Abstract
BackgroundMost medical students lack confidence and are unable to accurately interpret ECGs. Thus, better methods of ECG instruction are being sought. Current literature indicates that the use of e-learning for ECG analysis and interpretation skills (ECG competence) is not superior to lecture-based teaching. We aimed to assess whether blended learning (lectures supplemented with the use of a web application) resulted in better acquisition and retention of ECG competence in medical students, compared to conventional teaching (lectures alone).MethodsTwo cohorts of fourth-year medical students were studied prospectively. The conventional teaching cohort (n = 67) attended 4 hours of interactive lectures, covering the basic principles of Electrocardiography, waveform abnormalities and arrhythmias. In addition to attending the same lectures, the blended learning cohort (n = 64) used a web application that facilitated deliberate practice of systematic ECG analysis and interpretation, with immediate feedback. All participants completed three tests: pre-intervention (assessing baseline ECG competence at start of clinical clerkship), immediate post-intervention (assessing acquisition of ECG competence at end of six-week clinical clerkship) and delayed post-intervention (assessing retention of ECG competence 6 months after clinical clerkship, without any further ECG training). Diagnostic accuracy and uncertainty were assessed in each test.ResultsThe pre-intervention test scores were similar for blended learning and conventional teaching cohorts (mean 31.02 ± 13.19% versus 31.23 ± 11.52% respectively, p = 0.917). While all students demonstrated meaningful improvement in ECG competence after teaching, blended learning was associated with significantly better scores, compared to conventional teaching, in immediate (75.27 ± 16.22% vs 50.27 ± 17.10%, p < 0.001; Cohen’s d = 1.58), and delayed post-intervention tests (57.70 ± 18.54% vs 37.63 ± 16.35%, p < 0.001; Cohen’s d = 1.25). Although diagnostic uncertainty decreased after ECG training in both cohorts, blended learning was associated with better confidence in ECG analysis and interpretation.ConclusionBlended learning achieved significantly better levels of ECG competence and confidence amongst medical students than conventional ECG teaching did. Although medical students underwent significant attrition of ECG competence without ongoing training, blended learning also resulted in better retention of ECG competence than conventional teaching. Web applications encouraging a stepwise approach to ECG analysis and enabling deliberate practice with feedback may, therefore, be a useful adjunct to lectures for teaching Electrocardiography.
Highlights
Most medical students lack confidence and are unable to accurately interpret ECGs
Medical students underwent significant attrition of ECG competence without ongoing training, blended learning resulted in better retention of ECG competence than conventional teaching
Web applications encouraging a stepwise approach to ECG analysis and enabling deliberate practice with feedback may, be a useful adjunct to lectures for teaching Electrocardiography
Summary
Most medical students lack confidence and are unable to accurately interpret ECGs. better methods of ECG instruction are being sought. The concern is that medical students around the world lack competence and confidence in ECG analysis and interpretation [9,10,11,12,13,14]. For this reason, it is important to review the way that Electrocardiography has been conventionally taught. Web-based learning has previously been shown to be at least as effective as conventional methods of instruction in health sciences [20], e-learning on its own has not conclusively been shown to be more effective than lecture-based training for the acquisition of ECG analysis and interpretation skills (hereafter referred to as ECG competence) [18]. The effectiveness of blended learning on the retention of ECG competence remains unknown [18]
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