12-lead Electrocardiogram Interpretation Competencies for All Graduating Medical Students: A Delphi Study

Lack of physician competence in 12-lead electrocardiogram (ECG) interpretation can lead to adverse patient outcomes. Despite widespread diagnostic use, no standardized training or assessment exists for medical students regarding ECG interpretation in the United States. Previous studies lack agreement on standardized competencies for graduating medical students (GMS) on ECG interpretation at the transition to residency. We aim to determine ECG interpretation competencies important for all GMS. A modified Delphi methodology was used to determine ECG findings that students should be able to identify on ECG and findings they should be able to identify as requiring urgent or emergent attention, per Association of American Medical Colleges (AAMC) Entrustable Professional Activity (EPA) 10. This included an initial literature review to determine a candidate list of ECG findings that was distributed to a multi-disciplinary national panel of 23 medical education experts, and advanced through iterative rounds to create a final list. Experts agreed on 21 specific ECG findings all GMS should be required to be able to interpret regardless of intended specialty. Eight were found to be important for all GMS to be able to identify as requiring urgent or emergent attention. Respondents agreed students must be competent in fundamentals of ECG interpretation and know the indications for cardiac monitoring and obtaining a ECG. This study provides a content blueprint for standardized curricula and assessment tools defining competencies related to ECG interpretation in GMS at the transition to residency point. It integrates the EPA framework as it relates to identification and stabilization of emergent findings to promote patient safety. Future efforts should focus on creating ECG curricula utilizing these content guidelines and standardized assessment tools to ensure all students at the Undergraduate Medical Education (UME) to Graduate Medical Education (GME) transition are prepared to safely interpret ECGs.