Can a healthcare provider read an electrocardiogram (ECG)?

Can Healthcare Providers Read ECG?

Whether a healthcare provider can read ECGs depends entirely on their training, demonstrated competence through objective assessment, and maintenance of skills—not simply on their professional title or degree completion. 1

Training Requirements for Initial Competence

Physicians

The ACP/ACC/AHA Task Force recommends interpretation and review of 800 ECGs within a 3-year training period under supervision of experienced faculty to achieve competence. 1

• Cardiologists surveyed recommended 750 ECGs for general competence, while cardiology fellows should read 3,500 ECGs during fellowship training 1
• Internal medicine program directors and general internists estimated 100 ECGs as sufficient for basic competency 1
• Completion of residency or fellowship does not automatically guarantee competence, as some training programs lack structured ECG teaching 1

Alternative Pathways to Competence

Physicians can occasionally achieve competence through well-designed courses combined with interpreting large numbers of ECGs under expert supervision, but simply attending courses without individual interpretation testing will not result in competence. 1

Nurses and Paramedics

Paramedics and nurses can identify STEMI independently when there is mandatory initial training and ongoing concurrent medical oversight of all ECG interpretations. 2

• Research demonstrates triage nurses have good ability (84.6% sensitivity) in identifying ECG patterns indicative of time-dependent conditions correlated with major acute cardiovascular events 3
• However, overall nursing knowledge of ECG rhythm identification remains poor (only 55% correct), particularly for electrolyte-related abnormalities 4
• Critical care background shows positive correlation with ECG interpretation skills (r = 0.614, p < .001) 4

Competency Assessment Standards

For Bedside Interpretation

Internal medicine residency completion, Advanced Cardiac Life Support (ACLS) training, and board certification demonstrate basic competency to interpret resting 12-lead ECGs at the bedside in routine and emergency situations. 1

• Board certification examinations include ECG interpretation components, and successful passage implies competence 1
• Competency should be based on objective assessment and periodic documentation of interpretation skills in clinical context rather than completion of a minimum number of interpretations 1

For Interpretation Without Clinical Context

When physicians interpret ECGs without knowing the patient's clinical status, documentation of proficiency beyond residency training and board certification may be necessary, based on either experience or standardized testing. 1

• Noncardiologists are more affected by clinical history and automated computer interpretation than cardiologists when interpreting ECGs 1
• Cardiologists demonstrate greater accuracy than noncardiologists on standardized examinations when minimal history is provided 1

Evaluation When Competence Is Unclear

When a provider's competence is not clear, applicants for ECG interpretation privileges should be evaluated based on actual cognitive knowledge rather than training structure alone, through monitoring of interpretations or administration of competency tests. 1

Maintenance of Competence

Random samples of ECG interpretations should be reviewed periodically by independent experts to confirm continued competence, as regular reading alone may not ensure ongoing skill. 1

• No data document correlation between frequency of unsupervised ECG interpretations and maintained skill 1
• Continuing medical education through seminars or self-assessment programs is encouraged for physicians who read ECGs infrequently 1, 2
• There are insufficient data to recommend a specific yearly minimum number of ECG interpretations or continuing education hours 1

Critical Pitfalls to Avoid

Computer-interpreted ECGs must be verified and appropriately corrected by an experienced electrocardiographer, as frequent and significant errors occur with automated interpretation. 1, 2, 5

• Computer programs provide accurate heart rate, intervals, and axes, but interpretations of rhythm disturbances, ischemia, or infarction require careful physician over-reading 2
• Never interpret ECG findings in isolation—the same ECG pattern may occur in different pathophysiologic states, and clinical context is essential 2, 5
• Misplaced precordial leads can significantly alter findings and lead to false diagnoses 2
• Failure to compare with previous ECGs when available can miss important dynamic changes 2