Abstract
<title>Abstract</title> <p>ECG interpretation accuracy and inter-rater agreement stay limited across every level of training, and the interventions available today only nudge that number in the right direction. What could help is a practice stimulus that is reproducible and expert-verified; one that every institution can deliver in exactly the same way. Simulation platforms and commercial ECG testers already exist, and each solves part of the problem, but none combines an openly traceable, expert-verified waveform source with a playback pathway simple and cheap enough to install for reproducible training across multiple sites. This review asks whether standardized ECG repositories with documented clinical or expert-derived annotation processes, among them MIT-BIH, PTB-XL, and PTB Diagnostic, could supply that stimulus when paired with low-cost digital-to-analog playback hardware, and it lays out a staged framework for actually testing the idea. The underlying technology is not new: microcontroller- and DAC-based ECG signal generation has already been demonstrated in peer-reviewed proof-of-concept systems and commercial devices, though nobody has yet benchmarked how well it interoperates across different monitor brands. The educational case rests on deliberate practice, mastery learning, cognitive load theory, and functional task alignment, and together these suggest something reassuring: fidelity only needs to reach whatever threshold supports correct perceptual discrimination, not go beyond it. The evidence on learner stress is messier and does not support any tidy story where more realism simply calms people down. Taken together, database-sourced ECG playback looks technically feasible and educationally well motivated, but whether it outperforms existing training methods is still an open question. What comes next, then, is a three-phase validation agenda: bench-level fidelity testing, a randomized crossover trial, and a multisite pragmatic study offered here as the necessary step before anyone can claim an educational benefit.</p>