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The essential skill of ECG interpretation: How do we define and improve competency?
  1. Anthony Kashou1,
  2. Adam May2,
  3. Christopher DeSimone2,
  4. Peter Noseworthy2
  1. 1 Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Anthony Kashou, Mayo Clinic, Rochester, MN 55905, USA; kashou.anthony{at}

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It is hard to imagine something more central to the practice of medicine than the performance and interpretation of the ECG. This simple, non-invasive, and ubiquitous test is essential for the diagnosis of a wide range of medical conditions, across a broad range of medical settings—the emergency room, primary care office, intensive care unit and beyond. For nearly 100 years, this test has held up as a fundamental pillar of medical practice. Unfortunately, proficiency in ECG interpretation is not a universal skill, and the barriers in achieving ECG fluency are rooted at multiple levels of medical curricula.

To aid in solving the problem of declining ECG competency, clearly defined skill competencies for all healthcare professionals are needed. Once competency expectations are set, centralised educational resources may be used to achieve these benchmarks. The medical education community has been the driver to spearhead such societal initiatives and will need to be integral in the rejuvenation of proper ECG interpretation. In this context, medical educators ought to inspire the next generation as well as current providers to revisit and reinvigorate the complexities and beauty of ECG interpretation.

The all great and powerful ECG

The ECG is one of the most powerful diagnostic tools in modern medicine. As a graphical display of the heart’s electrical activity, the ECG communicates unique and vital information regarding the electrophysiological properties, anatomical structure, myocardial tissue characteristics, haemodynamic condition, and enveloping metabolic milieu of a patient’s beating heart. The ECG is one of the most used diagnostic tests, with an estimated 300 million ECGs performed annually in the USA alone. More recently, the application of artificial intelligence to the ECG has unlocked new promising functions, such as predicting a patient’s chronological age and sex,1 likelihood of developing atrial fibrillation,2 and underlying cardiac function.3 With new smartphone-based electrodes and the potential to serve …

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  • Contributors AHK: conceptualised, developed and carried out the seminar. AMM and PAN: also assisted in carrying out the seminar. AHK and AMM: involved with writing and finalising this work. PAN and CVD: assisted with editing and providing recommendations for improving the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.