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Viljoen CA, Millar RS, Manning K, et al. Clinically contextualised ECG interpretation: the impact of prior clinical exposure and case vignettes on ECG diagnostic accuracy. BMC Med Educ. 2021;21(1):417doi: 10.1186/s12909-021-02854-x.
Viljoen, C. A., Millar, R. S., Manning, K., Hoevelmann, J., & Burch, V. C. (2021). Clinically contextualised ECG interpretation: the impact of prior clinical exposure and case vignettes on ECG diagnostic accuracy. BMC medical education, 21(1), 417. https://doi.org/10.1186/s12909-021-02854-x
Viljoen, Charle André, et al. "Clinically contextualised ECG interpretation: the impact of prior clinical exposure and case vignettes on ECG diagnostic accuracy." BMC medical education vol. 21,1 (2021): 417. doi: https://doi.org/10.1186/s12909-021-02854-x
Viljoen CA, Millar RS, Manning K, Hoevelmann J, Burch VC. Clinically contextualised ECG interpretation: the impact of prior clinical exposure and case vignettes on ECG diagnostic accuracy. BMC Med Educ. 2021 Aug 03;21(1):417. doi: 10.1186/s12909-021-02854-x. PMID: 34344375; PMCID: PMC8336410.
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BMC Med Educ. 2021 Aug 03;21(1):417. doi: 10.1186/s12909-021-02854-x.

Clinically contextualised ECG interpretation: the impact of prior clinical exposure and case vignettes on ECG diagnostic accuracy.

BMC medical education

Charle André Viljoen, Rob Scott Millar, Kathryn Manning, Julian Hoevelmann, Vanessa Celeste Burch

Affiliations

  1. Division of Cardiology, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town, 7925, South Africa. [email protected].
  2. Department of Medicine, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town, 7925, South Africa. [email protected].
  3. Cape Heart Institute, University of Cape Town, Observatory, Cape Town, 7925, South Africa. [email protected].
  4. Division of Cardiology, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town, 7925, South Africa.
  5. Department of Medicine, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town, 7925, South Africa.
  6. Cape Heart Institute, University of Cape Town, Observatory, Cape Town, 7925, South Africa.
  7. Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Hospital, Homburg/Saar, Germany.

PMID: 34344375 PMCID: PMC8336410 DOI: 10.1186/s12909-021-02854-x

Abstract

BACKGROUND: ECGs are often taught without clinical context. However, in the clinical setting, ECGs are rarely interpreted without knowing the clinical presentation. We aimed to determine whether ECG diagnostic accuracy was influenced by knowledge of the clinical context and/or prior clinical exposure to the ECG diagnosis.

METHODS: Fourth- (junior) and sixth-year (senior) medical students, as well as medical residents were invited to complete two multiple-choice question (MCQ) tests and a survey. Test 1 comprised 25 ECGs without case vignettes. Test 2, completed immediately thereafter, comprised the same 25 ECGs and MCQs, but with case vignettes for each ECG. Subsequently, participants indicated in the survey when last, during prior clinical clerkships, they have seen each of the 25 conditions tested. Eligible participants completed both tests and survey. We estimated that a minimum sample size of 165 participants would provide 80% power to detect a mean difference of 7% in test scores, considering a type 1 error of 5%.

RESULTS: This study comprised 176 participants (67 [38.1%] junior students, 55 [31.3%] senior students, 54 [30.7%] residents). Prior ECG exposure depended on their level of training, i.e., junior students were exposed to 52% of the conditions tested, senior students 63.4% and residents 96.9%. Overall, there was a marginal improvement in ECG diagnostic accuracy when the clinical context was known (Cohen's d = 0.35, p < 0.001). Gains in diagnostic accuracy were more pronounced amongst residents (Cohen's d = 0.59, p < 0.001), than senior (Cohen's d = 0.38, p < 0.001) or junior students (Cohen's d = 0.29, p < 0.001). All participants were more likely to make a correct ECG diagnosis if they reported having seen the condition during prior clinical training, whether they were provided with a case vignette (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.24-1.71) or not (OR 1.58, 95% CI 1.35-1.84).

CONCLUSION: ECG interpretation using clinical vignettes devoid of real patient experiences does not appear to have as great an impact on ECG diagnostic accuracy as prior clinical exposure. However, exposure to ECGs during clinical training is largely opportunistic and haphazard. ECG training should therefore not rely on experiential learning alone, but instead be supplemented by other formal methods of instruction.

© 2021. The Author(s).

Keywords: Case vignette; Clinical context; ECG; Electrocardiography; Experiential learning

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