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Aims and Objectives Accurate electrocardiogram (ECG) interpretation at triage is essential in emergency medicine for early detection of critical conditions. However, studies have consistently reported variable competence and low confidence among clinicians. Focused teaching programmes have shown improved outcomes over self-directed learning, yet ECG training remains inconsistent across clinical grades. This study assessed ECG knowledge, training history, and confidence among staff during induction to a large UK-based teaching hospital Emergency Department (ED).Method and Design All new ED clinical staff involved in triage ECG screening, completed an anonymous 20-question ECG quiz during departmental induction. The quiz tested interval recognition, rhythm interpretation, and emergency decision-making. Participants reported previous ECG learning and confidence in emergency ECG interpretation. ANOVA and Tukey’s HSD were used to compare scores across grades.Results and Conclusion A total of 221 staff participated from October 2023 to April 2025. The mean score was 15.9/20 (SD ±2.26). Highest scores were achieved by advanced care practitioner (ACP) year 3 trainees (mean 18.5) and ST4–ST7 emergency medicine trainees (mean 17.0). Consultants generally scored 17–18 out of 20. Despite this, only 14.5% of participants reported feeling confident in emergency ECG interpretation, while 45% were neutral and 14.9% not confident. Although 83% had received ECG training, 62% had not engaged in it within the past year. ANOVA revealed significant differences across grades (p < 0.001), with Tukey’s test confirming lower performance in some junior groups. Confidence did not significantly correlate with performance.Despite ECGs being central to ED care, marked variation exists in clinician competence, especially among junior grades. Structured, role-specific ECG training particularly during induction may improve clinical confidence, accuracy, and patient safety. Although this is a single-centre study, the large sample provides valuable insight into national training challenges and educational priorities.