Study methods and benefits of passing the third-level ECG certification exam in six months for nurses; difficulty levels, strategies, pass rates, study hours, recommended question sets, past exams, reference books, last-minute seminars, and training for second and fourth levels. We will provide information on the exam dates for the 9th and 10th sessions in 2023 and 2024, how many times per year the exam is held, when applications can be made, examination fees, eligibility for taking the exam, and information on examination venues.

I did it, I passed! While managing the busy tasks of a nurse, I was able to obtain the desired qualification for the ECG Level 3 certification exam in 2021, thanks to just half a year of exam preparation and study methods. Perhaps, based on my personal impression of taking the exam, I must have barely passed with a borderline score… but regardless, a pass is a pass, even if it’s just by the skin of my teeth! 💮

In this article, as an active nurse, I will introduce efficient study methods and exam preparation, recommended reference books, problem sets, textbooks, training (education), seminars, and basic information about the ECG certification exam Level 3, which enabled me to pass while working in just half a year!

I will also discuss details such as ECG certification (Level 1, Level 2, Level 3) exam dates, eligibility requirements, the benefits of the exam, exam venue locations, directions, the exam-day situation, impressions of the problems, marking sheet techniques, tips, information about the 2022, 2023, 2024, and 2025 exams, pass rates, difficulty levels, number of exams per year, valid period (expiration date), study time, whether it can be listed on a resume, and when to apply!

I don’t know if the study methods I employed to pass the ECG certification exam were the correct ones, but I did pass the exam despite being a person like me. So, I hope this article will be helpful to nurses who aim to pass the ECG certification exam, nursing students, and medical professionals.

By obtaining ECG certification, medical professionals can increase their knowledge of electrocardiograms, which will be helpful in their work, and they can list it on their resumes, with many benefits. It is likely to be advantageous in exams and interviews if one intends to work or change jobs in a hospital.

(I will also work hard to pass and report with joy about the ECG certification exam Level 2 and ECG certification exam Level 1 in the future!)

(1)Reason for taking the ECG exam

After leaving the university hospital due to personal circumstances and working at a specialized cardiovascular hospital for about a year, I have many elderly patients with whom I repeatedly handle “diaper changes” every day. I have become quite skilled at this, to the point of considering myself a professional.

Now, my diaper fitting does not leak horizontally. Compared to when I first started, I have become quite adept at it 💮

At the previous university hospital, I hardly ever changed diapers, so I am surprised every day at the high level of care required at the community hospital.

It is a difficult job, but even I have become accustomed to changing diapers every day.

In the midst of all this, I thought that I needed to learn more specialized knowledge (which could be useful for job hunting and can also be included in my resume), and I found the ECG exam.

There are various qualifications related to healthcare, but it is rare to find a qualification that anyone can take without the prerequisite of a nursing license, such as the ECG exam.

If you are interested, you do not have to be a healthcare professional to take the ECG exam, even the general public can take it. The exam level ranges from 1st to 4th grade, and you can take it as many times as you want depending on your knowledge.

There are also many books and publications available for studying ECG.

Since I work at a specialized cardiovascular hospital, I decided to take the ECG exam because it seems likely to be useful for my job in the future and has its advantages.

However, even though I check the ECG monitor regularly, I usually only handle alarm responses, and occasionally glance over to see if there are any P-waves (whether it is SR or AF) and what the rate is (is it low rate? Is there a block?).

I wrote this on a whim, but that’s how I decided to take the ECG exam 3rd grade in 2021.

(2)About Electrocardiogram (ECG) Examination

ECG examination is a test for judging ECG readings, established by the Japanese Heart Rhythm Society.

The examination is held once a year for four different levels, from level 1 to level 4. Level 1, which is for high scorers, grants a “Master” certification. In 2021, the exams for level 2 and level 4 were held on January 10th, while the exams for level 1 and level 3 were held on January 11th.

The sixth exam was held in January 2021 at two locations, Tokyo (TOC Gotanda Messe, TOC Ariake) and Fukuoka (Acros Fukuoka).

The next exam is the eighth exam, which will be held in January 2023. Due to the COVID-19 pandemic, the exam I took (sixth exam) was postponed to the seventh exam, which was held in January 2022.

The eighth exam is scheduled for the following dates and locations. There are no plans to postpone this exam due to the COVID-19 pandemic.

January 14th, 2023 (Sat) – Level 4, Level 1 [Tokyo, Nagoya, Osaka, Fukuoka] January 15th, 2023 (Sun) – Level 3, Level 2 [Tokyo, Nagoya, Osaka, Fukuoka] *Note that candidates can only take the exam on one of the two days. Concurrent applications are not allowed.

