A standardized examination in the interpretation of electrocardiograms

Abstract

A standardized objective examination was developed by the Cardiovascular Subspecialty Board of the American Board of Internal Medicine to assess competence in the interpretation of electrocardiograms (ECGs). The questions consisted of 12 lead ECGs with lead II and V1 rhythm strips, accompanied by brief clinical statements. Examinees chose their answers from a comprehensive list of 129 choices; the list was the same for each question. The score from the ECG examination was combined with scores from the other sections of the examination to derive a single score for the Cardiovascular Board examination using a norm-referenced method for determining the passing score. An additional trial was conducted to study the feasibility of testing for a minimal level of competence; the trial used a subset of "core" ECGs and a criterion-referenced scoring method based on a consensus of members of the Cardiovascular Board on the level of performance that should be expected of certified cardiologists. Fifty examinees (2.7%) failed the core ECG examination. If examinees had been required to pass both the core ECG examination and the remainder of the examination, 164 examinees (9%) would have changed their pass-fail status on the overall examination. The examination appeared to be a valid test for a minimal level of skill in this area of cardiology. The minimal level of competence was met by a large majority but not all of the examinees.