American Research Journal of Emergency and Intensive Critical Care

The basic skill of being able to read ECGs at a high level of proficiency and accuracy is one of the objectives of the Saudi Arabian Emergency Medicine Residency Training Program (SAEMRTP). Our objective in this study is to assess the ECG reading knowledge and skill proficiency of the residents enrolled in the SAEMRTP in the three major regions of the Kingdom of Saudi Arabia for a variety of clinically important, and in some cases, fatal diagnoses. Methods: This is a prospective cross sectional observational study of Emergency Medicine residents enrolled in the SAEMRTP, with a questionnaire based assessment of the participating subject demographics, and their interpretation of ten 12-lead ECG tracings. The ECGs were selected from a well-known published book reference made for emergency physicians. All ECGs were representatives of deadly conditions that the residents are being taught about, and/or have seen in the clinical setting during their training. The residents were required to indicate the abnormalities in the traces, and their differential diagnosis, under timed conditions. All data was then collected, processed and analyzed to assess proportions, frequencies, and reading skill competency identified from a score of 2 for each ECG (2= correct, 1= partially correct, 0=incorrect). The reference for the findings was the ECG book. Statistical significance was ascertained by use of the Mann-Whitney U test for ordinal data and the Chi-squared test for nominal data. Results: Over the three regions, 132 residents were included in this study. We found that the average overall ECGs read correctly were 16.14% [95% CI 22.71- 9.56%]. There was an observed trend of improving reading competency between the junior residents 10.89% [95% CI 17.72-4.05%] and the senior residents 23.96% [95% CI 29.25-18.67%] p-value < 0.0001. The Competency score mean ranged from: 18.18% for WPW syndrome, to 0.76% for Suspected Digoxin Toxicity. Conclusion: Despite improvement in the interpretation competency with clinical experience, the overall performance of the residents remains alarmingly low. The proficiency of ECG reading skills fall well below the observed international levels of other international programs. Further research into methods for improving the resident proficiency at ECG reading, should be to done in order to improve the current standards