Training and Competency Evaluation for Interpretation of 12-Lead Electrocardiograms: Recommendations from the American College of Physicians*

Stephen M. Salerno, MD, MPH; Patrick C. Alguire, MD; and Herbert S. Waxman, MD

6 May 2003 | Volume 138 Issue 9 | Pages 747-750

This paper is part 1 of a 2-part series on interpretation of 12-lead resting electrocardiograms (ECGs). Part 1 is a position paper that presents recommendations for initial competency, competency assessment, and maintenance of competency on ECG interpretation, as well as recommendations for the role of computer-assisted ECG interpretation. Part 2 is a systematic review of detailed supporting evidence for the recommendations.

Despite several earlier consensus-based recommendations on ECG interpretation, substantive evidence on the training needed to obtain and maintain ECG interpretation skills is not available. Some studies show that noncardiologist physicians have more ECG interpretation errors than do cardiologists, but the rate of adverse patient outcomes from ECG interpretation errors is low. Computers may decrease the time needed to interpret ECGs and can reduce ECG interpretation errors. However, they have shown less accuracy than physician interpreters and must be relied on only as an adjunct interpretation tool for a trained provider.

Interpretation of ECGs varies greatly, even among expert electrocardiographers. Noncardiologists seem to be more influenced by patient history in interpreting ECGs than are cardiologists. Cardiologists also perform better than other specialists on standardized ECG examinations when minimal patient history is provided. Pending more definitive research, residency training in internal medicine with Advanced Cardiac Life Support instruction should continue to be sufficient for bedside interpretation of resting 12-lead ECGs in routine and emergency situations. Additional experience or training in ECG interpretation when the patient's clinical condition is unknown may be useful but requires further study.

*This guideline was developed for and approved by the American College of Physicians Education Committee on 17 June 2002. Members of the Committee were Barbara L. Schuster, MD (Chair); Allan H. Goroll, MD (Vice Chair); Kevin B. Weiss, MD, MPH; R. Hal Baker, MD; Richard J. Simons, MD; Patricia Hale, MD, PhD; Barbara M. Alving, MD; Jeffrey Glassroth, MD; Scott Litin, MD; Isabel V. Hoverman, MD; Kelly O'Brien-Falls, MD; Lawrence G. Smith, MD; and Francine C. Wiest, MD. The guideline was endorsed by the Board of Regents on 14 July 2002.

Deceased.

Author and Article Information

From Tripler Army Medical Center, Honolulu, Hawaii, and the American College of Physicians, Philadelphia, Pennsylvania.

Drs. Alguire and Salerno dedicate this article to Herbert Waxman, MD, a friend and colleague whose vision, leadership, and friendship will be missed. Dr. Waxman, who served as Senior Vice President for Medical Knowledge and Education at the American College of Physicians, died on 15 February 2003.

Disclaimer: The opinions or assertions presented are the private views of the authors and are not to be construed as official or as reflecting those of the Department of the Army or Department of Defense.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Customer Service, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, custserv{at}acponline.org.

Current Author Addresses: Dr. Salerno: Department of Medicine (MCHK-DM), Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859.

Dr. Alguire: Medical Knowledge and Education Division, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.