Learning by Experiencing: An Immersive Digital Twin Tool for ECG Education

Authors

  • Daniel Flores-Martin COMPUTAEX. Extremadura Supercomputing Center, Cáceres, Spain
  • Francisco Díaz-Barrancas University of Extremadura, Badajoz, Spain
  • Pedro J. Pardo University of Extremadura, Badajoz, Spain
  • Javier Berrocal University of Extremadura, Badajoz, Spain
  • Juan M. Murillo University of Extremadura, Badajoz, Spain

DOI:

https://doi.org/10.13052/jwe1540-9589.2534

Keywords:

Electrocardiogram, digital twins, edge computing, simulation, deep learning, formation

Abstract

Practical training in electrocardiogram (ECG) interpretation remains uneven, particularly in resource-limited settings, despite the central role of ECGs in cardiovascular diagnosis. This work evaluates whether an ECG-focused digital twin that integrates interactive simulation and deep learning guidance can achieve educationally valid realism, improve recognition of patterns and abnormalities through interactivity, and enhance accuracy and learner motivation via predictive feedback. We present ECGTwinMentor, a cross-platform system that synthesizes parameterized ECG waveforms, enables fine-grained control of physiologic variables, and delivers immediate predictive feedback for formative assessment. The diagnostic model supports low-latency inference on modest hardware. Validation with healthcare experts and medical students showed positive evaluations for realism, usability, and integration potential. Experts reported average ratings between 3.5 and 4.5 out of 5, while students rated usability between 4.6 and 4.8 and motivation and realism at 5.0, with most items scoring at least 4. These findings support the conclusion that an interactive, predictive digital twin can narrow the gap between theory and practice in ECG interpretation, offering an accessible, scalable, and reproducible approach to ECG education.

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Author Biographies

Daniel Flores-Martin, COMPUTAEX. Extremadura Supercomputing Center, Cáceres, Spain

Daniel Flores-Martin is a researcher and head of the systems and supercomputing department at COMPUTAEX. His research interests include the Internet of Things, artificial intelligence, and high-performance computing.

Francisco Díaz-Barrancas, University of Extremadura, Badajoz, Spain

Francisco Díaz-Barrancas is a post-doc researcher at the University of Extremadura. His main interests are virtual reality, artificial intelligence and color processing.

Pedro J. Pardo, University of Extremadura, Badajoz, Spain

Pedro J. Pardo is an Associate Professor at the University of Extremadura. His research interests include color vision, neural networks and computer networks.

Javier Berrocal, University of Extremadura, Badajoz, Spain

Javier Berrocal (IEEE Member) is an Associate Professor at the University of Extremadura. His main research interests are software architectures, mobile computing, and edge and fog computing.

Juan M. Murillo, University of Extremadura, Badajoz, Spain

Juan Manuel Murillo (IEEE Member) is a Full Professor at the University of Extremadura. His research interests include software architectures, mobile computing, and cloud computing.

References

Alazab, M., Khan, L.U., Koppu, S., Ramu, S.P., Boobalan, P., Baker, T., Maddikunta, P.K.R., Gadekallu, T.R., Aljuhani, A., et al.: Digital twins for healthcare 4.0-recent advances, architecture, and open challenges. IEEE Consumer Electronics Magazine 12(6), 29–37 (2022)

Ali, O.M.A., Kareem, S.W., Mohammed, A.S.: Evaluation of electrocardiogram signals classification using cnn, svm, and lstm algorithm: A review. In: 2022 8th International Engineering Conference on Sustainable Technology and Development (IEC). pp. 185–191. IEEE (2022)

Attia, Z.I., Harmon, D.M., Behr, E.R., Friedman, P.A.: Application of artificial intelligence to the electrocardiogram. European heart journal 42(46), 4717–4730 (2021)

Avula, V., Wu, K.C., Carrick, R.T.: Clinical applications, methodology, and scientific reporting of electrocardiogram deep-learning models: a systematic review. JACC: Advances 2(10), 100686 (2023)

Breen, C., Kelly, G., Kernohan, W.: Ecg interpretation skill acquisition: A review of learning, teaching and assessment. Journal of electrocardiology 73, 125–128 (2022)

Chiu, T.K., Xia, Q., Zhou, X., Chai, C.S., Cheng, M.: Systematic literature review on opportunities, challenges, and future research recommendations of artificial intelligence in education. Computers and Education: Artificial Intelligence 4, 100118 (2023)

Cluitmans, M.J., Plank, G., Heijman, J.: Digital twins for cardiac electrophysiology: state of the art and future challenges. Herzschrittmachertherapie+ Elektrophysiologie 35(2), 118–123 (2024)

Cooper, J.B., Taqueti, V.: A brief history of the development of mannequin simulators for clinical education and training. Postgraduate medical journal 84(997), 563–570 (2008)

Díaz-Barrancas, F., Flores-Martin, D., Berrocal, J., Peguero, J.C., Pardo, P.J.: Integrating real-time ecg data into virtual reality for enhanced medical training. In: 2025 IEEE Conference on Virtual Reality and 3D User Interfaces Abstracts and Workshops (VRW). pp. 1436–1437. IEEE (2025)

Flores-Martin, D., Berrocal, J., García-Alonso, J., Murillo, J.M.: Extending w3c thing description to provide support for interactions of things in real-time. In: International conference on web engineering. pp. 30–41. Springer (2020)

