Impact of teaching and assessment format on electrocardiogram interpretation skills


Tobias Raupach MD, Department of Cardiology and Pneumology, University Hospital Göttingen, D-37099 Göttingen, Germany. Tel: 00 49 551 39 8922; Fax: 00 49 551 39 6887; E-mail:


Medical Education 2010: 44: 731–740

Objectives  Interpretation of the electrocardiogram (ECG) is a core clinical skill that should be developed in undergraduate medical education. This study assessed whether small-group peer teaching is more effective than lectures in enhancing medical students’ ECG interpretation skills. In addition, the impact of assessment format on study outcome was analysed.

Methods  Two consecutive cohorts of Year 4 medical students (n = 335) were randomised to receive either traditional ECG lectures or the same amount of small-group, near-peer teaching during a 6-week cardiorespiratory course. Before and after the course, written assessments of ECG interpretation skills were undertaken. Whereas this final assessment yielded a considerable amount of credit points for students in the first cohort, it was merely formative in nature for the second cohort. An unannounced retention test was applied 8 weeks after the end of the cardiovascular course.

Results  A significant advantage of near-peer teaching over lectures (effect size 0.33) was noted only in the second cohort, whereas, in the setting of a summative assessment, both teaching formats appeared to be equally effective. A summative instead of a formative assessment doubled the performance increase (Cohen’s d 4.9 versus 2.4), mitigating any difference between teaching formats. Within the second cohort, the significant difference between the two teaching formats was maintained in the retention test (p = 0.017). However, in both cohorts, a significant decrease in student performance was detected during the 8 weeks following the cardiovascular course.

Conclusions  Assessment format appeared to be more powerful than choice of instructional method in enhancing student learning. The effect observed in the second cohort was masked by an overriding incentive generated by the summative assessment in the first cohort. This masking effect should be considered in studies assessing the effectiveness of different teaching methods.