(19) Improving Competency and Confidence of Pediatric Residents in Obtainingand Interpreting EKGs

Background: Existing literature has described a lack of competency among pediatric residents in both basic electrocardiogram (EKG) interpretation and proper acquisition technique. These gaps in knowledge among trainees may lead to inappropriate consults and referrals, errors in diagnosis and delays in treatment, ultimately negatively impacting patient care. Further exacerbating the problem, a systematic method for interpretation of EKGs is not standardized and formal instruction varies by residency program and institution.

Objectives: The objective of this study was to assess pediatric residents’ skills and knowledge in both EKG acquisition and interpretation before and after an educational intervention consisting of a formal lecture and use of a standardized instructional checklist.

Design/Methods: Pediatric residents at a large free-standing children's hospital were asked to complete a pre-test comprised of 10 questions that assessed their knowledge on how to properly obtain EKGs (e.g., proper lead placement) and 10 questions that assessed their ability to accurately diagnose common pediatric arrhythmias. After attending a 45 minute didactic session, participants were provided an instructional checklist for EKG interpretation and asked to complete a posttest. A paired t-test was used to analyze pre and post-test scores. A p-value < 0.05 was considered statistically significant.

Results: A total of 78 pediatric residents, representative of three discrete cohorts, completed both the pretest and posttest. Following intervention, average EKG Acquisition score improved from 12.19 (53%) to 18.50 (80%) (p <.0001). Average EKG Interpretation score improved from 6.31 (32%) to 11.08 (55%) (p <.0001). The number of residents that reported feeling comfortable using the EKG machine improved from 42% to 63% (p <.05). The number of residents that reported feeling comfortable interpreting EKGs independently improved significantly from 19% to 36% (p <.05).

Conclusion: Proper EKG acquisition and accurate interpretation are critical to providing high quality patient care. It is essential that pediatric residents receive adequate training in acquiring and assessing EKGs. However, subjective and objective assessments of competency in EKG acquisition and interpretation are low among pediatric trainees. Our study demonstrates that formal instruction and use of a standardized checklist can improve resident confidence and proficiency in basic EKG acquisition and diagnosis.