title: How can we improve teaching of ECG interpretation skills? Findings from a prospective randomised trial.
abstract: BACKGROUND
  There is an ongoing debate on how ECG interpretation should be taught during undergraduate medical training. This study addressed the impact of teaching format, examination consequences and student motivation on skills retention.
  
  
  METHODS
  A total of 493 fourth-year medical students participated in a six-group, partially randomised trial. Students received three levels of teaching intensity: self-directed learning (2 groups), lectures (2 groups) or small-group peer-teaching (2 groups). On each level of teaching intensity, end-of-course written examinations (ECG exit exam) were summative in one group and formative in the other. Learning outcome was assessed in a retention test two months later.
  
  
  RESULTS
  Retention test scores were predicted by summative assessments (adjusted beta 4.08; 95% CI 1.39-6.78) but not by the type of teaching. Overall performance levels and motivation did not predict performance decrease or skills retention.
  
  
  CONCLUSIONS
  Summative assessments increase medium-term retention of ECG interpretation skills, irrespective of instructional format.
authors.affiliation: Health Behaviour Research Centre, University College, London, UK; Department of Cardiology and Pneumology, University Medical Centre, Göttingen, Germany. Electronic address: raupach@med.uni-goettingen.de.
authors.forename: T
authors.initials: T
authors.lastname: Raupach
authors.affiliation: Department of Internal Medicine, University Medical Centre, Hamburg-Eppendorf, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Harendza
authors.affiliation: Department of Legal Medicine, University Medical Centre, Hamburg-Eppendorf, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Anders
authors.affiliation: Department of Haematology and Oncology, University Medical Centre, Göttingen, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Schuelper
authors.affiliation: Health Behaviour Research Centre, University College, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Brown
mesh_terms: D002309:Cardiology / Q000193:education*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D004501:Education, Medical / Q000458:organization & administration*; D004521:Educational Measurement / Q000706:statistics & numerical data; D004562:Electrocardiography / Q000706:statistics & numerical data*; D005858:Germany; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013663:Teaching / Q000379:methods*; D055815:Young Adult
keywords: Assessment; Decrease; Electrocardiogram; Forgetting; Learning; Medical education; Teaching