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Prior knowledge of normal ECGs enhances accuracy in ECG interpretation among medical students

Jennifer Edwards Orcid Logo, Alistair Gallagher, Joe MacInnes Orcid Logo

Advances in Physiology Education, Volume: 50, Issue: 3, Pages: 671 - 678

Swansea University Authors: Jennifer Edwards Orcid Logo, Alistair Gallagher, Joe MacInnes Orcid Logo

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DOI (Published version): 10.1152/advan.00288.2025

Abstract

Electrocardiograms (ECGs) are frequently misdiagnosed with potentially serious consequences, yet evidence for effective teaching strategies remains limited. Eye-tracking offers insight into the perceptual processes behind accurate interpretation. We conducted an eye-tracking study among medical stud...

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Published in: Advances in Physiology Education
ISSN: 1043-4046 1522-1229
Published: American Physiological Society 2026
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URI: https://cronfa.swan.ac.uk/Record/cronfa71839
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last_indexed 2026-06-12T13:20:56Z
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spelling 2026-06-11T15:00:37.1889152 v2 71839 2026-04-30 Prior knowledge of normal ECGs enhances accuracy in ECG interpretation among medical students 52a4901f921c0cb040c06b9c6dd19f2b 0009-0000-5819-1709 Jennifer Edwards Jennifer Edwards true false 008b8a3b5fb194b140aabcf8972d1d15 Alistair Gallagher Alistair Gallagher true false 06dcb003ec50192bafde2c77bef4fd5c 0000-0002-5134-1601 Joe MacInnes Joe MacInnes true false 2026-04-30 Electrocardiograms (ECGs) are frequently misdiagnosed with potentially serious consequences, yet evidence for effective teaching strategies remains limited. Eye-tracking offers insight into the perceptual processes behind accurate interpretation. We conducted an eye-tracking study among medical students to assess whether priming with normal ECGs improves diagnostic accuracy. We hypothesized that participants viewing normal ECGs before interpreting unknown ECGs would perform more accurately. This between-subjects priming study presented students with one of three image types prior to an ECG task: normal ECGs with instruction that they were normal, normal ECGs without instruction, or chest X-rays (control). The diagnostic task comprised 30 ECGs across six conditions. The study was built using Experiment Builder, and eye movements recorded using an EyeLink 1000 Plus system. Students performed well above chance, with accuracy comparable to the 54% reported in meta-analysis. Atrial fibrillation was most often identified correctly, whereas left bundle branch block was the most challenging. Across groups, faster responses and finally fixating the primary abnormality (PA) predicted accuracy, although inaccurate participants spent longer overall on the PA area of interest. Students who were informed that the priming ECGs were normal responded faster and more accurately than those primed unknowingly or with chest radiographs. ECG-primed groups also showed longer fixations in non-relevant areas, while explicitly primed students showed no significant related secondary abnormality fixation sequences and more dispersed spatial attention. These early findings suggest that targeted priming with normal ECGs may support learning. Variation in diagnostic difficulty across conditions indicates that tailored training approaches may be required. Journal Article Advances in Physiology Education 50 3 671 678 American Physiological Society 1043-4046 1522-1229 ECG interpretation, medical education, eye-tracking 1 9 2026 2026-09-01 10.1152/advan.00288.2025 COLLEGE NANME COLLEGE CODE Swansea University Not Required 2026-06-11T15:00:37.1889152 2026-04-30T11:53:51.0921535 Faculty of Science and Engineering School of Mathematics and Computer Science - Computer Science Jennifer Edwards 0009-0000-5819-1709 1 Alistair Gallagher 2 Joe MacInnes 0000-0002-5134-1601 3 71839__36945__156a1ee185ac4acca6720813d2be6c1b.pdf 71839.VOR.pdf 2026-06-11T14:57:14.8161964 Output 1512266 application/pdf Version of Record true © 2026 The Authors. Licensed under Creative Commons Attribution CC-BY-NC 4.0. true eng https://creativecommons.org/licenses/by-nc/4.0/
title Prior knowledge of normal ECGs enhances accuracy in ECG interpretation among medical students
spellingShingle Prior knowledge of normal ECGs enhances accuracy in ECG interpretation among medical students
Jennifer Edwards
Alistair Gallagher
Joe MacInnes
title_short Prior knowledge of normal ECGs enhances accuracy in ECG interpretation among medical students
title_full Prior knowledge of normal ECGs enhances accuracy in ECG interpretation among medical students
title_fullStr Prior knowledge of normal ECGs enhances accuracy in ECG interpretation among medical students
title_full_unstemmed Prior knowledge of normal ECGs enhances accuracy in ECG interpretation among medical students
title_sort Prior knowledge of normal ECGs enhances accuracy in ECG interpretation among medical students
author_id_str_mv 52a4901f921c0cb040c06b9c6dd19f2b
008b8a3b5fb194b140aabcf8972d1d15
06dcb003ec50192bafde2c77bef4fd5c
author_id_fullname_str_mv 52a4901f921c0cb040c06b9c6dd19f2b_***_Jennifer Edwards
008b8a3b5fb194b140aabcf8972d1d15_***_Alistair Gallagher
06dcb003ec50192bafde2c77bef4fd5c_***_Joe MacInnes
author Jennifer Edwards
Alistair Gallagher
Joe MacInnes
author2 Jennifer Edwards
Alistair Gallagher
Joe MacInnes
format Journal article
container_title Advances in Physiology Education
container_volume 50
container_issue 3
container_start_page 671
publishDate 2026
institution Swansea University
issn 1043-4046
1522-1229
doi_str_mv 10.1152/advan.00288.2025
publisher American Physiological Society
college_str Faculty of Science and Engineering
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hierarchy_top_id facultyofscienceandengineering
hierarchy_top_title Faculty of Science and Engineering
hierarchy_parent_id facultyofscienceandengineering
hierarchy_parent_title Faculty of Science and Engineering
department_str School of Mathematics and Computer Science - Computer Science{{{_:::_}}}Faculty of Science and Engineering{{{_:::_}}}School of Mathematics and Computer Science - Computer Science
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description Electrocardiograms (ECGs) are frequently misdiagnosed with potentially serious consequences, yet evidence for effective teaching strategies remains limited. Eye-tracking offers insight into the perceptual processes behind accurate interpretation. We conducted an eye-tracking study among medical students to assess whether priming with normal ECGs improves diagnostic accuracy. We hypothesized that participants viewing normal ECGs before interpreting unknown ECGs would perform more accurately. This between-subjects priming study presented students with one of three image types prior to an ECG task: normal ECGs with instruction that they were normal, normal ECGs without instruction, or chest X-rays (control). The diagnostic task comprised 30 ECGs across six conditions. The study was built using Experiment Builder, and eye movements recorded using an EyeLink 1000 Plus system. Students performed well above chance, with accuracy comparable to the 54% reported in meta-analysis. Atrial fibrillation was most often identified correctly, whereas left bundle branch block was the most challenging. Across groups, faster responses and finally fixating the primary abnormality (PA) predicted accuracy, although inaccurate participants spent longer overall on the PA area of interest. Students who were informed that the priming ECGs were normal responded faster and more accurately than those primed unknowingly or with chest radiographs. ECG-primed groups also showed longer fixations in non-relevant areas, while explicitly primed students showed no significant related secondary abnormality fixation sequences and more dispersed spatial attention. These early findings suggest that targeted priming with normal ECGs may support learning. Variation in diagnostic difficulty across conditions indicates that tailored training approaches may be required.
published_date 2026-09-01T05:30:29Z
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