The utility of a 12-lead ECG Electrode Misplacement Simulator in education

Research output: Chapter in Book/Report/Conference proceedingConference contributionpeer-review


IntroductionA standard 12-lead electrocardiogram (ECG) is recorded using 6 precordial electrodes and 3 limb electrodes, all of which are positioned at precise anatomical landmarks. Nevertheless, up to 4% of all 12-lead ECGs are recorded with incorrect electrode placement. In these circumstances, the 12-lead ECG can emulate or conceal a pathological condition and, therefore, produce a misdiagnosis. This can be detrimental to the patient because it may yield unnecessary therapy. Despite this fact, ECG textbooks contain little or no information regarding the effects of electrode misplacement. In addition, current pedagogic tools, for example, physical mannequins, do not facilitate the free positioning of electrodes. In an attempt to address this issue, an intuitive Web-based application referred to as the Electrode Misplacement Simulator (EMS), has been developed to aid the classical teaching of electrocardiology. The EMS facilitates the free positioning of electrodes while rendering the corresponding ECG leads in real time. This study assessed the utility of the EMS as an educational tool.MethodsThe study population comprised 23 undergraduate students enrolled on the second year of a clinical physiology program. Eleven students were randomly selected and given access to the EMS for 1 week. The remaining 12 students did not use the EMS and relied solely on lectures for tuition. All students were informed that an examination relating to the effects of electrode misplacement would take place the following week. After 7 days, 9 students from the experimental group and 8 students from the control group completed the examination. The experimental group completed an additional questionnaire regarding the usability of the EMS.ResultsThe mean score of the control group was 11.56 (±2.83), whereas the mean score of the experimental group was 16.44 (±2.24). On interpretation, the experimental group performed approximately 30% better when compared with the control group. An unpaired 2-sample t test (t15 = 3.96, P = .00125) was used to examine this hypothesis. The P value rejected the null hypothesis and indicated a statistical significance at the 1% level (P <.01). Students who completed the usability questionnaire rated the usefulness, learnability, and the look and feel of the EMS between 4 and 5 on the Likert scale.ConclusionIn conclusion, the EMS was found to be a beneficial adjunct to the classical teaching of electrocardiology. This study hypothesized and proved that access to the EMS facilitated a better understanding of the effects of electrode misplacement as evidenced through an examination. In general, this study justifies the need for novel interactive tools to aid teaching in the field of electrocardiology.
Original languageEnglish
Title of host publicationUnknown Host Publication
Number of pages1
Publication statusPublished (in print/issue) - 1 Nov 2011
EventInternational Society for Computerised Electrocardiology -
Duration: 1 Nov 2011 → …


ConferenceInternational Society for Computerised Electrocardiology
Period1/11/11 → …


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