Pediatric Electrocardiogram Educational Initiative to Increase Resident Physicians’ Proficiency and Confidence

Background: Pediatric electrocardiogram (P-ECG) is a diagnostic tool that is widely used to evaluate/screen for cardiac disease in infants, children, and adolescents. However, proficiency and confidence in P-ECG interpretation is lacking, leading to misdiagnosis, potential overtreatment, and adverse outcomes. This project aims to assess the impact of a resident physician P-ECG educational initiative on interpretation skills and confidence.

Methods: This is an IRB approved prospective cohort study. Pediatric, medicine-pediatric, and family medicine residents from 2019-2021were invited to participate. Residents were asked to complete a pre-survey and quiz to assess their baseline P-ECG interpretation confidence and skills. Following the pre-survey, a P-ECG interpretation lecture and a simplified checklist pocket card developed by the authors were given to the subjects. P-ECG interpretation confidence and skills were then reassessed following the lecture. Pre and post-quiz scores were compared using a paired t-test and confidence levels were compared using the Wilcoxon sign rank test to determine the impact of the education initiative.

Results: 39 residents participated in the study and completed the pre-survey and quiz. Of those, 15 completed the post-survey and quiz. Mean scores on the P-ECG quiz had a significant increase by 26.6% (pre: 40.8%, post: 67.4%, p: 0.0162) following the education initiative. When comparing pre- and post-scores grouped by post graduate year (PGY), all classes improved (Figure 1), but only the PGY1 group had a statistically significant difference (pre: 37.6%, post: 67.4%, p: 0.0488).
Additionally, P-ECG interpretation skills for rhythm disturbance (pre: 24.0%, post: 65.3%, p: 0.0122), sinus variants (pre: 25.0%, post: 65.0%, p: 0.0163), and P-ECG intervals (pre: 40.0%, post: 80.0% , p: 0.0091) significantly improved post the education initiative (Figure 2).
Interestingly, despite the improvement in the P-ECG skills, there was no significant difference in mean confidence scores following the education initiative (pre: 44.7%, post: 46.7%, p: 0.2769).

Conclusion: Targeted P-ECG education improves resident physician interpretation skills, but does not significantly increase their level of confidence. These results suggest residents are transitioning between consciously incompetent to consciously competent learners, and require a continuum of P-ECG education.