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This pilot cross-sectional questionnaire study assessed ECG interpretation competency and confidence among 165 residents using eight 12-lead ECGs with brief clinical scenarios. Results showed acceptable internal reliability (Cronbach’s alpha 0.75) but poor overall interpretation scores [6(4,8)] and low complete diagnostic confidence (\u003C10%). Performance differed by clinical subgroup, with highest competency for ST-elevated myocardial infarction and poorest accuracy for long QT and left bundle branch block.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/evaluating-the-competency-and-confidence-in-ecg-interpretation-among-residents-a-multi-center-pilot-study/434282/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/evaluating-the-competency-and-confidence-in-ecg-interpretation-among-residents-a-multi-center-pilot-study/434282.png","ImageObject",300,407,{"name":92,"@type":93},"Damian","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-03","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What was the aim of this multi-center pilot study?","Question",{"text":112,"@type":113},"To evaluate whether low competency and confidence in ECG interpretation are also common among Chinese residents.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was ECG interpretation competency assessed in the study?",{"text":117,"@type":113},"Residents completed a cross-sectional, questionnaire-based assessment using eight 12-lead ECGs, each paired with a brief clinical scenario.",{"name":119,"@type":110,"acceptedAnswer":120},"What were the key findings on interpretation ability and confidence?",{"text":121,"@type":113},"Overall ECG interpretation ability was poor with low test scores, and few participants reported complete confidence about diagnosis (under 10%).","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},434282,1790741885,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":44,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},137451208677,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Advances in Medical Education and Practice  \nOpen Access Full Text Article ORIGINAL RESEARCH  \nEvaluating the Competency and Confidence in ECG Interpretation Among Residents:  \nA Multi-Center Pilot Study  \nShengwei Liang*, Ruihui Lai*, Tan Xu   \nDepartment of Cardiology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, People’s Republic of China  \n*These authors contributed equally to this work Correspondence: Tan Xu, Email [xutan0501@163.com](xutan0501@163.com)  \n\n| Background: Electrocardiography (ECG) is a pivotal diagnostic tool. However, the accuracy of ECGs interpretation by resident varies from region to region, but overall interpretation ability is poor. The aim to assess whether the low competency described worldwide are also prevalent in the Chinese residents.\u003Cbr>Methods: This pilot study was a cross-sectional, questionnaire-based assessment of ECG interpretation skills of residents (n=165) . We selected eight 12-lead ECGs. Each ECG was provided with a brief clinical scenario, consisted of age, gender, and chief complaint. Results: The Cronbach’s Alpha for Likert scale used item questionnaire was 0.75. In the university learning situation, only a small number of students considered they were proficient in ECG (n=3, 1.82%) . More than half of residents (n=102, 61.82%) relearned the ECG knowledge during their clinical clerkships. The overall ECG interpretation ability is poor, as ECG test scores were 6(4,8) . Just 17 residents (10.3%) scored more than 10 points. The non-internal medicine residents had a better performance in the interpretation of supraventricular tachycardia compared with internal medicine residents (median score 2 versus 0, p\u003C0.05). The highest competency was observed in the ST elevated myocardial infarction (correct rate 54.55%). The poorest ability to misread ECG was long QT and left bundle branch block (correct rate 0.61% and 0.00%). Few participants reported complete confidence about their diagnosis (less than 10%) . Conclusion: Our research reveals that residents do not appear to be prepared to interpret ECG abnormalities, including common emergencies and common abnormalities, even the normal ECG strip.\u003Cbr>Keywords: competency, confidence, ECG, residents, questionnaire |\n| --- |\n| Background\u003Cbr>In clinical setting electrocardiography (ECG) serves as an essential diagnostic tool for the early diagnosis and treatment of myocardial infarction and arrhythmias.1 Additionally, it is crucial for residents to accurately interpret the ECGs and be able to determine when a cardiology consultation might be necessary.2 ECG learning is a basic course for medical students for their under-graduating and postgraduate clinical training.3 Furthermore, acquiring ECG interpretation skills is a common and crucial part of the cognitive training for medicine physicians in their initial residency.4\u003Cbr>In order to attain the ECG interpretation skill, the American College of Cardiology (ACC)/ American Heart Association’s (AHA) guidelines recommend interpreting a minimum of 500 supervised ECGs during initial training, using standardized testing in ECG interpretation to confirm initial competency and interpreting 100 ECGs yearly to maintain competency.5 The recommendation revealed the difficulty of acquiring and maintaining this competency. A systematic review demonstrated resident accuracy in ECG interpretation varied from 46% to 83% compared with reference standards.6 As previously shown, it has been reported that up to 33% of ECG interpretations in clinical practice contain errors of major importance.7 Research has revealed that the average accuracy scores reported through studies range from 25% to 93%8 and 36% to 96% .9 |\n\nReceived: 30 June 2025  \nAccepted: 12 November 2025  \nPublished: 31 December 2025  \nAdvances in Medical Education and Practice 2025:16 2481–2489 2481  \n© 2025 Liang et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at [https:","cbCaipHN7wPBgbfV","https://ap.wps.com/l/cbCaipHN7wPBgbfV","pdf",2081716,"English","# Background\n## ECG as an essential diagnostic tool\n## Guideline recommendations for ECG training\n## Evidence gaps across regions and methods\n# Methods and Results\n## Study design and questionnaire assessment\n## Reliability and learning experience\n## Interpretation performance by condition\n# Conclusion","[{\"question\":\"What was the aim of this multi-center pilot study?\",\"answer\":\"To evaluate whether low competency and confidence in ECG interpretation are also common among Chinese residents.\"},{\"question\":\"How was ECG interpretation competency assessed in the study?\",\"answer\":\"Residents completed a cross-sectional, questionnaire-based assessment using eight 12-lead ECGs, each paired with a brief clinical scenario.\"},{\"question\":\"What were the key findings on interpretation ability and confidence?\",\"answer\":\"Overall ECG interpretation ability was poor with low test scores, and few participants reported complete confidence about diagnosis (under 10%).\"}]","Evaluating the Competency and Confidence in ECG Interpretation Among Residents - A Multi-Center Pilot Study | PDF",1790668350,23]