The Six Second ECG Simulator

Why a web-based cardiac rhythm simulator?
What assumptions are made on who is the learner?
Is learning theory used in the design and development of the Six Second ECG?
What design principles were used as foundations to the development of
the Six second ECG?
How does the Cardiac Simulator work?

Why a web-based cardiac rhythm simulator?

The rhythm simulator results from feedback received over many years of seminar workshops in dysrhythmia interpretation. Many participants found that using a cardiac rhythm simulator with a cardiac monitor was a very effective learning tool - most closely approximating the experience in the field. While many cardiac simulators exist in acute health care settings, most nurses and paramedics do not have access to the $3000 - $5000 simulation hardware, not to mention the $10,000 - $40,000 cardiac monitors.

The web already offers several sites that specialize in text based ECG tutorials. Only recently, with the arrival of recent versions of Flash can a simulator be created on the web that satisfies certain criteria:

-rapid download (less than 400k in size);
-advanced interactivity without the large file size;
-cross platform capability (Flash is available to Windows, Mac, and UNIX);
-ability to build once, play anywhere - even Java hasn't lived up to this promise;
-streaming ability to allow playing the application before a full download

These criteria along with the improved user base for hardware and browser software provide firm footing for a cardiac rhythm simulator -especially a simulator offered for free with a download size of less than 400k.

The Six Second ECG is a learning module and an ECG interpretation game that facilitate learning experiences that are fast, fun and effective. In fact, the module is designed to promote basic ECG interpretation in 6 seconds or less!

What assumptions are made on who is the learner?

Nursecom designed the cardiac rhythm simulator after close consultation with physicians, nurses and paramedics who comprise our target group of learners - players - users. From this consultation, we believe that health professionals:

-are exceptionally time conscious. Time has become one of the rarest of resources in our increasingly hectic lives;
-learn usually by observing and by doing on the job;
-are keenly interested in being and becoming competent in all aspects of their professional lives;
-have access to the Internet or at least plan to soon;
-are disappointed by the quality of educational experiences on the Internet while at the same time are impressed by the breadth of information;
-find the pace of change accelerating...with it the speed where information and knowledge becomes obsolete; and
-want to learn and expect to learn throughout their lives.

The design of the Six Second ECG reflects our assumptions of who is the learner.

Is learning theory used in the design and development of the Six Second ECG?

The Six Second ECG was developed with attention to the learning theories of Albert Bandura (Self-Efficacy), John Dewey, and Paolo Friere. The cardiac rhythm simulator promotes a positive experience reading ECGs. The immediate feedback to the learner reinforces the skill of correctly and quickly reading ECGs. We believe that the health professionals are self-motivated learners (Dewey, ) intent on empowering themselves and their community (Friere). The close similarity between interpreting ECGs online (Six Second ECG) and in the clinical area fosters the carry-over of skills learned online to the work setting (Bandura).In short, a simulator promotes a sense of self-efficacy.

What design principles were used as foundations to the development of the Six second ECG?

The cardiac rhythm simulator was designed with the concepts of time and game theory as primary design parameters. Of course the constraints of the Internet (bandwidth, multiple platform, multiple hardware configurations, range in user profile) are significant factors when designing any application for the web.

Beside the primary parameters and the constraints mentioned, usability also has a significant role in design. For example, the use of color to group rhythms into categories, the use of prominent colors and larger fonts for the main buttons, and the grouping of support documents under menu titles all help increase ease of use.

The learner remains the center of design and development. The first cardiac rhythm simulator released on the web was version 45 after each earlier version was prototyped and tested. This process is endless. Within the next quarter, the Six Second ECG simulator will evolve into a full featured application, designed to systematically facilitate ECG interpretation skills for health professionals.

How does the Cardiac Simulator work?

The cardiac rhythm simulator begins with an introductory screen where the participant is prompted to enter their name or nickname and then click 'Start'. This introduction displays the progress of downloading and also makes the experience more personal with feedback that uses your name in the message.

Upon clicking on 'Start', the next screen is displayed. This default screen is the learning mode of the simulator. You can access either the 'Learn' mode or the 'Game' mode by choosing the button of the same name.

The 'Freeze' button stops the rhythm and places a grid under the rhythm for reference. Once frozen, the rhythm's intervals and rate can be quickly determined. For a closer look, right click the mouse on the screen in the area you want magnified and choose 'Zoom In'. To return to the original screen magnification right-click again and choose either 'Zoom Out' or 'Show All'.

Each rhythm label is a button that once clicked begins an animated cardiac rhythm of its namesake. Note the window at the bottom of the screen. This is a reference window, providing brief details on the characteristics and significance of each rhythm.

The 'Settings' button opens a small window to allows you to change default settings. Choose whether you want the sound to be on or off (button sounds are not affected). Choose whether you want the ECG rhythms to remain static or dynamic (rhythm is animated). The time settings are for the length of the ECG Challenge in game mode.

Choosing 'Game' mode adds a few extra features to the interface. A time clock and various scores present.Find a 'Reset' button that begins the game anew with each click.

The objective of the game or challenge is to correctly identify as many rhythms as possible within a certain time frame. The ECG Challenge game defaults to one minute (choose a different timeframe with the 'Settings' window).

In 'Game' mode, the 'Freeze' button will stop the rhythm and make visible the reference grid (like 'Learn' mode) but the time clock does not stop. Upon clicking 'Start', animated rhythms are generated randomly. Click on the appropriate rhythm name to identify the rhythm. If your choice is correct, you will see a "Correct" below the rhythm names and center.

A 'Correct' stops the clock. Click on 'Next' to continue the game and the clock. If the rhythm name chosen does not fit the cardiac rhythm displayed, a 'Try Again' will be displayed - the clock will continue. Continue choosing rhythm names until a 'Correct' appears.

The game concludes at the end of the respective time period. At the conclusion of the game, personal feedback is provided on total attempts tried, percent correct, and the average time taken to correctly identify cardiac rhythms - along with a little personalized encouragement in the form of a text and audio message. Choosing 'Reset' and then 'Start' begins a new game.

We hope you enjoy the cardiac simulator, a kernel of the Six Second ECG learning series. If you have comments, suggestions, or would like to just drop us a 'hi', please email us. We would love to hear from you.