Activity

Activity ID

7075

Expires

November 2, 2023

Format Type

Journal-based

CME Credit

1

Fee

$30

CME Provider: JAMA Internal Medicine

Description of CME Course
Abstract

Importance:
The electrocardiogram (ECG) is the most common cardiovascular diagnostic test. Physicians’ skill in ECG interpretation is incompletely understood.

Objectives:
To identify and summarize published research on the accuracy of physicians’ ECG interpretations.

Data Sources:
A search of PubMed/MEDLINE, Embase, Cochrane CENTRAL (Central Register of Controlled Trials), PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health), ERIC (Education Resources Information Center), and Web of Science was conducted for articles published from database inception to February 21, 2020.

Study Selection:
Of 1138 articles initially identified, 78 studies that assessed the accuracy of physicians’ or medical students’ ECG interpretations in a test setting were selected.

Data Extraction and Synthesis:
Data on study purpose, participants, assessment features, and outcomes were abstracted, and methodological quality was appraised with the Medical Education Research Study Quality Instrument. Results were pooled using random-effects meta-analysis.

Main Outcomes and Measures:
Accuracy of ECG interpretation.

Results:
Of 1138 studies initially identified, 78 assessed the accuracy of ECG interpretation. Across all training levels, the median accuracy was 54% (interquartile range [IQR], 40%-66%; n?=?62 studies) on pretraining assessments and 67% (IQR, 55%-77%; n?=?47 studies) on posttraining assessments. Accuracy varied widely across studies. The pooled accuracy for pretraining assessments was 42.0% (95% CI, 34.3%-49.6%; n?=?24 studies; I2?=?99%) for medical students, 55.8% (95% CI, 48.1%-63.6%; n?=?37 studies; I2?=?96%) for residents, 68.5% (95% CI, 57.6%-79.5%; n?=?10 studies; I2?=?86%) for practicing physicians, and 74.9% (95% CI, 63.2%-86.7%; n?=?8 studies; I2?=?22%) for cardiologists.

Conclusions and Relevance:
Physicians at all training levels had deficiencies in ECG interpretation, even after educational interventions. Improved education across the practice continuum appears warranted. Wide variation in outcomes could reflect real differences in training or skill or differences in assessment design.

Disclaimers

1. This activity is accredited by the American Medical Association.
2. This activity is free to AMA members.

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Commercial Support?
No

NOTE: If a Member Board has not deemed this activity for MOC approval as an accredited CME activity, this activity may count toward an ABMS Member Board’s general CME requirement. Please refer directly to your Member Board’s MOC Part II Lifelong Learning and Self-Assessment Program Requirements.

Educational Objectives

: To identify and summarize published research on the accuracy of physicians' electrocardiogram (ECG) interpretations.

Keywords

Cardiology, Medical Education and Training

Competencies

Medical Knowledge

CME Credit Type

AMA PRA Category 1 Credit

DOI

10.1001/jamainternmed.2020.3989

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