How can we improve teaching of ECG interpretation skills? Findings from a prospective randomised trial

•Electrocardiogram interpretation is not adequately taught in many medical schools.•The ideal teaching format to achieve a good learning outcome is yet unknown.•We found no medium-term impact of teaching intensity on ECG interpretation skills.•Medium-term retention was enhanced by summative (vs. formative) exams.•ECG teaching should be accompanied by well-designed summative exams.

BackgroundThere is an ongoing debate on how ECG interpretation should be taught during undergraduate medical training. This study addressed the impact of teaching format, examination consequences and student motivation on skills retention.MethodsA total of 493 fourth-year medical students participated in a six-group, partially randomised trial. Students received three levels of teaching intensity: self-directed learning (2 groups), lectures (2 groups) or small-group peer-teaching (2 groups). On each level of teaching intensity, end-of-course written examinations (ECG exit exam) were summative in one group and formative in the other. Learning outcome was assessed in a retention test two months later.ResultsRetention test scores were predicted by summative assessments (adjusted beta 4.08; 95% CI 1.39–6.78) but not by the type of teaching. Overall performance levels and motivation did not predict performance decrease or skills retention.ConclusionsSummative assessments increase medium-term retention of ECG interpretation skills, irrespective of instructional format.