Evaluating the Competency and Confidence in ECG Interpretation Among Residents: A Multi-Center Pilot Study

Background: Electrocardiography (ECG) is a pivotal diagnostic tool. However, the accuracy of ECGs interpretation by resident varies from region to region, but overall interpretation ability is poor. The aim to assess whether the low competency described worldwide are also prevalent in the Chinese residents. Methods: This pilot study was a cross-sectional, questionnaire-based assessment of ECG interpretation skills of residents (n=165). We selected eight 12-lead ECGs. Each ECG was provided with a brief clinical scenario, consisted of age, gender, and chief complaint. Results: The Cronbach's Alpha for Likert scale used item questionnaire was 0.75. In the university learning situation, only a small number of students considered they were proficient in ECG (n=3, 1.82%). More than half of residents (n=102, 61.82%) relearned the ECG knowledge during their clinical clerkships. The overall ECG interpretation ability is poor, as ECG test scores were 6(4,8). Just 17 residents (10.3%) scored more than 10 points. The non-internal medicine residents had a better performance in the interpretation of supraventricular tachycardia compared with internal medicine residents (median score 2 versus 0, p<0.05). The highest competency was observed in the ST elevated myocardial infarction (correct rate 54.55%). The poorest ability to misread ECG was long QT and left bundle branch block (correct rate 0.61% and 0.00%). Few participants reported complete confidence about their diagnosis (less than 10%). Conclusion: Our research reveals that residents do not appear to be prepared to interpret ECG abnormalities, including common emergencies and common abnormalities, even the normal ECG strip.