Competency in electrocardiogram interpretation among internal medicine and emergency medicine residents

Accurate interpretation of the electrocardiogram is critical, yet there are no evidence-based guidelines for assessing competency. Our study evaluated the ability of internal medicine residents and emergency medicine residents to interpret a variety of electrocardiograms.

The 120 participants included 87 internal medicine residents and 33 emergency medicine residents at two hospitals. Participants reported their sex, training level, adequacy of training, career interest in cardiology, and estimated electrocardiogram proficiency. They then took a test containing 12 electrocardiograms and recorded their diagnosis and certainty. Two cardiologists independently established the correct diagnoses. Two blinded, independent graders scored each electrocardiogram (0 = incorrect, 1 = partially correct, 2 = correct).

The median proficiency was 6 out of 10, total electrocardiogram score was 15 of 24, and certainty was 33 of 48. There was no significant difference in overall competency between emergency medicine and internal medicine residents (14.0 vs 15.0, P = 0.239). Internal medicine residents interested in a cardiology career scored higher than those not interested in a cardiology career (17.3 vs. 14.1, P = 0.003). When analyzing the most critical diagnoses, we found that the mean score for ventricular tachycardia was 1.6 of 2.0, for myocardial infarction was 1.3 of 2.0, and for complete heart block was 0.8 of 2.0. Over half of the participants felt their electrocardiogram training was inadequate.

Despite improvement in interpretation with clinical experience, overall performance was low. Research is needed to find optimal methods to improve electrocardiogram competency.