A Novel Tool for Assessment of Emergency Medicine Resident Skill in Determining Diagnosis and Management for Emergent Electrocardiograms: A Multicenter Study.
BACKGROUND
Reading emergent electrocardiograms (ECGs) is one of the emergency physician's most crucial tasks, yet no well-validated tool exists to measure resident competence in this skill.


OBJECTIVE
To assess validity of a novel tool measuring emergency medicine resident competency for interpreting, and responding to, critical ECGs. In addition, we aim to observe trends in this skill for resident physicians at different levels of training.


METHODS
This is a multi-center, prospective study of postgraduate year (PGY) 1-4 residents at five emergency medicine (EM) residency programs in the United States. An assessment tool was created that asks the physician to identify either the ECG diagnosis or the best immediate management.


RESULTS
One hundred thirteen EM residents from five EM residency programs submitted completed assessment surveys, including 43 PGY-1s, 33 PGY-2s, and 37 PGY-3/4s. PGY-3/4s averaged 74.6% correct (95% confidence interval [CI] 70.9-78.4) and performed significantly better than PGY-1s, who averaged 63.2% correct (95% CI 58.0-68.3). PGY-2s averaged 69.0% (95% CI 62.2-73.7). Year-to-year differences were more pronounced in management than in diagnosis.


CONCLUSIONS
Residency training in EM seems to be associated with improved ability to interpret "critical" ECGs as measured by our assessment tool. This lends validity evidence for the tool by correlating with a previously observed association between residency training and improved ECG interpretation. Resident skill in ECG interpretation remains less than ideal. Creation of this sort of tool may allow programs to assess resident performance as well as evaluate interventions designed to improve competency.
Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Nicholas D
ND
Hartman
Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
Natasha B
NB
Wheaton
Department of Emergency Medicine, Advocate Christ Medical Center, Chicago, Illinois.
Kelly
K
Williamson
Division of Emergency Medicine, St. Louis University School of Medicine, St. Louis, Missouri.
Erin N
EN
Quattromani
Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington.
Jeremy B
JB
Branzetti
Emergency Medicine Physicians, Ltd, Department of Emergency Medicine, Presence St. Joseph Medical Center, Joliet, Illinois.
Amer Z
AZ
Aldeen
D001145:Arrhythmias, Cardiac / Q000175:diagnosis*; D002983:Clinical Competence / Q000592:standards; D004521:Educational Measurement / Q000379:methods*; D004562:Electrocardiography; D004635:Emergency Medicine / Q000193:education / Q000592:standards*; D006801:Humans; D006947:Hyperkalemia / Q000175:diagnosis; D007396:Internship and Residency; D009203:Myocardial Infarction / Q000175:diagnosis*; D011446:Prospective Studies
educational assessments; emergency electrocardiography; residency education