Prioritizing Electrocardiogram Interpretation for Emergency Medicine Residency Training: A Modified Delphi Study

Area of Science:

• Medical Education
• Emergency Medicine
• Cardiology

Background:

• Electrocardiogram (ECG) interpretation is crucial for emergency medicine (EM) physicians.
• A consensus on prioritizing ECG patterns for training is lacking.
• Competency-Based Medical Education (CBME) requires defined performance expectations for diagnostic skills like ECG interpretation.

Purpose of the Study:

• To identify the most important ECG patterns for EM physicians.
• To align ECG pattern recognition with CBME frameworks.
• To base prioritization on "importance to identify" and "clinical significance".

Main Methods:

• A three-round electronic modified Delphi survey was conducted.
• Participants included geographically diverse EM fellows and faculty in the United States (N=14).
• Panelists rated ECG patterns on importance to identify and clinical significance using Likert scales.

Main Results:

• A list of 78 ECG patterns was generated.
• Top-rated patterns included those from Advanced Cardiac Life Support (ACLS) and acute coronary syndrome indicators.
• Some patterns (e.g., atrial fibrillation) were important to identify but had lower clinical significance, while others (e.g., cardiac glycoside toxicity) had high significance but lower identification importance.

Conclusions:

• A Delphi study generated a prioritized list of ECG patterns.
• This list can guide ECG curriculum development and assessment in EM.
• The findings support aligning ECG education with CBME targets based on clinical relevance and diagnostic importance.