Comparing IM Residents with EM Resident for Their Skills of ECG Interpretation and Outlining Management Plan Accordingly

  • Hamid Reza Karimpoor Tari Internal Medicine resident, Shahid Beheshti University of Medical Sciences and Health Services
  • A Arhami Dolatabadi Assistant professor, Shahid Beheshti University of Medical Sciences and Health Services
  • R Miri Assistant professor, Shahid Beheshti University of Medical Sciences and Health Services
  • MR Ra’oofi GP


Background and Purpose: Electrocardiogram (ECG) is one of the most commonly performed investigations in cardiac diseases and ECG abnormalities can reveal the early manifestations of cardiac ischemia, metabolic disorders, or life-threatening disrhythmias. Misinterpretation of ECG and its consequent mistreatment or performing inessential  interventions may cause life-threatening cardiac events. Since EM residents and internal medicine (IM) residents are usually the first to visit at bedside and start treatments based on patient’s ECG, we intended to evaluate the ability of EM residents to interpret ECGs and to compare it with that of IM residents using various ECG samples.
Method: 63 participants including 33 IM residents and 30 EM residents from two education hospitals of Shahid Beheshti University of Medical Sciences were enrolled in our study. A diagnosis test consisting of 15 ECG samples associated with a questionnaire containing questions about gender, academic year and proficiency in ECG interpretation was taken from all participants. This study was conducted under the supervision of a cardiologist and an emergency specialist who supervised the ECG selection, answers and scoring of each ECG. The maximum score for each ECG was 6 which were given to a completely correct diagnosis and -0.25 negative point was given if the answer was wrong or any differential diagnosis was mentioned. After the test, the answer sheets were collected and were
analyzed with SPSS program, by two of study authors who were kept blind to the real identities of participants.
Results: After classification of groups, the overall mean score was 45.5/100 (38-60). The mean score of IM and EM residents was 56.0/100 (44.9-72) and 38.9/100 (31.5-45.5), respectively (p< 0.001).
No significant correlation was found between the diagnosis scores and participant’s self-judgment on her/his ECG interpretation skills (p=0.897, r=0.017). Five ECGs were considered as the most important and analysis revealed the overall mean score (out of 6) of participants was 5 for MI, 4.4 for ventricular tachycardia, 1.18 for pericarditis, 5.91 for WPW, and 5.09 for pulmonary emboli.
Conclusion: our study revealed that the overall scores in ECG interpretation are low and the ECG interpretation skill in IM residents was better compared to EM residents. We demonstrated that there are several weaknesses in ECG interpretation which may have an important role in treatment of patients. Therefore there is a need for more and better ECG training programs especially in cardiac emergencies.


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