Task force II: Training in electrocardiography

A. Importance. Electrocardiography is the most commonly used diagnostic test in cardiology. Properly interpreted, it contributes significantly to the diagnosis and management of patients with cardiac disorders. Importantly, it is the only practical method of recording arrhythmias and similarly it is the first procedure obtained in patients with chest pain. These two conditions account for the majority of cardiac catastrophes. B. Goal of training. Although every physician should have some basic knowledge of electrocardiography and the general internist should have a more advanced knowledge, the subspecialist in cardiology should be familiar with nearly all clinically encountered patterns and arrhythmias. He or she should understand their clinical implications and, equally important, their sensitivity and specificity. The trainee should have sufficient basic knowledge to understand the physiologic mechanisms for arrhythmias and electrocardiographic waveforms rather than simply recognize patterns. Recognizing and understanding the basis for the items included in the appendix of this task force report are minimal requirements for each trainee. C. Training. The essence of training is to interpret a large volume of electrocardiograms and to review the interpretations with an experienced faculty. The suggested minimal number of electrocardiograms is 3,500/36 months. This can be accomplished by one or more training periods assigned specifically for interpretation of electrocardiograms. The experience should include clinical correlation in patients in intensive care units, emergency rooms and pacemaker clinics. The electrocardiogram should be integrated with the clinical problem. Formal courses in electrocardiography and correlative conferences in electrocardiography are desirable. D. In-training evaluation. Skills in electrocardiography and interpretation of electrophysiologic studies should be reviewed and it is essential that the trainee be familiar with interpretation of electrophysiologic studies and the indications for such studies. Similarly, he or she should be familiar with the principles of intracardiac electrophysiologic studies, thei~ indications, contraindications, sensitivity and specificity. He or she should be evaluated on an ongoing basis by the responsible faculty. An in-training examination