Accepted for/Published in: JMIR Medical Education
Date Submitted: Nov 11, 2025
Date Accepted: Aug 14, 2026
Teaching ACS High Risk ECG Interpretation and Clinical Decision Making Through FOAMed Videos and Podcast Versus Print-based Materials in Emergency Care Providers: Randomized Controlled Mixed Methods Trial
ABSTRACT
Background:
High-risk electrocardiogram (ECG) signs in acute coronary syndrome (ACS)—such as De Winter waves or the Aslanger sign—play a critical role in diagnosis and treatment decisions but remain underrepresented in clinical practice. Over the past decade, digital formats like podcasts and videos have gained popularity in medical self-study, particularly through Free Open Access Medical Education (FOAMed). However, few studies have empirically evaluated the effectiveness of FOAMed in teaching complex ECG content.
Objective:
This study evaluates the learning effectiveness of selected FOAMed formats (podcasts and videos) compared to traditional print materials (guidelines and textbooks) in teaching validated high-risk ECG signs of ACS to emergency medical professionals.
Methods:
A prospective, interprofessional, randomized controlled mixed-methods study (MERSQI score: 16.5/18) was conducted with 103 paramedics, prehospital emergency physicians, and emergency department clinicians in Germany. Participants completed a 30-minute self-study session using either traditional print materials or selected FOAMed content. Print resources were selected based on a prior survey of over 1,000 emergency professionals, identifying the most commonly used and recommended textbooks and guidelines. We assessed knowledge gain using pre- and post-tests consisting of 10 ECG cases and 10 text-based questions. We analyzed quantitative data using mixed ANOVA and evaluated qualitative feedback through content analysis according to Mayring.
Results:
At baseline, participants answered 56% of ECG cases and 46% of text questions correctly, with no significant differences between professional groups. The media-supported group showed a significantly greater increase in knowledge (ECG: +12.4%, p = .017; text: +11.3%, p = .033) and rated learning comfort and confidence in action more positively than the print media group. We observed knowledge deficits equally for both newer and established ECG signs.
Conclusions:
Digital self-learning formats such as podcasts and videos significantly enhance the interpretation of high-risk ECG signs in ACS. These formats offer a modern, user-friendly approach to lifelong learning. Empirical evidence for the effectiveness of FOAMed in clinical education supports its integration into curricula and continuing education to enhance clinical confidence and patient safety in emergency care.
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