Better training on ECG interpretation needed

In the latest issue of The British Journal of Cardiology, the editorial considers the importance of ECG training. The following is a summary:

The first human ECG was recorded over 125 years ago.

Despite the development of many new investigative techniques, the ECG remains an essential part of any cardiovascular assessment, whether in relation to acute or chronic health issues, to insurance assessment or to the assessment of risk in critical occupations or in sports professionals.

In terms of interpretation, it is fair to say that the ECG occupies a unique and unsatisfactory position.

Unlike pathology specimens, images produced by modern techniques, and biochemical data, ECGs are most commonly reported and acted upon by frontline users who have had no formal training – and no assessment of competency in – ECG interpretation. They also normally proceed with no clear guidelines about the limits of normality or the precise criteria for specific abnormalities.

There is no formal, national programme for training in ECG interpretation or for the assessment of ECG interpretation skills.

Inevitably, therefore the standard of ECG interpretation in both general practice and hospital medicine is highly variable and is often extremely poor.

Moreover the quality of ECG interpretation remains completely obscure to the patient. When any healthcare professional speaks to a patient about that patient’s ECG, the patient automatically assigns to the healthcare professional a degree of competence in the said professional’s ability to read the ECG, which the patient (very reasonably) presumes the professional to have. Sadly, this confidence is usually misplaced.

Furthermore, the healthcare workers themselves are often completely unaware of their lack of competence.

Possible solutions

There are three possible approaches to the alleviation of this problem:

1. the use of computers in ECG interpretation

2. the provision of a system of rapid access to ECG recording and to a central area of skilled ECG interpretation

3. the widespread formal training, testing and re-training of healthcare professionals at all levels in relation to their ECG interpretation skills

Computer interpretation of ECGs

This sounds the most obvious solution, but with currently available equipment, it is totally unsatisfactory. All studies of computer interpretation of the ECG have revealed very significant error rates.

Not infrequently, the errors involved are serious with potential consequences in relation to patient management. Official bodies (e.g. the American College of Cardiology and the American Heart Association) consistently counsel against the use of this strategy.

Provision of rapid access to skilled interpretation

This can only be achieved by immediate telemetric access to a central reporting facility. Such organisations do exist, currently providing a service under contract to specific NHS purchasers.

Training, testing and re-training of professionals

Training for NHS healthcare workers is desperately needed in ECG interpretation across the board.

Teaching, training and assessment should be rigorous and committed, both on the part of the trainers and trainees. Such training should be extensively available.