Tokyo venues: TOC Ariake, Tokyo Big Sight (for Level 3 and Level 2 only)
Nagoya venue: Nagoya International Conference Center
Osaka venue: Congrès Convention Center
Fukuoka venue: Fukuoka International Exhibition Center & Conference Center

You can apply online through the website of the Japanese Heart Rhythm Society for the Heart Rhythm Examination. Applications are accepted only through the online application system (PC/smartphone), and applications by phone, fax, or email are not accepted.

Applications for the 8th exam (January 2023) will start from around September to October 2022. The application schedule varies depending on the examination location and grade.

The application reception for the 8th Heart Rhythm Examination (2022) seems to have started on October 3rd, and the venues are filling up quickly, so it is recommended to apply early if you plan to take the exam.

The application reception for the 8th Heart Rhythm Examination (2022) seems to have ended on October 31st. To everyone who took the 8th exam, good luck!

It seems that the admission tickets for the 8th Heart Rhythm Examination (2022) have been sent to the examinees.

The pass/fail announcement for the 8th Heart Rhythm Examination (2022) was on February 15th, 2023.


The examination fee is 10,000 yen for the 1st grade, 8,000 yen for the 2nd grade, 6,000 yen for the 3rd and 4th grades, and payment is possible through convenience store payments and credit card payments.

Application for the Heart Rhythm Examination of the Japanese Heart Rhythm Society

Regarding the 9th exam (January 2024), the details such as the schedule have not been decided yet.

The Heart Rhythm Examination is becoming more and more popular every year, and the application deadline is reached when the number of applications reaches the maximum capacity, so it is recommended to apply early if you have decided to take the exam.

Eligibility for the Heart Rhythm Examination

There are no special qualifications required to take the examination, and it is open to not only medical professionals such as doctors, nurses, clinical laboratory technicians, medical students, and medical industry personnel, but also to those who are interested in electrocardiograms. It is possible to take the examination as many times as you want, even if you fail.

You do not need to pass the lower grades when taking the examination, so for example, it is possible to take the examination from the 3rd grade without taking the 4th grade.

(I also took the exam from the 3rd grade without taking the 4th grade, thinking that I could somehow manage it.)

Classification (test category) and level of the Heart Rhythm Examination and pass rate

[Heart Rhythm Examination 4th grade] Basic reading ability of electrocardiograms is required. The level is assumed to be for medical professionals such as nurses who have worked in the cardiology department for several years. It is a mark-sheet format (70 minutes) with 50 questions. The pass rate in 2021 was 68.4%, with 340 of the 497 candidates passing.

[Electrocardiogram (ECG) Examination – Grades 3, 2, 1, and Master]

The ability to read ECG from basic to moderate level is required for Grade 3. This level is intended for medical professionals such as nurses in cardiology departments and general practitioners. The exam consists of 50 questions in a multiple-choice format (90 minutes). In 2021, out of 547 examinees, 418 passed, resulting in a pass rate of 76.4%.

Grade 2 requires the ability to read ECG from moderate to advanced level. This level is intended for medical professionals such as experienced nurses in cardiology departments and general cardiologists. The exam consists of 50 questions in a multiple-choice format (90 minutes). In 2021, out of 497 examinees, 340 passed, resulting in a pass rate of 68.4%.

Grade 1 requires advanced ability to read ECG, with a high level of difficulty. This level is intended for medical professionals such as nurses in cardiology departments with extensive knowledge of ECG and specialized cardiologists. The exam consists of 50 questions in a multiple-choice format (90 minutes). In 2021, out of 413 examinees, 225 passed, resulting in a pass rate of 54.5%.

For the Master level, an extremely advanced ability to read ECG is required. It is designated for those who obtained a high score in Grade 1. Every year, about 5 to 10 individuals are certified.

Individuals who pass Grades 1, 2, 3, or 4 can receive a certificate and badge. Those who are certified as “Master” in Grade 1 can receive a special shield and badge.

The ECG examination qualification is valid for a lifetime once it has been obtained, with no expiration date.

Other certification systems and examination tests recognized by the Japanese Heart Rhythm Society include the JHRS Certification for ECG Specialists, CDR Certification System, and Implantable Cardiac Device Certification System.

The ECG Examination is conducted by the Japanese Heart Rhythm Society, a non-profit organization located at KYONI BLDG. 4th floor, 4-3-24 Kudan-kita, Chiyoda-ku, Tokyo 102-0073. Contact number: 03-6261-7351.

(3)Training courses, seminars, reference books, books, practice tests, and textbooks that I took to pass the ECG examination.

