Navigating inhabited institutionalism: A framework for electrocardiogram workshops in teaching hospitals.

Introduction: This narrative review examines the challenge of poor electrocardiogram (ECG) interpretation by Emergency Medicine (EM) clinicians from the perspective of EM consultants in a teaching hospital. Methods: This study is underpinned by the Inhabited Institutionalism Theoretical framework. Pressures faced by EM consultants are analysed within a system that navigates both macro-level institutional and regulatory mandates and micro-level pressure from the clinicians and EM trainees they manage. Analysis of these literature reviews highlights the challenge faced by 'middle managers' in balancing the often-opposing forces. Synthesis: The study advocates the use of Continuous Professional Development (CPD)-accredited ECG in-service training workshops to support quality improvement and meet both macro and micro needs. It recognises the complexity in the implementation of such workshops and offers a "Framework for a Sustainable ECG Workshop" that meets the CPD requirements of the Health Professions Council of South Africa (HPCSA), the University's needs to train registrars and to decolonise the curriculum, the hospital's needs for quality improvement, addresses the unique challenges faced by clinicians working in emergency departments, and addresses clinicians' inherent negative attitudes towards ECG interpretation. Conclusion: This narrative review addresses ECG misinterpretation in South African EM. Through the analytical lens of Inhabited Institutionalism, it interrogates macro-, meso‑, and micro-level influences on ECG training in teaching hospitals and proposes a meso‑level framework to guide consultants in designing sustainable CPD-accredited ECG workshops responsive to institutional mandates, local clinical realities, and learning needs. Further empirical work should evaluate its effect on ECG competence and patient outcomes.