In the present study, we investigated the
adequacy and quality of video trainings on ECG
recording on YouTube for the training of healthcare
professionals based on the uploader source.
According to the results, GQS was associated
with the total ECG score (b-coefficient 2.05, 95%
confidence interval (CI): 1.62 to 2.49; p<0.001),
and videos uploaded from an unknown source were
associated with lower total ECG scores (b-coefficient
-1.03, 95% CI: -1.99 to -0.07; p=0.035 (Table
4).
Electrocardiography is a procedure that requires a
long time and repetitive training to learn the recording,
understand its physiology and interpret it clinically,
and it still presents many unknowns for healthcare
professionals.[9] It can only be correctly assessed, if
the electrodes are placed in the correct anatomical
positions and the recording is of good technical quality.
It may be also necessary to compare serial ECGs to
identify dynamic ECG changes over time, particularly
in ischemic conditions, and it is important that all
recordings should be made using a technique consistent
with the same standard.[3]
Various studies have shown that differences between
individuals and centers in ECG and departure from
the standard technique cause clinically significant
differences.[10,11] Many factors and technical problems
in ECG recording can change the interpretation of
ECGs, leading to erroneous diagnoses and putting
patients at risk by making therapeutic interventions
inappropriate. It is critical for patients and healthcare
professionals to perform ECG recording at appropriate
standards. Therefore, ECG training programs should
include correct electrode placement and differences
between normal and pathological patterns, and focus
on recognizing ECG patterns derived from electrode
misplacement, artifacts, and other technical problems
that cause misinterpretation.[12]
There may not always be practical training
opportunities for healthcare professionals for ECG
recording, and repeated training may be needed.
Depending on learning types of individuals, the
principles learned from lectures or books can be
difficult to apply to real-life situations. It is evident
that the closer the educational environment or material
is to the real one, the more effective would be the
learning tool for the student.[13] In addition, online and
distance learning has become much more important
in these days of the novel coronavirus 2019 disease
(COVID-19) pandemic and the transition to the
digital age has accelerated.
In the pre-Internet era, books and articles were the
main source of information.[14] As a result of the rapid
advancement of technology and the widespread use of
the Internet all over the world, training videos have become very popular in healthcare, as in all areas.[15]
Currently, sources of access to information in many
areas have become almost unlimited and it is often
possible to access these information sources even
from our home. However, the information age that
we live in may bring unique difficulties. Therefore,
we should question the accuracy, source and adequacy
of the information we have reached. As in many other
areas, healthcare training videos are shared a lot on
video sharing and training sites; however, there is no
specific tool to determine the adequacy and quality of
the uploaded video. Some of the tools used to assess
websites have been used in YouTube research, but the
fact that they are not produced for specific online
video media such as YouTube limits the use of these
tools.
Founded in 2005, YouTube is the most popular
social media platform. In addition to providing
unlimited information, some of the videos are loaded
from reliable sources (i.e., hospitals, universities,
healthcare training sites) and some from uncontrolled
non-scientific sources based on personal experiences.
Unsupervised videos on YouTube and resource
diversity can lead to false or misleading health
information.[4] This resource diversity considerably
restricts the quality of training and reliability of
information and may negatively affect the learning
skills of those who are willing to receive training in
this field.[13]
Considering the number of views of videos, it
is obvious that incorrect or incomplete information
would have serious consequences, particularly in
healthcare training videos.[9] As shown in our study,
individual training videos that do not follow a specific
guide or source are quite inadequate than the training
videos that follow the current guidelines in hospitals
and healthcare training sites. In addition, inadequate
videos do not differ in the number of views compared
to highly adequate videos. This may point to the risks
of incomplete and inadequate videos that reach large
audiences. Therefore, healthcare professionals who
are trained on these videos should be strongly advised
to question the video sources and the identity of the
uploader. Encouraging educational institutions and
universities to be a part of this education and accessing
online ECG teaching videos by medical professionals
or students directly from reliable scientific and
institutional sources can contribute to the solution of
this problem.[4]
Another remarkable finding of this study is that
the videos mostly focus on the placement of the chest
leads, and the other stages of ECG recording are not
paid the same amount of attention. As this is the
most important and difficult-to-learn stage of ECG
recording, video uploaders probably have focused on
this stage most with a similar thought. However, no
sufficient emphasis has been placed on the basic steps of
ECG recording, such as entering the patient's identity
information correctly, reducing the patient's stress by
informing them about the procedure, infection control,
which we appreciate much better in the pandemic, and
determining the recording standards of the device.
The exclusion of online video sites other than
YouTube (e.g., Dailymotion) and languages other than
English can be counted among the limitations of our
study. All 72 videos included in this study only via
YouTube may not reflect all the online training videos.
In addition, the fact that some tools that measure the
quality of the data published on the websites are not
suitable for online video sites can be considered as
another limitation in our study; however, to avoid this
limitation, the GQSs were used.
In conclusion, in the YouTube database, the
scientific quality of the videos for standard 12-lead
ECG recording training is highly variable. Training
videos uploaded by hospitals and corporate healthcare
training sites contain higher quality and scientific
data than individual videos and videos of an
unknown source; therefore, healthcare professionals
should question the source and scientific quality
of the training videos. Specific tools need to be
developed for healthcare training videos uploaded to
YouTube; thus, it may be possible to prevent adverse
conditions that may arise with online videos that
are complimentary, but not alternative to classical
training.
Declaration of conflicting interests
The authors declared no conflicts of interest with respect
to the authorship and/or publication of this article.
Funding
The authors received no financial support for the research
and/or authorship of this article.