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e-Learning versus lecture-based courses in ECG interpretation for undergraduate medical students: a randomized noninferiority study

Montassier, Emmanuel; Hardouin, Jean-Benoît; Segard, Julien; Batard, Eric; Potel, Gilles; Planchon, Bernard; Trochu, Jean-Noël; Pottier, Pierre

European Journal of Emergency Medicine: April 2016 - Volume 23 - Issue 2 - p 108–113
doi: 10.1097/MEJ.0000000000000215

Objective An ECG is pivotal for the diagnosis of coronary heart disease. Previous studies have reported deficiencies in ECG interpretation skills that have been responsible for misdiagnosis. However, the optimal way to acquire ECG interpretation skills is still under discussion. Thus, our objective was to compare the effectiveness of e-learning and lecture-based courses for learning ECG interpretation skills in a large randomized study.

Participants and methods We conducted a prospective, randomized, controlled, noninferiority study. Participants were recruited from among fifth-year medical students and were assigned to the e-learning group or the lecture-based group using a computer-generated random allocation sequence. The e-learning and lecture-based groups were compared on a score of effectiveness, comparing the 95% unilateral confidence interval (95% UCI) of the score of effectiveness with the mean effectiveness in the lecture-based group, adjusted for a noninferiority margin.

Results Ninety-eight students were enrolled. As compared with the lecture-based course, e-learning was noninferior with regard to the postcourse test score (15.1; 95% UCI 14.2; +∞), which can be compared with 12.5 [the mean effectiveness in the lecture-based group (15.0) minus the noninferiority margin (2.5)]. Furthermore, there was a significant increase in the test score points in both the e-learning and lecture-based groups during the study period (both P<0.0001).

Conclusion Our randomized study showed that the e-learning course is an effective tool for the acquisition of ECG interpretation skills by medical students. These preliminary results should be confirmed with further multicenter studies before the implementation of e-learning courses for learning ECG interpretation skills during medical school.

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aEmergency Department, Nantes University Hospital

bFaculty of Medicine

cDepartment of Internal Medicine, Faculty of Medicine

dDepartment of Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences, University of Nantes

eNantes University Hospital Centre, l’Institut du Thorax, Nantes, France

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Correspondence to Emmanuel Montassier, MD, PhD, Emergency Department, Nantes University Hospital, 1 place A Ricordeau ,44093 Nantes Cedex 1, France Tel/fax: +33 240 412 854; e-mail:

Received June 26, 2014

Accepted September 9, 2014

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.