocardiogram interpretation training and competency assessment in emergency medicine residency programs. Acad Emerg Med 2004;11:982-4.