ArticleAdvances in medical education and practice2026
ABCD Framework-Based Stratified Analysis of ECG Interpretation Among Chinese Internal Medicine Residents: A Cross-Sectional Study.
Article in Advances in medical education and practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Deficiencies in electrocardiogram (ECG) interpretation remain a challenge in residency training. The ABCD framework enables competency-based ECG assessment by stratifying findings by clinical urgency and prevalence. However, empirical data on its application in non-Western training settings are scarce. This study applied the framework to evaluate ECG interpretation skills among Chinese internal medicine residents. Methods: In this cross-sectional study, 158 internal medicine residents (PGY-1/2/3) at a Chinese tertiary hospital completed a 40-item ECG examination aligned with the ABCD framework in December 2025. The primary outcome was the proportion meeting a pre-specified Category A (common emergencies) benchmark (≥90% correct). Secondary outcomes included mean accuracy, proportion at or below a screening threshold (≤70% correct), and flawless performance (100% correct). Factors associated with benchmark attainment were explored using multiple logistic regression. Results: Mean overall accuracy was 68.6% (SD 15.2%). Category A accuracy increased with training year (PGY-1: 78.1%; PGY-3: 92.1%). Only 30.2% of PGY-1 residents met the benchmark (≥90% correct), compared with 94.7% of PGY-3 residents. Performance at or below the screening threshold was observed in 34.0% of PGY-1 residents versus 0% of PGY-3 residents. Flawless performance was achieved by 5.7% of PGY-1 and 34.2% of PGY-3 residents. In adjusted analysis, seniority was independently associated with benchmark attainment (PGY-3 vs. PGY-1: adjusted OR=21.46, 95% CI 4.18-110.23; Firth-adjusted OR=13.07, 95% CI 3.52-79.49). The wide confidence interval reflects near-ceiling performance and warrants conservative interpretation. Conclusion: Under timed examination conditions, over one-third of first-year residents scored below a pre-specified screening threshold for common emergency patterns, despite moderate group-mean accuracy, highlighting a gap between aggregate knowledge and consistent individual performance. These findings support competency-based ECG curricula that emphasize early mastery of emergency patterns through structured, repetitive practice.
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