Mastering Electrocardiogram Interpretation Skills Through a Perceptual and Adaptive Learning Module
Mastering Electrocardiogram Interpretation Skills Through a Perceptual and Adaptive Learning Module
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DOI：
10.1002/aet2.10454
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发表时间：
2021-04-01
影响因子：
1.8
通讯作者：
Niemann, James T.
中科院分区：
文献类型：
--
作者：
Krasne, Sally;Stevens, Carl D.;Niemann, James T.
虽然标准12导联心电图（ECG）的准确解释是诊断心脏病的基础，但一些先前的研究报告称，医学生、住院医生和执业医生的准确率较低。本研究的目的是确定在线ECG感知和自适应学习模块（ECG PALM）是否是教授ECG判读的有效工具，ECG PALM包括415个独特的ECG描记，以及相关的预测、后测和延迟测试，每个测试使用30个额外的ECG来衡量培训的有效性和持久性。2013年至2015年期间，共有113名三年级和156名四年级医学生和34名一年级，41名二年级和37名三年级急诊医学居民完成了PALM和相关测试。我们测量了两个掌握标准：准确性，正确解释的百分比，以及流畅性，在15秒内准确解释图像的百分比。ECG PALM产生了统计学上显著的改善（0.0001 < p 0.0045）学生和住院医师的准确度表现（效应量= 0.9至3.2）和流畅性（效应量= 2.5至3.1）的培训后，范围从46 +/- 24分钟（R3）至88 +/- 32分钟（三年级医学生）。医学院学生和住院医师在培训后一年的测试（延迟测试）中的表现明显优于那些没有事先接受ECG PALM培训的人（预测试）。R3居民对15种诊断类别进行分类的流畅度在15种诊断中有9种低于60%，只有一种超过80%。在PALM培训后，15个类别中有7个类别的流利度高于80%，只有两个类别的流利度低于60%。在识别ST段抬高心肌梗死（STEMI）的准确性是高的PALM培训之前和之后的R3，但流畅性只有64%的前STEMI的预测试，增加到93%以下PALM training.These观察表明，心电图PALM是一个有效的和持久的补充工具，发展掌握解释常见的心电图异常。
Although accurate interpretation of the standard 12-lead electrocardiogram (ECG) is fundamental to diagnosing heart disease, several prior studies report low accuracy rates among medical students, residents, and practicing physicians. The objective of this study was to determine if an online ECG Perceptual and Adaptive Learning Module (ECG PALM) is an efficient instrument to teach ECG interpretation.The ECG PALM consists of 415 unique ECG tracings with associated pretest, posttest, and delayed tests, each using 30 additional ECGs to gauge the effectiveness and durability of training. Between 2013 and 2015, a total of 113 third-year and 156 fourth-year medical students and 34 first-year, 41 second-year, and 37 third-year emergency medicine residents completed the PALM and associated tests. We measured two mastery criteria: accuracy, the percentage of correct interpretations, and fluency, the percentage of images interpreted accurately within 15 seconds.The ECG PALM produced statistically significant improvements (0.0001 < p 0.0045) in student and resident performance for both accuracy (effect size = 0.9 to 3.2) and fluency (effect size = 2.5 to 3.1) following training ranging from 46 +/- 24 minutes (R3s) to 88 +/- 32 minutes (third-year medical students). Medical students and residents performed significantly better on a test the year following training (delayed test) than those without prior ECG PALM training (pretest). The fluency of R3 residents in classifying the 15 diagnostic categories was less than 60% for nine of the 15 diagnoses and greater than 80% for only one. Following PALM training, fluency was higher than 80% for seven of the 15 categories and less than 60% for only two categories. Accuracy in recognizing ST-elevation myocardial infarctions (STEMIs) was high both before and after PALM training for R3s, but fluency was only 64% for anterior STEMIs on the pretest, increasing to 93% following PALM training.These observations suggest that the ECG PALM is an effective and durable supplemental tool for developing mastery in interpreting common ECG abnormalities.