Accuracy of electrocardiogram interpretation improves with emergency medicine training

Objective:  To assess whether electrocardiogram (ECG) interpretation accuracy improves with advancing years of emergency medicine training. Methods:  A prospective cross-sectional double-blinded study of emergency medicine trainees attending teaching sessions in ACEM accredited Victorian hospitals. Subjects completed a survey about level of training, rotations completed and ECG training. They were then asked for the ‘main diagnosis’ on 10 clinically significant ECG. Those in their fourth year of advanced training onwards, or in active preparation for fellowship examination (senior trainees) were compared with trainees in earlier years (other trainees). Results:  There were 122 trainees surveyed in total. In the present study, 48/122 were senior trainees and 74/122 were other trainees. The overall accuracy of ECG interpretation was 67.5% (95% confidence interval [CI] 63.2–71.8%) for the senior trainees and 49.6% (95% CI 45.2–53.9%) for the others. Results for some of the individual ECG were: left bundle branch block: 81.3% (95% CI 69.9–92.6%) seniors and 58.1% (95% CI 46.6–69.7%) others; ventricular tachycardia: 43.8% (95% CI 29.3–58.2%) seniors and 37.8% (95% CI 26.5–49.2%) others; and ventricular fibrillation: 70.8% (95% CI 57.6–84.1%) seniors and 63.5% (95% CI 52.2–74.9%) others. Conclusion:  There is an improvement in ECG interpretation accuracy with advancing years of emergency medicine training in Victoria. There exists, however, a low level of accuracy for some critical ECG diagnoses. There is a call by trainees for more formalized and regular ECG education to begin earlier in their training.