# EYE-ECG2: Addressing medical student feedback in an RCT with eye-tracking videos featuring cued retrospective reporting and modified learning sequences for ECG interpretation skills training

## TL;DR

This study tested an improved eye-tracking video method to help medical students learn ECG interpretation, finding it beneficial for some students, especially those with prior cardiology experience.

## Contribution

The study introduces EYE-ECG2, an enhanced eye-tracking video intervention with cued retrospective reporting and modified learning sequences for ECG training.

## Key findings

- ECG training significantly improved students' ECG interpretation skills.
- A strong start in the training session was key to these improvements.
- Students with prior cardiological experience reported greater benefit from the EYE-ECG2 videos.

## Abstract

This study aimed to evaluate the effectiveness of an enhanced eye-tracking video intervention (EYE-ECG2) in improving ECG interpretation skills of medical students. Building on the foundational EYE-ECG1 study [Scherff et al. GMS J Med Educ. 2024], which tested the utility of expert eye movement modelling and retrospective think-aloud commentary for ECG skill acquisition, this follow-up study introduces modifications designed to optimise learning outcomes.

A randomised controlled trial was conducted with medical students (N=94) allocated to either the control group (TAU) with standard ECG interpretation training, consisting of a validated set of 4 ECG cases for ECG interpretation; or the intervention group (INT) who additionally received the EYE-ECG2 video. The EYE-ECG2 video included refined ECG gaze cues and Cued Retrospective Reporting (CRR) by a senior cardiology expert. Performance was assessed pre- and post-training. Data were analysed to compare improvements in diagnostic accuracy, decision-making processes and student feedback were evaluated.

The results of the previous study were successfully replicated, showing an overall significant learning benefit from the cases and a moderate, yet nonsignificant tendency for INT>TAU (ΔM=0.80-2.42%; p=.79-.30). Randomised case presentation attenuated the special role of learning case 1 observed previously in EYE-ECG1. Exploration of student feedback showed a largely positive or neutral evaluation (74%), and a prior cardiological clerkship was a distinguishing factor resulting in positive (vs. neutral/negative) sentiment regarding the eyetracking videos with CRR (χ2(2)=7.57, p=.03).

The ECG training significantly improved participants’ ECG interpretation skills, with a strong start in the training session playing a key role in these improvements. Student feedback indicated that certain subgroups, particularly those with prior cardiological experience, may derive a greater self-reported benefit from the EYE-ECG2 videos.