HOW SATISFACTORY ARE THE ECG INTERPRETATION SKILLS OF FAMILY PHYSICIANS?

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HOW SATISFACTORY ARE THE ECG INTERPRETATION
SKILLS OF FAMILY PHYSICIANS?

• Zekeriya Akturk, Turan Set, Nezih Dagdeviren,
• Cahit Ozer, Mehmet Akin
• Edirne, Turkey

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• ECG is used in approximately 2 of primary care
  encounters
• It reveals some pathology in 30-38 of the cases

Froom J 1984
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What do we see ?

• Normal 22
• ST-T changes 18
• Atrial fibrillation 10
• MI 8
• Ventricular premature complexes 5
• Atrial premature complexes 3

Rutten FH 2000
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Facts

• 21 of residents can not recognise MI
• There is no difference in identifying AMI and
  normal ECGs between US residents, UAE residents,
  senior clerks, interns, or UAE GPs

Sur DK, 2000
Margolis S, 2001
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Aim

• To define the ECG reading skills of Turkish
  family physicians and compare them with
• untrained GPs and
• internists

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Sample

• 59 family physicians
• 37 senior clercks
• 22 residents
• 30 untrained GPs
• 51 internists
• 20 senior clercks
• 31 residents

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Instrument and Mesurement

• 10 different, 12 lead ECGs
• Each ECG can be normal or contain up to 3
  abnormalities
• Overall 16 diagnoses
• 30 minutes
• Use of resources not allowed
• Score 1-correct answers, 2-wrong answers

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Sample ECG
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Mean Correct Scores
9.85
8.16
7.05
6.59
4.73
(F18.983, p0.000)
10
Mean False Scores
2.73
2.54
2.40
1.71
1.20
(F4.284, p0.003)
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Correct identification of two normal ECGs
(Chi-square 0.680, p 0.954)
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Correct identification of AMI
(Chi-square 17.192, p 0.002)
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Discussion

• Current state in Turkey
• Residents of internal medicine receive 5 months
  of cardiology training
• FP residency education no place for cardiology

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• ECG interpretation is a worldwide problem
• Residency training increases ECG interpretation
  skills
• Special training in cardiology has an improving
  effect on ECG interpretation skills

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• Hiring untrained GPs in primary care should be
  stopped as soon as possible
• Special attention should be given to the
  residency and postgraduate education of family
  physicians with regard to ECG interpretation

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• Focusing on the most frequent and most important
  ECG diagnoses encountered in primary care could
  be a wise approach in teaching ECG interpretation
  skills to family physicians