title: The acquisition and retention of ECG interpretation skills after a standardized web-based ECG tutorial-a randomised study.
abstract: BACKGROUND
  Electrocardiogram (ECG) interpretation is of great importance for patient management. However, medical students frequently lack proficiency in ECG interpretation and rate their ECG training as inadequate. Our aim was to examine the effect of a standalone web-based ECG tutorial and to assess the retention of skills using multiple follow-up intervals.
  
  
  METHODS
  203 medical students were included in the study. All participants completed a pre-test, an ECG tutorial, and a post-test. The participants were also randomised to complete a retention-test after short (2-4 weeks), medium (10-12 weeks), or long (18-20 weeks) follow-up. Intragroup comparisons of test scores were done using paired-samples t-test. Intergroup comparisons of test scores were performed using independent-samples t-test and ANOVA, whereas demographic data were compared using ANOVA and Chi-squared test.
  
  
  RESULTS
  The overall mean test score improved significantly from 52.7 (SD 16.8) in the pre-test to 68.4 (SD 12.3) in the post-test (p < 0.001). Junior and senior students demonstrated significantly different baseline scores (45.5 vs. 57.8 points; p < 0.001), but showed comparable score gains (16.5 and 15.1 points, respectively; p = 0.48). All three follow-up groups experienced a decrease in test score between post-test and retention-test: from 67.4 (SD 12.3) to 60.2 (SD 8.3) in the short follow-up group, from 71.4 (SD 12.0) to 60.8 (SD 8.9) in the medium follow-up group, and from 66.1 (SD 12.1) to 58.6 (SD 8.6) in the long follow-up group (p < 0.001 for all). However, there were no significant differences in mean retention-test score between the groups (p = 0.33). Both junior and senior students showed a decline in test score at follow-up (from 62.0 (SD 10.6) to 56.2 (SD 9.8) and from 72.9 (SD 11.4) to 62.5 (SD 6.6), respectively). When comparing the pre-test to retention-test delta scores, junior students had learned significantly more than senior students (junior students improved 10.7 points and senior students improved 4.7 points, p = 0.003).
  
  
  CONCLUSIONS
  A standalone web-based ECG tutorial can be an effective means of teaching ECG interpretation skills to medical students. The newly acquired skills are, however, rapidly lost when the intervention is not repeated.
authors.affiliation: Centre for Clinical Education, Rigshospitalet, Afsnit 5404, Teilumbygningen, Blegdamsvej 9, 2100, Copenhagen, Denmark. txl932@alumni.ku.dk.
authors.forename: Signe
authors.initials: S
authors.lastname: Rolskov Bojsen
authors.affiliation: Department of Cardiology, Hillerød Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark. sbewrg@gmail.com.
authors.forename: Sune Bernd Emil Werner
authors.initials: SB
authors.lastname: Räder
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark. anders@kanten.dk.
authors.forename: Anders Gaardsdal
authors.initials: AG
authors.lastname: Holst
authors.affiliation: Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, opg, Q, Postboks 2099, CSS, 1014, Copenhagen, Denmark. lk@sund.ku.dk.
authors.forename: Lars
authors.initials: L
authors.lastname: Kayser
authors.affiliation: Faculty of Health, Aarhus University, Ndr. Ringgade 1, 8000, Aarhus C, Denmark. charlotte.ringsted@au.dk.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Ringsted
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark. Jesper.Hastrup.Svendsen@regionh.dk.
authors.forename: Jesper
authors.initials: J
authors.lastname: Hastrup Svendsen
authors.affiliation: Centre for Clinical Education, Rigshospitalet, Afsnit 5404, Teilumbygningen, Blegdamsvej 9, 2100, Copenhagen, Denmark. Lars.Konge@regionh.dk.
authors.forename: Lars
authors.initials: L
authors.lastname: Konge
mesh_terms: D000704:Analysis of Variance; D002309:Cardiology / Q000193:education; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D004562:Electrocardiography; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D007858:Learning; D008297:Male; D012153:Retention, Psychology; D013337:Students, Medical; D013664:Teaching Materials; D055815:Young Adult