# Challenges in ECG learning: a questionnaire analysis of medical students

## TL;DR

Medical students struggle with ECG interpretation due to complex and abstract waveforms, and practical experience helps reduce this difficulty.

## Contribution

The study identifies specific challenges in ECG learning and proposes a novel translation method to improve teaching strategies.

## Key findings

- ECG waveforms are perceived as complex and abstract, increasing learning difficulty.
- Internship experience significantly reduces students' perceived difficulty in ECG learning.
- A lack of textual labels in ECG diagrams is strongly correlated with increased learning challenges.

## Abstract

Poor electrocardiogram (ECG) interpretation skills among medical students are a widespread issue globally. However, few studies have systematically investigated the practical challenges students face during the learning process. This study aimed to identify the specific obstacles encountered by medical students in learning ECG interpretation and to propose evidence-based recommendations for curricular improvement.

A questionnaire survey was conducted among interns and other relevant student groups who were about to begin or had completed their ECG internship at the Second Affiliated Hospital of Anhui Medical University. A total of 309 valid, voluntarily submitted responses were collected and analyzed using descriptive statistics, difference analysis, and correlation analysis.

Most students agreed with statements such as "Even with solid theoretical knowledge, interpreting ECGs in practice is challenging", "Practical ECG waveforms are complex and variable, making analysis difficult", and "The abstract nature of ECG waveforms increases the threshold for learning electrocardiography". These perceptions did not differ significantly by gender, identity, level of education, or undergraduate field of study (P > 0.05). Correlation analysis revealed a significant association between "the absence of textual labels in ECG diagrams" and "the abstract nature of ECG waveforms may increase the difficulty of learning ECG" (r = 0.728), as well as between "Even with solid theoretical knowledge, ECG interpretation remains challenging" and "ECG diagrams are complex and difficult to analyze" (r = 0.715). Moreover, internship experience significantly reduced medical students' perceived difficulty in learning ECGs (3.99 ± 0.70 vs. 3.75 ± 0.71, P = 0.002).

The primary barrier in ECG interpretation is the abstract and complex nature of waveforms. Teaching should focus on strategies to address this challenge. The proposed translation method offers a novel approach to improve learning.

The online version contains supplementary material available at 10.1186/s12909-025-08376-0.