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. 2024 Mar;25(2):155-159.
doi: 10.5811/westjem.18085.

Bridging the Gap: Evaluation of an Electrocardiogram Curriculum for Advanced Practice Clinicians

Steven Lindsey  1 , Tim P Moran  1 , Meredith A Stauch  2 , Alexis L Lynch  1 , Kristen Grabow Moore  1
Affiliations

Bridging the Gap: Evaluation of an Electrocardiogram Curriculum for Advanced Practice Clinicians

Steven Lindsey et al. West J Emerg Med. 2024 Mar.

Abstract

Background: Training programs for advanced practice providers (APP) often have significant variability in their curriculum, including electrocardiogram (ECG) education. Despite limitations in formal ECG training, APPs in the emergency department (ED) may be the first practitioner to interpret an ECG. Foundations of Emergency Medicine (FoEM) offers free, open-access curricula that are widely used for resident education. We sought to improve APP ECG interpretation skills by implementing the FoEM ECG I course.

Methods: This was a single-site, pre- and post-intervention study of 23 APPs at our high-acuity, urban ED. In the fall of 2020, APP learners enrolled in a FoEM ECG I course led by faculty and senior resident instructors. The course consisted of six virtual, small-group, active-learning ECG workshops. Participants completed a 15-question multiple-choice test before, immediately after, and six months post-intervention to quantify knowledge acquisition. Additionally, a pre- and post-intervention knowledge, attitudes, and practices survey was administered on ECG interpretation skills and to evaluate the course. We evaluated change in ECG knowledge scores using a Wilcoxon signed-rank test. Changes in self-assessed knowledge were evaluated using an ordinal logistic mixed-effects regression.

Results: A total of 23 APPs enrolled in the course. Knowledge assessments showed APPs improved from the pre-test (median 9/15, interquartile range [IQR] 7-11) to the post-test (median 12/15, IQR 10-13; P = 0.001). Test scores did not significantly change from the post-test to the delayed post-test (median 12/15, IQR 12-13; P = 0.30). Respondents' subjective rating of their skill did not significantly change (P = 0.06). Respondents reported no change in their likelihood of approaching an attending when uncertain of the correct interpretation of an ECG (P = 0.16). Overall, 91% were satisfied with the course and 96% agreed that the course difficulty was appropriate.

Conclusion: The FoEM ECG course provided a standardized curriculum that improved APP knowledge for interpreting ECGs. Despite this, the course did not alter APPs' willingness to approach physicians for guidance with interpretation of abnormal ECGs. These findings may inform expansion of this concept for other programs who desire formalized APP ECG education.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1.
Figure 1.
Advanced practice provider perceived and objective knowledge acquisition before and after foundations of emergency medicine (FoEM) Electrocardiogram Gram (ECG) I course. A) Self-assessment of respondents’ understanding of ECG interpretation as a function of time. B) Boxplot depicting knowledge test scores as a function of time. C) Waterfall plot depicting the change in knowledge test scores from pre-test to post-test for each individual respondent. D) Waterfall plot depicting the change in knowledge test scores from post-test to delayed post-test for each individual respondent.
See this image and copyright information in PMC

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