Journal of General Internal Medicine

, Volume 14, Issue 2, pp 126–129

Impact of a clinical scenario on accuracy of electrocardiogram interpretation

  • Rose Hatala
  • Geoffrey R. Norman
  • Lee R. Brooks
Brief Reports

Abstract

To examine the effect of clinical history on the electrocardiogram (ECG) interpretation skills of physicians with different levels of expertise, we randomly allocated to an ECG test package 30 final-year medical students, 15 second-year internal medicine residents, and 15 university cardiologists at university-affiliated teaching hospitals. All participants interpreted the same set of 10 ECGs. Each ECG was accompanied by a brief clinical history suggestive of the correct ECG diagnosis, or the most plausible alternative diagnosis, or no history. Provision of a correct history improved accuracy by 4% to 12% compared with no history, depending on level of training. Conversely, a misleading history compared with no history reduced accuracy by 5% for cardiologists, 25% for residents, and 19% for students. Clinical history also affected the paticipants’ frequencies of listing ECG features consistent with the correct diagnosis and features consistent with the alternative diagnosis (allp values <.05). For physicians at all levels of expertise, clinical history has an influence on ECG diagnostic accuracy, both improving accuracy when the history suggests the correct diagnosis, and reducing accuracy when the history suggests an alternative diagnosis.

Key words

electrocardiogram interpretation bias (epidemiology) medical history taking 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Lesgold A, Glaser R, Rubinson H, Klopfer D, Feltovich P, Wang Y. Expertise in a complex skill: diagnosing x-ray pictures. In: Chi MTH, Glaser R, Farr MJ, eds. The Nature of Expertise. Hillsdale, NJ: Erlbaum; 1989:311–42.Google Scholar
  2. 2.
    Norman GR, Brooks LR, Coblentz CL, Babcook CJ. The correlation of feature identification and category judgments in diagnostic radiology. Memory Cognition. 1992;20(4):344–55.PubMedGoogle Scholar
  3. 3.
    Berbaum KS, Franken EA, Dorfman DD, et al. Tentative diagnoses facilitate the detection of diverse lesions in chest radiographs. Invest Radiol. 1986;21:532–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Schreiber MH. The clinical history as a factor in roentgenogram interpretation. JAMA. 1963;185:399–401.PubMedGoogle Scholar
  5. 5.
    Doubilet P, Herman PG. Interpretations of radiographs: effect of clinical history. AJR. 1981;137:1055–8.PubMedGoogle Scholar
  6. 6.
    Elmore JG, Wells CK, Howard D, Feinstein AR. The impact of clinical history on mammographic interpretations. JAMA. 1997; 277(1):49–52.PubMedCrossRefGoogle Scholar
  7. 7.
    Swensson RG, Hessel SJ, Herman PG. The value of searching films without specific preconceptions. Invest Radiol. 1985;20:100–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Good BC, Cooperstein LA, DeMarino GB, et al. Does knowledge of the clinical history affect the accuracy of chest radiograph interpretation? AJR. 1990;154(4):709–12.PubMedGoogle Scholar
  9. 9.
    Grum GM, Gruppen LD, Woolliscroft JO. The influence of vignettes on EKG interpretation by third-year students. Acad Med. 1993;68(10):S61–3.PubMedCrossRefGoogle Scholar
  10. 10.
    Dunn PM, Levinson W. The lack of effect of clinical information on electrocardiographic diagnosis of acute myocardial infarction. Arch Intern Med.1990;150:1917–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Hatala RA, Norman GR, Brooks LR; The effect of clinical history on physician’s ECG interpretation skills. Acad Med. 1996;71 (10 suppl):S68–70.PubMedCrossRefGoogle Scholar
  12. 12.
    Underwood DA. Clinical Electrocardiography: Self-Assessment and Review. Philadelphia, Pa: WB Saunders Company; 1993.Google Scholar

Copyright information

© Society of General Internal Medicine 1999

Authors and Affiliations

  • Rose Hatala
    • 1
  • Geoffrey R. Norman
    • 2
  • Lee R. Brooks
    • 3
  1. 1.Department of MedicineMcMaster UniversityHamiltonCanada
  2. 2.Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
  3. 3.Department of PsychologyMcMaster UniversityHamiltonCanada
  4. 4.Henderson HospitalHamiltonCanada

Personalised recommendations