Formal teaching can reduce serious errors in interpretation

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6977.468 (Published 18 February 1995) Cite this as: BMJ 1995;310:468
  1. P A Woodmansey,
  2. T White,
  3. K S Channer
  1. Research registrar Medical student Consultant cardiologist

    EDITOR,—We were not surprised by the results of Hugh Montgomery and colleagues' study of doctors' ability to interpret electrocardiograms.1 We have audited the ability of senior house officers to interpret electrocardiograms in an accident and emergency department.2 We found that only 114 of 245 traces were interpreted correctly but that management was seriously affected by misinterpretation in only eight cases. After formal teaching and the issue of guidelines serious errors of misinterpretation fell by half to four out of 242 (1.6%; confidence interval 0.7% to 4%).

    We also tested the ability of cardiographers, cardiac technicians, nurses in the coronary care unit, anaesthetic registrars, and medical senior house officers to interpret electrocardiograms; we used a standard set of 20 electrocardiograms. All the subjects were asked to report the rate, rhythm, QRS axis, and abnormalities. Answers were graded 1-4, where 1=complete concordance; 2=minor disagreement (for example, first degree heart block); 3=disagreement (for example, left ventricular hypertrophy); and 4=appreciable disagreement potentially affecting management (for example, ST segment elevation). All the paramedical staff were better than the doctors and made fewer serious errors (table; χ2=27.2, P<0.01).

    We believe that these results are explained by the fact that formal training in interpretation of electrocardiograms is given to all the groups of staff that we tested except the doctors. It is an indictment of medical education that doctors can interpret electrocardiograms less well than paramedical staff. Should this interpretation be part of the undergraduate curriculum? We believe that it should certainly be part of postgraduate training for doctors in clinical specialties. It is particularly important when decisions about giving thrombolytic treatment to patients with acute myocardial infarction depend partly on interpretation of the electrocardiogram. If general practitioners begin to use thrombolysis in the community they must be capable of recording and interpreting an electrocardiogram.


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