Flores-Martin, D., Laso, S., Berrocal, J., Murillo, J.M.: Towards digital health: Integrating federated learning and crowdsensing through the contigo app. SoftwareX 28, 101885 (2024)

Grandits, T., Gillette, K., Plank, G., Pezzuto, S.: Accurate and efficient cardiac digital twin from surface ecgs: Insights into identifiability of ventricular conduction system. Medical Image Analysis 105, 103641 (2025). , https://www.sciencedirect.com/science/article/pii/S1361841525001884

Iqbal, N., Kandasamy, R., Jyothish, K., Johnson, O., Sundaram, B., et al.: Virtual reality simulation for the acquisition and retention of electrocardiogram interpretation skills: A randomized controlled trial among undergraduate medical students. Cureus 16(6) (2024)

Ko, Y., Issenberg, S.B., Roh, Y.S.: Effects of peer learning on nursing students’ learning outcomes in electrocardiogram education. Nurse education today 108, 105182 (2022)

Li, C., Wu, Y., Lin, H., Li, J., Zhang, F., Yang, Y.: Ecg denoising method based on an improved vmd algorithm. IEEE Sensors Journal 22(23), 22725–22733 (2022)

Park, J., An, J., Kim, J., Jung, S., Gil, Y., Jang, Y., Lee, K., Oh, I.y.: Study on the use of standard 12-lead ecg data for rhythm-type ecg classification problems. Computer Methods and Programs in Biomedicine 214, 106521 (2022)

Patro, K.K., Jaya Prakash, A., Jayamanmadha Rao, M., Rajesh Kumar, P.: An efficient optimized feature selection with machine learning approach for ecg biometric recognition. IETE Journal of Research 68(4), 2743–2754 (2022)

Qi, W., Su, H.: A cybertwin based multimodal network for ecg patterns monitoring using deep learning. IEEE Transactions on Industrial Informatics 18(10), 6663–6670 (2022)

Qian, S., Ugurlu, D., Fairweather, E., Toso, L.D., Deng, Y., Strocchi, M., Cicci, L., Jones, R.E., Zaidi, H., Prasad, S., et al.: Developing cardiac digital twin populations powered by machine learning provides electrophysiological insights in conduction and repolarization. Nature Cardiovascular Research 4(5), 624–636 (2025)

Rafie, N., Kashou, A.H., Noseworthy, P.A.: Ecg interpretation: clinical relevance, challenges, and advances. Hearts 2(4), 505–513 (2021)

Rijnbeek, P.R., Van Herpen, G., Bots, M.L., Man, S., Verweij, N., Hofman, A., Hillege, H., Numans, M.E., Swenne, C.A., Witteman, J.C., et al.: Normal values of the electrocardiogram for ages 16–90 years. Journal of electrocardiology 47(6) (2014)

Salvador, M., Kong, F., Peirlinck, M., Parker, D.W., Chubb, H., Dubin, A.M., Marsden, A.L.: Digital twinning of cardiac electrophysiology for congenital heart disease. Journal of the Royal Society Interface 21(215), 20230729 (2024)

Shivashankara, K.K., Shervedani, A.M., Clifford, G.D., Reyna, M.A., Sameni, R., et al.: Ecg-image-kit: a synthetic image generation toolbox to facilitate deep learning-based electrocardiogram digitization. Physiological measurement 45(5), 055019 (2024)

Siontis, K.C., Noseworthy, P.A., Attia, Z.I., Friedman, P.A.: Artificial intelligence-enhanced electrocardiography in cardiovascular disease management. Nature Reviews Cardiology 18(7), 465–478 (2021)

Somani, S., Russak, A.J., Richter, F., Zhao, S., Vaid, A., Chaudhry, F., De Freitas, J.K., Naik, N., Miotto, R., Nadkarni, G.N., et al.: Deep learning and the electrocardiogram: review of the current state-of-the-art. EP Europace 23(8), 1179–1191 (2021)

Stamate, E., Piraianu, A.I., Ciobotaru, O.R., Crassas, R., Duca, O., Fulga, A., Grigore, I., Vintila, V., Fulga, I., Ciobotaru, O.C.: Revolutionizing cardiology through artificial intelligence—big data from proactive prevention to precise diagnostics and cutting-edge treatment—a comprehensive review of the past 5 years. Diagnostics 14(11), 1103 (2024)

Wen, H., Xu, W., Chen, F., Jiang, X., Zhang, R., Zeng, J., Peng, L., Chen, Y.: Application of the boppps-cbl model in electrocardiogram teaching for nursing students: a randomized comparison. BMC Medical Education 23(1), 987 (2023)

Wu, H., Patel, K.H.K., Li, X., Zhang, B., Galazis, C., Bajaj, N., Sau, A., Shi, X., Sun, L., Tao, Y., et al.: A fully-automated paper ecg digitisation algorithm using deep learning. Scientific Reports 12(1), 20963 (2022)

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Published

2026-04-19

How to Cite

Flores-Martin, D. ., Díaz-Barrancas, F. ., Pardo, P. J. ., Berrocal, J. ., & Murillo, J. M. . (2026). Learning by Experiencing: An Immersive Digital Twin Tool for ECG Education. Journal of Web Engineering, 25(03), 373–394. https://doi.org/10.13052/jwe1540-9589.2534

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