Reading and analysing electrocardiograms (ECGs) is widely recognised as one of the most challenging skills for medical students to get to grips with. When Senior Lecturer in Physiology Dr Lujain Alsadder and third-year medical student Gregoris Orphanides approached us to share a new teaching method they had developed, we were excited to hear more.
The new approach was led by Gregoris, with Lujain providing supervision and guidance. It was inspired by his own experience learning ECGs as a medical student. One of the key issues he highlighted was the abstract nature of what is being taught and the overwhelming amount of information that students have to process. As Gregoris highlighted:
“As you begin to learn, it's very difficult to remember all of this information… it was not clear to me why you measure, why you get different answers… You measure the same thing but obtain 12 different results.”
Another prominent issue with the current way we teach ECGs is that the heart is inherently three-dimensional, while most of the images and diagrams used in teaching are two-dimensional representations. As Lujain noted, students often develop a negative attitude towards ECGs because of the level of imagination and abstraction required.
Visualising the heart
The solution Gregoris developed was to make the learning more tangible and intuitive. Rather than relying on abstract visualisations, he has developed a piece of software that shows a three-dimensional representation of the different electrical signals from the heart alongside a model of a body. This allows students to see exactly where the signals are in relation to any one of 12 leads that would be placed on a patient during an ECG. Additionally, it can import freely available ECG data and show students what different cardiac conditions might look like.
This isn’t the first piece of software to look at ECGs, so what makes this one so different? It’s the ability for this software to translate complex ECG information into an interactive 3D visualisation. As Lujain explained:
“Other software…just shows the electrical activity as it is, without having the contextual relationship to where it lies within the human body …this software brings that element where students can see the electrical current from all different anatomical views, which is a core feature.”
In short, the programme doesn’t just show what is happening but aims to help students understand why.
From concept to classroom
Once the app was created, they wanted to see if it worked in practice. Gregoris ran two lessons for 30 Year One and Two medical students as part of a research project. Each lesson consisted of traditional teaching on ECGs followed by teaching using the new programme. Each teaching approach was accompanied by a quiz, and they observed a significant difference between the two methods. Students’ ability to interpret ECGs increased by 35% when using the new software (p<0.01).
While this improvement was what they had hoped for, they also found some surprising results. After using the program, year one students achieved similar grades to year two students. This was very unexpected, as year one students have not been taught certain aspects of ECGs yet in the usual course of their study.
But what has caused these dramatic improvements? Part of the answer, they suggest, is that the learning is far more active and allows students to better relate to the underlying concepts. As Gregoris noted:
“A lot of [students] commented that [with the new software] they were able to actually grasp the idea behind this and not just do simple pattern recognition.”
But the improvements went beyond ECG interpretation. As Lujain highlighted:
“Students said… they found learning even more enjoyable… and they were able to change the inputs and observe changes in different pathological conditions quite quickly.”
Looking forward
This was a very impressive project, made even more impressive by the fact that it is something that Gregoris developed in addition to all his other commitments as a third-year student. Even though this was a pilot, it’s already receiving recognition: Gregoris received the Young Investigator Travel Award at the 10th Annual Meeting of the European Section of the International Academy of Cardiovascular Sciences in Slovakia. Lujain has also presented the application to The Physiological Society’s Challenges and Solutions for Physiology Education meeting in Bristol. At both events, there was a great deal of interest from participants, which has encouraged them to think about where they can go from here.
They have plenty of ideas: from wider testing, to introducing more capabilities such as simulating additional ECG leads, to investigating how the application might support patient understanding and care.
Final thoughts
This has been another example in this month’s newsletter highlighting the power of co-creation and empowerment, and how we can utilise technology for meaningful and sustainable change. Gregoris and Lujain have been able to make something that really responds to a community need, and found being involved in the project very fulfilling. As Gregoris noted:
“Many students would not want to ‘risk it’ to do something extra, but I would just say to take... take the risk and in the long term, by doing extracurricular projects, you obtain skills that are not given to you by the medical school, but they're actually skills that a lot of employers and a lot of people in the medical community would expect you to have as a physician.”
And from a teacher's perspective, Lujain highlighted:
“[With] co-creation or extracurricular activities, you get plenty of surprises and you get a lot of joy in creating with students... it's quite, you know, enjoyable being with Gregoris and developing this software and running this project, so it was very rewarding.”