How do healthcare practitioners read electrocardiograms? A dual-process model of electrocardiogram interpretation

Abstract

Background/Aims: This article aims to improve the understanding of the applied cognitive processes when interpreting electrocardiograms in clinical practice. It will do this by examining the self-reported approach practitioners take to interpret any barriers they encounter. Methods: This was a qualitative study in which medical practitioners, who routinely interpret electrocardiograms (n=31), were interviewed. The semi-structured interviews covered: their experience of interpretation; use of a system; pitfalls; changes to approach over time. An inductive thematic analysis was used to identify commonly occurring themes. A further set of practitioners (n=31), completed surveys that concerned their approach to an interpretation and use of interpretation frameworks/systems. Results: Practitioners find it easier to interpret electrocardiograms as they gain experience, but the process remains difficult. Barriers to successful interpretation include artefacts altering the waveform, lack of familiarity with the presenting condition, stress/panic at the prospect of making an inaccurate judgement, and overconfidence in one's interpretation abilities. Conclusions: The results support a dual-process system model that is developed with experience and enhances performance. Over time, experienced practitioners become able to move fluidly between a more formal systematic method and an experience-driven pattern recognition system. Potential errors that may arise from a reliance on pattern recognition (e.g. missing details) can be mitigated by using a systematic approach.