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

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 experiencedriven
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.