Techniques for teaching electrocardiogram interpretation: self-directed learning is less effective than a workshop or lecture

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Teaching 12-lead electrocardiogram (ECG) interpretation to students and residents is a challenge for medical educators. To date, few studies have compared the effectiveness of different techniques used for ECG teaching. This study aimed to determine if common teaching techniques, such as those involving workshops, lectures and self-directed learning (SDL), increase medical students' ability to correctly interpret ECGs. It also aimed to compare the effectiveness of these formats. This was a prospective randomised study conducted over a 28-month period. Year 4 medical students were randomised to receive teaching in ECG interpretation using one of three teaching formats: workshop, lecture or SDL. All three formats covered the same content. Students were administered three tests: a pre-test (before teaching); a post-test (immediately after teaching), and a retention test (1 week after teaching). Each tested the same content using 25 questions worth 1 point each. A mixed-model repeated-measures analysis of variance (anova) with least squares post hoc analysis was conducted to determine if differences in test scores between the formats were statistically significant. Of the 223 students for whom data were analysed, 79 were randomised to a workshop, 82 to a lecture-based format and 62 to SDL. All three teaching formats resulted in a statistically significant improvement in individual test scores (p < 0.001). Comparison of the lecture- and workshop-based formats demonstrated no difference in test scores (marginal mean [MM] for both formats = 12.4, 95% confidence interval [95% CI] 11.7-13.2]; p = 0.99). Test scores of students using SDL (MM = 10.7, 95% CI 9.8-11.5) were lower than those of students in the workshop (p = 0.003) and lecture (p = 0.002) groups. Compared with those taught using workshop- and lecture-based formats, medical students learning ECG interpretation by SDL had lower test scores.