Primary care and general physicians’ electrocardiogram interpretation competence and readiness for emergency myocardial infarction management in Saudi Arabia

A BSTRACT Objectives: To provide the first nationwide assessment of licensed physicians’ competence in electrocardiogram (ECG) interpretation and emergency myocardial infarction (MI) management in Saudi Arabia and to identify specialty-specific gaps that could inform targeted educational strategies. Methods: An analytical cross-sectional survey was conducted from September 11, 2025 to October 15, 2025 via Google Forms. Eligible participants included consultants, fellows, residents, and general physicians across cardiology, internal medicine, emergency medicine, family medicine, general surgery, anesthesia, and intensive care medicine. A validated, self-administered questionnaire captured demographics, ECG knowledge triggers, interpretation of seven key ECG findings, and prior workshop attendance. Each correct response was coded as 1/0, summed, and scaled to a 0–100 composite score. Data were analyzed in R (v4.3.2) using Kruskal–Wallis tests with Bonferroni-adjusted Dunn post-hoc comparisons ( P < 0.0083). Results: Of 364 respondents, 69.3% were general physicians and 61.8% had attended an ECG workshop. Cardiologists achieved the highest median interpretation scores, whereas general physicians and surgical specialties performed significantly lower ( P < 0.001). Workshop attendance was associated with higher scores. ST-elevation recognition demonstrated the highest accuracy, whereas reciprocal change identification was poorest. Conclusions: Competency gaps in ECG interpretation and MI management remain substantial, particularly among general physicians. Mandatory ECG modules in residency programs, expansion of continuing medical education requirements, and tele-ECG over-read systems are urgently needed to standardize acute cardiac care and improve reperfusion timelines.