Electrocardiogram interpretation skills in psychiatry trainees

Rashmi Yadav,Ankush Vidyarthi

doi:10.1192/pb.bp.112.038992

Abstract

Aims and methodTo assess the competence of psychiatry trainees in identifying major abnormalities in a 12-lead electrocardiogram (ECG). This was a three-stage prospective study. In stage 1, selected ECG traces were presented to the trainees. They were then asked to comment on any abnormalities of note on the ECG traces. In stage 2, an ECG e-book was made available to the trainees and the survey repeated. In stage 3, ECG workshop sessions were introduced in the mandatory teaching programme and the survey was repeated.ResultsThe number of correct responses after the introduction of the workshops were significantly more when compared with correct responses in stage 2 (P= 0.0002), and stage 1 (P= 0.0091). When compared with stage 1, the correct responses in stage 2 actually showed deterioration (P= 0.0284).Clinical implicationsOur study not only shows that providing access to an e-book is not enough to improve these skills, it also shows that ECG refresher sessions improved the diagnostic accuracy markedly.

Highlights

Srikanthan et al found that the management plan had to be changed in 8.9% of patients after a review of the ECGs by cardiologists following the initial diagnosis by junior doctors
The psychiatry trainees are constantly made aware of the importance of performing ECGs and their clinical implications, it is not unrecognised that ECG interpretation is often a neglected learning objective in psychiatry training
The expectation, is not to teach psychiatric trainees to make a complicated diagnosis from an ECG or to improve their skills to match those of a cardiologist, but to teach them, for example, how to differentiate between a sinus bradycardia and a new-onset atrial fibrillation in a patient with an eating disorder, in order to aid accurate diagnosis, treatment and an appropriate referral

Summary

Results

Participation rates were relatively high, with 81% of trainees (38 out of 47) taking part at stage 1, 76% (32 out of 42) at. When compared with the baseline, the correct responses in stage 2 showed deterioration Initially not confident with identifying this trace (21% correct responses in stage 1, 16.1% in stage 2), trainees showed some improvement by stage 3 (60.9% responses correct). Trace 4: normal sinus rhythm This trace caused trainees less trouble than the previous three and most of the responses were correct in stages 1 and 3 (68.4% and 85.3% respectively), with just under a half correct in stage 2 (45.1%). Trace 6: complete heart block This was the trace trainees had least trouble with and most gave a correct response: 78.9% in stage 1, 54.8% in stage 2, 97.5% in stage 3

Method

Discussion

Limitations