Proficiency of South African intern doctors in recognising ischaemia on an electrocardiogram

Interpreting an electrocardiogram (ECG) is challenging for junior doctors, and proficiency gaps exist commonly worldwide. This study assessed interpretation accuracy and self-confidence of South African intern doctors in identifying acute myocardial ischaemia on an ECG and analysed the impact of an education strategy.

This descriptive, quantitative study included a prospective analytical component using a standardised teaching session. All participants completed an ECG interpretation test and self-confidence questionnaire both before and after the teaching session. Descriptive statistics summarised demographics; data analyses included means, medians, modes, and individualised comparisons of pre- and post-teaching test scores and self-confidence.

One hundred and sixty-four interns were analysed. At baseline, interns demonstrated above-average accuracy (mean test score 60.1%) and most declared moderate insecurity with ECG interpretation. Post-teaching, accuracy improved marginally (mean test score 65.8%) (p < 0.001), and self-confidence improved drastically with most becoming moderately confident (p < 0.001). However, while there was a significant improvement in the recognition of four ischaemic and two non-ischaemic ECG patterns, the misinterpretation of one non-ischaemic ECG significantly worsened, and there was an insignificant impact on half of the ischaemic ECGs tested.

Interns demonstrated above-average accuracy in identifying acute myocardial ischaemia on an ECG with moderate insecurity at baseline. While a teaching session improved self-confidence, its impact on accuracy was mixed. This highlights a need for ongoing training of South African intern doctors in ECG interpretation.

This study was the first to assess ECG interpretation accuracy and associated self-confidence of South African intern doctors, thereby offering a local perspective on this essential skill.