A Module-Based Pediatric ECG Curriculum to Improving Accuracy of ECG Interpretation by Pediatric Emergency Medicine Providers

Publication ID Published Volume
9779 April 24, 2014 10

Abstract

Electrocardiograms (ECGs) are ordered frequently in the pediatric emergency department (ED), as they are an important diagnostic tool in the work up of a variety of common presentations including syncope, dizziness, palpitations, ingestion, electrolyte imbalances, seizure and chest pain. The majority of these ECGs are interpreted initially by pediatric emergency (PEM) physicians, with a cardiologist reinterpreting the ECG after patient disposition has been made. PEM physicians have typically completed either a pediatric or an emergency medicine residency program, with subsequent fellowship in pediatric emergency medicine.

Previous studies have shown that neither emergency medicine nor pediatric residency training programs adequately train residents to read ECGs, with accuracy of interpretation of clinically significant ECGs ranging from 41-66%, depending on training program, specific rotations completed and year of training. The low accuracy in ECG interpretation carries through to PEM physicians, both when compared to pediatric cardiologists and to a computerized ECG interpretation software. There is a higher rate of discordance (27%) among ECGs with clinically significant findings, as opposed to those with clinically insignificant findings. There is a need to improve the ability of PEM physicians to read ECGs, particularly those with clinically significant findings.

Recognizing this need, we designed a web-based pediatric ECG curriculum aimed specifically at PEM providers (fellows and attendings). The overall goal of this curriculum is to improve the ‘first read’ accuracy of ECG interpretation and to decrease the number of missed diagnoses.

The curriculum consists of 7 web-based modules focusing on pediatric ECGs and their interpretation in the emergency department setting:

  1. The Basics.
  2. Long QT Syndrome & Brugada.
  3. Supraventricular Tachycardia & Wolff Parkinson White Syndrome.
  4. Heart Block & Sick Sinus Syndrome.
  5. Ventricular Tachycardia.
  6. Ischemia & Infarct.
  7. Congenital Heart Disease.

Modules run for 7-12 minutes and are interactive, requiring the user to recognize abnormalities and perform necessary calculations before proceeding. The modules are case-based, allowing the user to work through ECGs to learn about the topics listed. Topics are taught from the perspective of the PEM physician. At the completion of the curriculum, the user will be comfortable reading and interpreting a pediatric ECG, recognizing and initiating treatment plans for each of the clinically significant findings listed above, and determining when a cardiology consult is necessary from the emergency department.

In order to determine the effectiveness of the curriculum, the Pediatric Emergency Medicine fellows at a large urban pediatric teaching hospital were studied (N=9). An anonymous pre-test consisting of 20 ECGs was administered to all PEM fellows and a self-selected group of PEM attendings. Participants were asked to identify the abnormality in free text responses. The module-based ECG curriculum was created. Modules were released one week prior to an interactive session with a pediatric cardiologist (EAG). During the sessions, small groups worked through unknown ECGs related to the module. At the completion of the curriculum, a post-test designed similarly to the pre-test was administered to assess improvement in the accuracy of ECG interpretation. A satisfaction survey was also administered.

The overall accuracy of identifying the ECG abnormality on the pre-test was 42.8% [PEM Fellows 40.6% (N=9), PEM Attendings 45.7% (N=7)]. All nine fellows completed the post-test. There was a statistically significant improvement in the ability of PEM fellows to accurately interpret ECG findings that had been taught through dedicated modules (42.0% v 53.1%, p = 0.047 using a Wilcoxon Signed-Rank test). No statistically significant improvement was found in the accuracy of interpretation of ECG abnormalities without dedicated teaching modules. Of the PEM fellows and attendings who responded to the satisfaction survey, 100% would recommend the curriculum to a colleague and 76.5% thought the ECG modules could stand alone in teaching ECG interpretation to the PEM provider.

Given the results of this study, we determined that the implementation of a combined module-based and didactic pediatric ECG curriculum improves the ability of PEM fellows to accurately interpret ECGs with abnormalities specifically addressed in the curriculum.

Citation

Gopwani P, Patel S, Greene E, Chapman J. A module-based pediatric ECG curriculum to improving accuracy of ECG interpretation by pediatric emergency medicine providers. MedEdPORTAL Publications. 2014;10:9779. http://doi.org/10.15766/mep_2374-8265.9779

Educational Objectives

  1. Demonstrate a systematic approach to reading pediatric electrocardiograms.
  2. Describe clinically significant findings on pediatric electrocardiograms.
  3. Formulate the initial treatment plan for pediatric patients with clinically significant findings on electrocardiogram.

Keywords

  • Pediatric Emergency Medicine, Electrocardiograms, ECGs, Electrocardiography, Pediatrics

Material Access

Please sign in to access this material.

Please register for an AAMC account if you do not have one.

Register

  • Contact Us

ISSN 2374-8265