Can Progress Tests Improve Medical Students' ECG Interpretation Skills? A Feasibility Trial.

Abstract

Introduction and objectives: In daily clinical practice the electrocardiogram (ECG) is an accessible and very relevant diagnostic test. Thus, ECG interpretation constitutes a central medical skill, that should be acquired during undergraduate medical students' training. Whether this may be improved by using the progress testing (PT) methodology, an active learning strategy involving students' repeated exposure to problem-solving tests, is not established. PT was previously shown effective in other medical teaching contexts. The present study aimed at analyzing the feasibility and efficacy of a PT program in improving medical undergraduate students' ECG interpretation skills. It was conducted at a Portuguese University. Methods: All fourth-year undergraduate students attending a Portuguese Medicine Master course were invited to participate. Those who accepted were randomly assigned into an intervention group (IG) or a control group (CG). At baseline both groups completed an initial ECG interpretation-test (IIT). This consisted of 24 ECG-tracings, each with a five-choice answer with only one correct option. During the 10-week follow-up, the IG, but not the CG, completed two additional 12 ECG-tracings Mini-Tests, at 4 and 6 weeks. At 9 weeks of follow-up, and during an additional week, both groups completed a 24 ECG-tracings final interpretation-test (FIT). The study primary outcome was the students ECG-interpretation performance improvement (assessed by the percentage of correct answers) at final test, comparing to baseline. Results: Among a total of 154 students, only 59 (38.3%) accepted to participate into the study and adhered to the study protocol . Both the IG and CG showed an improved performance at FIT comparing to IIT. The IG failed to show a statistically significant better performance improvement than the CG. At final test, the ECG tracings gathering the highest rates of correct answers were Atrial Fibrillation (97% correct answers) and Left Bundle Branch Block (96% correct answers).[EM2] Comparing to CG, IG showed a better performance in identifying Myocardial Infarction and Bradyarrhythmia. Conclusions: The small number of students accepting to participate into this PT program resulted in a small sample size, thus limiting the results of this study. Students' performance did improve when comparing FIT with IIT, however this was similar among the two student groups[jc3] . This study failed to prove the efficacy of progress test methodology in promoting a higher ECG interpretation literacy. However, improved students' recruitment into a future trial will shed light on the potential value of a PT program in improving medical students' ECG learning.