Original Article

Evaluating a Blended Learning Model for Medical Student ECG Teaching

Authors: Adrienne W. Mann, MD, John Cunningham, MD, Alexis Tumolo, MD, Christopher King, MD


Objectives: The ability to interpret a 12-lead electrocardiogram (ECG) is an essential skill in inpatient and outpatient settings. In medical school, this skill is generally taught during the Internal Medicine clerkship. Blended learning is a pedagogical tool that combines different modes of information delivery, models of teaching, and learning styles combining face-to-face learning sessions with online learning. The objectives of this study were to develop a curriculum using a blended educational model including lecture, focused educational videos, flipped classroom, and team-based learning to teach a systematic approach to ECG interpretation and enhance the ability of students to identify common and life-threatening electrocardiographic abnormalities.

Methods: Between 2016 and 2019, 349 medical students from the University of Colorado School of Medicine received the blended learning curriculum, which included an introductory lecture followed by five 30-minute sessions. These sessions encompassed preclass videos and team-based learning in a flipped-classroom design covering critical concepts in electrocardiography. A sample of 64 students completed a survey evaluating confidence in ECG interpretation skills before and after the curriculum. All of the students completed a 17-item pretest and posttest.

Results: The new curriculum improved learner confidence in ECG interpretation (Wilcoxon signed rank-sum test, P < 0.001). Postcurriculum test scores showed statistically significant improvement in all of the diagnoses tested (paired Student t test, P < 0.01), the most significant gains occurring in the life-threatening tracings of ventricular fibrillation and in ventricular tachycardia.

Conclusions: Using a blended learning model with multiple educational modalities resulted in significant improvement in learners’ performance and confidence in ECG interpretation.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. O’Brien KE, Cannarozzi ML, Torre DM, et al. Training and assessment of ECG interpretation skills: results from the 2005 CDIM survey. Teach Learn Med 2009;21:111–115.
2. Jablonover RS, Lundberg E, Zhang Y, et al. Competency in electrocardiogram interpretation among graduating medical students. Teach Learn Med 2014;26: 279–284.
3. Fent G, Gosai J, Purva M. Teaching the interpretation of electrocardiograms: which method is best? J Electrocardiol 2015;48:190–193.
4. Alliance for Academic Internal Medicine. CDIM Core Medicine Clerkship Curriculum Guide. 4th ed. https://www.im.org/resources/ume-gme-program-resources/curriculum/clerkship-curriculum. Accessed September 30, 2022.
5. Ochsmann EB, Zier U, Drexler H, et al. Well prepared for work? Junior doctors’ self-assessment after medical education. BMC Med Educ 2011;11:99.
6. Hatala R, Norman GR, Brooks LR. Impact of a clinical scenario on accuracy of electrocardiogram interpretation. J Gen Intern Med 1999;14:126–129.
7. Hatala RA, Norman GR, Brooks LR. The effect of clinical history on physicians’ ECG interpretation skills. Acad Med 1996;71(10 suppl):S68–S70.
8. Mahler SA, Wolcott CJ, Swoboda TK, et al. Techniques for teaching electrocardiogram interpretation: self-directed learning is less effective than a workshop or lecture. Med Educ 2011;45:347–353.
9. Hatala RM, Brooks LR, Norman GR. Practice makes perfect: the critical role of mixed practice in the acquisition of ECG interpretation skills. Adv Health Sci Educ Theory Pract 2003;8:17–26.
10. Raupach T, Harendza S, Anders S, et al. How can we improve teaching of ECG interpretation skills? Findings from a prospective randomised trial. J Electrocardiol 2016;49:7–12.
11. Davies A, Macleod R, Bennett-Britton I, et al. E-learning and near-peer teaching in electrocardiogram education: a randomised trial. Clin Teach 2016;13:227–230.
12. Draffan EA, Rainger P. A model for the identification of challenges to blended learning. ALT-J 2006;14:1, 55–67.
13. Viljoen CA, Millar RS, Manning K, et al. Effectiveness of blended learning versus lectures alone on ECG analysis and interpretation by medical students. BMC Med Educ 2020;3;20:488.
14. Morton CE, Saleh SN, Smith SF, et al. Blended learning: how can we optimise undergraduate student engagement? BMC Med Educ 2016; 16:195.
15. Rui Z, Lian-Rui X, Rong-Zheng Y, et al. Friend or foe? Flipped classroom for undergraduate electrocardiogram learning: a randomized controlled study. BMC Med Educ 2017;17:53.
16. Kim S, Kim CG. Effects of an electrocardiography training program: team-based learning for early-stage intensive care unit nurses. J Contin Educ Nurs 2020; 51:174–180.
17. Burgess A, Bleasel J, Haq I, et al. Team-based learning (TBL) in the medical curriculum: better than PBL? BMC Med Educ 2017;17:243.