Implementation of a Virtual Cardiac Electrophysiology Simulator in the Teaching of Electrocardiography and Cardiopulmonary Resuscitation

Introduction: Virtual Cardiac Electrophysiology Simulation in Electrocardiography (V-CESE)integrated into Cardiopulmonary Resuscitation is increasingly recognized as a vital tool inmedical education by organizations such as the US Accreditation Council for Graduate Medical Education. The objective of our study was to implement a V-CESE to evaluate the ability to recognize specific electrocardiographic rhythm strip traces, shockable and non-shockable rhythms. While V-CESE is a recent addition to medical programs, its adoption in developing countries remains under-explored, therefore, our current study tested the hypothesis that an interactive learning tool like V-CESE would have higher learning acceptability to train medical students for the accuracy of diagnosis in a safe environment. Methods. This study included 356 medical students. After a 45-minute theoretical lecture on electrophysiology fundamentals, participants engaged with a free web-based simulator ( https://ecg-sim.web.app/simulator/ ) and an EKG axis trainer ( https://david-shrk.github.io/ecgaxistrainer/ ). The V-CESE is composed of a visualization/interface, with controls to highlight each EKG segment and wave, change cardiac rhythms and frequency in real time, displaying the simulated surface EKG lead, with ancillary functions to create or clone EKG rhythms, each participant provided informed consent. Cardiac axis was tested to practice the interpretation using the free cardiac axis simulator. Normal cardiac rhythm, shockable and non-shockable rhythms were taught and tested in the V-CESE to assess students’ performance interpretation, as well as during cardiopulmonary resuscitation. The acceptability was assessed using a five-point Likert scale to evaluate: “general” perception, compliance with “virtual simulation objectives”, “realism”, “educational value”, “quality of practice”, and free text comments. Mean (SD) were obtained for the scale excellent=5, very good=4 and adequate=3. Free text comments were grouped according to recurrent themes, age and sex were obtained. Data analysis was performed using STATA 12. Results. Of the 356 participants, 165 (46.35%) and 191 (53.65%) were men and women respectively, the median (IQR) age was 22(20-23). The survey data for virtual simulation were as follows: general perception, 4.36 (SD:0.71); objectives reached, 4.36 (SD:0.71); realism, 4.33 (SD:0.74); educational value, 4.44 (SD:0.70); and quality of practice, 4.40 (SD:0.69); there were no mediocre or poor ratings. Recurrent comments were: “Excellent way to learn EKG”, “I wish this had been implemented before”, “Deliver this activity on a regular basis to learn EKG´s interpretation”. Conclusions. Teaching EKG with V-CESE integrated into Cardiopulmonary Resuscitation showed high learning acceptability, accelerating the learning process to evaluate diagnostic skills in a more realistic way than is possible in a static exam, allowing schools of medicine in low-to-middle-income countries to overcome the barriers of cost-effective accessible equipment. This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.