Proficiency of South African intern doctors in recognising ischaemia on an electrocardiogram

Abstract

Background: Interpreting an electrocardiogram (ECG) is challenging for junior doctors, and proficiency gaps exist commonly worldwide. This study assessed interpretation accuracy and self-confidence of South African intern doctors in identifying acute myocardial ischaemia on an ECG and analysed the impact of an education strategy.

Methods: This descriptive, quantitative study included a prospective analytical component using a standardised teaching session. All participants completed an ECG interpretation test and self-confidence questionnaire both before and after the teaching session. Descriptive statistics summarised demographics; data analyses included means, medians, modes, and individualised comparisons of pre- and post-teaching test scores and self-confidence.

Results: One hundred and sixty-four interns were analysed. At baseline, interns demonstrated above-average accuracy (mean test score 60.1%) and most declared moderate insecurity with ECG interpretation. Post-teaching, accuracy improved marginally (mean test score 65.8%) (p < 0.001), and self-confidence improved drastically with most becoming moderately confident (p < 0.001). However, while there was a significant improvement in the recognition of four ischaemic and two non-ischaemic ECG patterns, the misinterpretation of one non-ischaemic ECG significantly worsened, and there was an insignificant impact on half of the ischaemic ECGs tested.

Conclusion: Interns demonstrated above-average accuracy in identifying acute myocardial ischaemia on an ECG with moderate insecurity at baseline. While a teaching session improved self-confidence, its impact on accuracy was mixed. This highlights a need for ongoing training of South African intern doctors in ECG interpretation.

Contribution: This study was the first to assess ECG interpretation accuracy and associated self-confidence of South African intern doctors, thereby offering a local perspective on this essential skill.