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

Hamid Reza Karimpoor Tari, A Arhami Dolatabadi, R Miri, MR Ra’oofi



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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Fish C. Evolution of the clinical electrocardiogram. J Am Coll Cardiol. 1989;14:1127-1138.

Gillespie ND, Brett CT, Morrison WG, et al. Interpretation of the emergency electrocardiogram by Junior hospital doctors. J Accid Emerg Med 1996;13:395-397.

Sur DK, Kaye L, Mikus M, et al. Accuracy of electrocardiogram reading by family practice residents. Fam Med 2000;32:346-349.

Jayes Rl JR, Larsen GC, Beshansky JR, et al. Physician electrocardiogram reading in the emergency department- accuracy and effect on training decisions: Finding from a multi center study. J Gan Intern Med 1992;7:387-392.

Todd KH, Hoffman JR, Morgan MT. Effect of cardiologist E.C.G review on emergency department practice. Am Emerg Med. 1996;27:16-21.

Lee TH, Rovan GW, Weisberg MC, Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room. Am J cardiol.1987;60;219-224.

Salerno S. Alguire P, Wazmam H. Training and Competency evaluation for interpretation of 12- lead electrocardiograms: recommendations from the American college of physicians. Ann Intern Med. 2003;138;747-750.

Brady WJ, Perron AD, Chan T: Electrocardiographic ST- segment elevation: correct identification of acute myocardial infarction (AMI) and non- AMI syndromes by emergency physicians. Acad Emerg M ed 2001; 8: 349 – 360

Berger JS. Competency in electrocardiogram interpretation among internal medicine and emergency medicine residents. Am J Med 2005;118:873-880.

White T, Woodmansey P, Ferguson DG, Channer KS. Improving the interpretation of electrocardiographs in an accident an emergency department. Postgrad Med J. 1995; 71:132-135.

Montgomery H, Hunter S, Morris S, Maunton- Morgan R, Marshall RM. Interpretation of electrocardiograms by doctors. BMJ. 1994;309:1551-1552.

Schor S, Behar S, Modan B, et al. Disposition of presumed coronary patients from an emergency room: a fallow- up study. JAMA. 1976;236:941-943.

Pope JH, Aufder heide TP, Ruthazer R, et al.Missed diagnosis of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342:1163-1170.

Hata la R, Norman GR, Brooks LR. Impact of a clinical scenario on accuracy of electrocardiogram interpretation. J Gen Intern Med. 1999;14:126-129.

Wigton Rs, Blank LL, Nicolas JA, Tape TG. Procedural skills training in internal medicine residencies. Ann intern Med. 1989;11:932-938.

Goodacre S, Webster A, Morris F, Do computer generated E.C.G reports improve interpretation by accident and emergency senior house officers? Postgrad Med J. 2001;455-457.

Brailer DL, Kroch E, Pauly MV. The impact of computer- assisted test interpretation on physician decision making: The case of electrocardiograms. Med Decis Making. 1997;17:80-86.

Loy CT, Irwig L. Accuracy of diagnostic test read with and without clinical information: a systemic review. JAMA. 2004;292:1602-1609.

Hatal RA, Norman GR, Brooks LR. The effete of clinical history on physician, E.C.G interpretation skills. Acad Med. 1996;71:568- 570.


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