JMIR Publications

ABSTRACT

Background:

Electrocardiography (ECG) interpretation is a fundamental skill for medical students and practicing medical professionals. Recognising ECG pathologies promptly allows for quick intervention, particularly important in the acute setting where urgent care may be needed. Despite its importance, many medical students find ECG interpretation and understanding of underlying pathology challenging, with teaching methods varying greatly. Therefore, this study involved the development of novel animations demonstrating the passage of electrical activity for well-described cardiac pathologies and showcased them alongside corresponding live ECG traces during an online tutorial for final-year medical students.

Objective:

The aim of this innovative teaching method was to improve medical students’ confidence in visualising cardiac electrical activity and ECG interpretation.

Methods:

Final-year medical students at Imperial College were recruited through student communication channels to an online tutorial demonstrating the seven animations depicting cardiac electrical activity and corresponding ECG trace. Students were asked to complete an anonymous Qualtrics questionnaire composed of 5-point Likert-scale questions assessing participants’ confidence in interpreting ECGs and visualising cardiovascular electrical transmission in each of the pathologies covered in the tutorial, before and after the tutorial. Students were also invited to participate in an online focus-group directly following the session in groups of 5 students and 1 researcher, to further explore their experiences of past ECG teaching and the current tutorial, with a particular focus on aspects they found helpful and what could be further improved in the delivery of the tutorial and design of the visualisations. Two-tailed, paired T-tests were used to assess statistical significance of any reported changes in confidence. Focus group transcripts were analysed using inductive thematic analysis.

Results:

The first 20 students who signed-up to participate were allocated a slot in the teaching session, of which 19 attended. Of these, 15 (78.9%) completed both the pre- and post-session questionnaires. Overall, mean results for confidence interpreting ECGs increased between pre-tutorial (2.1 ±1.0) and post-tutorial (3.2 ±0.8) scores (P<.001). Improvement was seen in both confidence reviewing or diagnosing cardiac rhythms, and visualisation of cardiac electrical activity in the demonstrated pathologies. The main themes from thematic analysis were that ECGs are regarded as a complex topic, and past ECG learning used CBL and involved the memorisation of traces. Animations and associated explanations promoted a deeper understanding, and ECG learning requires repetition and clinical links remain essential.

Conclusions:

This study highlights the value of ECG teaching that incorporates visual animations to demonstrate the electrical activity of different pathologies, alongside providing vignettes in which discussions regarding investigations and management options can be made. Interactivity within the tutorial through quizzes and spaced practice are also recommended, in which students can access the resources, including the animation used in a tutorial at a later date, to help solidify their learning.