Competency in electrocardiogram interpretation among graduating medical students
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Updated: Apr 27, 2026
Patient Directed Recording of a Bipolar Three-Lead Electrocardiogram using a Smartwatch with ECG Function
Published on: December 11, 2019
Robert S Jablonover1, Erin Lundberg, Yilong Zhang
1a Division of General Internal Medicine , George Washington University School of Medicine and Health Sciences , Washington , DC , USA.
Background:
The ability to accurately interpret electrocardiogram (ECG) abnormalities is a core competency for graduating medical students (GMS). Incorrect interpretation of ECG findings can result in adverse patient outcomes. To our knowledge, there has been no published study evaluating the level of competency in ECG interpretation in GMS.
Purposes:
To evaluate the ability of graduating medical students to interpret abnormal and critical ECGs and to correlate student performance with self-reported confidence and adequacy of ECG training.
Methods:
A list of 22 ECGs which GMS are expected to identify was developed. Classic examples of each ECG were identified and verified by two board-certified cardiologists. The 22 ECGs along with 11 questions related to confidence and degree of ECG training were administered to (a) 168 4th-year George Washington University School of Medicine (GWUSOM) students, (b) 63 incoming housestaff to GWUSOM, and (c) 22 graduating internal medicine housestaff.
Results:
Given the lack of statistical differences, GW medical students and incoming housestaff were combined into a single group (GMS, n=231). Mean number of correct answers on the 22 ECG examination for GMS was 8.2 (SE=0.529) and 13.9 (SE=1.312) for graduating residents (p<.0001). On the 6 life-threatening ECGs, GMS scored lower than graduating residents (3.4 SE=0.191 vs. 4.6 SE=0.541; p<.0002). Mean score in the GMS group was associated with increasing levels of reported confidence and degree of ECG experience.
Conclusions:
A 22-item ECG examination was developed, piloted, and demonstrated to have construct validity. GMS had a limited level of competency in ECG interpretation which was correlated with reported self-confidence and degree of ECG exposure in Years 3-4.
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