To pass the ECG examination, I bought various reference books, textbooks, practice tests, and attended various training courses and seminars. Here, I would like to introduce some of the recommended training courses and books from my perspective. Please note that I searched the internet, but it seems that past ECG examination questions are not circulating.

Fukuda Electronics’ Seminar (Training Course)
Fukuda Electronics’ ECG training course is a must-attend. I attended the beginner, basic A, and B courses for three days for 12,000 yen.

The lecturer was very easy to understand, and answered questions politely. The lecturer taught with the ECG examination in mind.

If you make a reservation online, you can also receive benefits such as dividers, ECG scales with rulers, desk pads, and recently, hand sanitizers for just under 2,000 yen.

As a food lover, I also looked forward to the bento lunch during the break ♪.

The bento that I had was very stylish, and I especially loved Kinbei-san’s bento (^○^).

It is very satisfying to have a delicious lunch break between studying. It refreshes you.

As the training location is near Yushima Tenjin Shrine, I felt lucky when I took the exam.

When I attended, it was during the COVID-19 pandemic, but the number of participants was strictly limited, and infection prevention measures such as temperature measurement and disinfection were thoroughly implemented.

As the cost is low and it is popular, I recommend making a reservation early.

Mastering 12-Lead ECG Reading (Book)
This book had high ratings on the internet reviews, so I bought both the “Basic Edition” and “Training Edition” for about 3,000 yen.

The content gave me quite a maniacal impression! It may not be necessary for the third-grade examination.

I used the “Basic Edition” as a dictionary. I did the “Training Edition” while looking at the answers.

By the way, I saw several people who had this book on the day of the exam.

Dr. Heart’s ECG Seminar (Training Course)
It seems good to take Dr. Heart’s ECG seminar at the very beginning of your studies.

The use of examples was very clever (e.g., the sinoatrial node is like the chief, and the atrioventricular node is like the assistant chief), and I found it easy to understand.

The price is somewhat high, but I took it in November 2020 during the COVID-19 pandemic, and it was very crowded.

It was good that practical knowledge that can be used in the field was incorporated.

Heart-sensei wanted to take the heart failure training because it was recommended by my admired senior, but unfortunately it was cancelled due to COVID-19. However, there are online training and books available, so it seems like a good idea to choose according to your own situation.

④Other recommended reference books and problem sets:

・Medica Publishing Co., Ltd. “Official Problem Set & Guide for ECG Certification 2nd/3rd Class”
This is the official problem set for ECG certification edited by the Japan Arrhythmia Cardiologists Society and ECG Certification Committee. It includes 2nd and 3rd class hypothetical questions based on the format of the certification exam, with careful explanations of the reasoning and reading points.

・Yoshihiko Miyake “Easy Monitoring ECG through Manga!”
This book allows you to understand the basics of ECG through manga, and with detailed explanations in text, you can read it according to your own proficiency and level. It is recommended for those who are starting to study ECG or are considering studying it in the future.

・Kazutoshi Oshima “Understanding ECG Reading: From Monitoring to 12 Leads”
You can learn about the types of ECG, basic waveform characteristics, and how to distinguish abnormal waveforms with easy-to-understand diagrams. This reference book is designed to explain the key points of the basics in detail, so even ECG beginners can study with peace of mind.

・Hiroaki Sato “Only This ECG for Residents”
This reference book not only helps you prepare for the ECG certification exam, but also allows you to learn across the board the diagnostic skills, causes of arrhythmia from the pathophysiology to the ECG, and the flow of treatment that will be useful in actual medical settings.

・Shigeyuki Watanabe and Iwao Yamaguchi “Perfect Manual for ECG Reading – Thorough Training in Theory and Waveform Patterns!”
This reference book allows you to completely master the essential skill of ECG interpretation for physicians. It presents many actual size ECGs and explains the diagnostic points, causes, and symptoms of arrhythmias concisely. With abundant training problems, you can learn the basics and their applications.

(4)Situation on the day of the exam, impression of the questions, marking sheet techniques, and tips

Finally, the day of the exam has arrived!!!

The ECG certification exam in 2020 was postponed due to COVID-19, and the test date for Level 3 was January 11, 2021.

My test site was at Toc Gotanda Messe in Tokyo, not the larger TOC venue, but one that was located further back. Although I was familiar with the area, I still got lost, so be careful.

I think it’s important to do a site visit to avoid confusion on the day of the test or to make sure you arrive at the test location on time.

After a temperature check at the entrance, we were allowed to enter. Due to the pandemic, there were fewer test-takers.

I don’t remember the questions exactly since they were collected after the exam, but I’ll do my best to describe them.

The Level 3 exam consisted of 50 questions with a test time of 90 minutes. There were five choices for each question, and you usually had to choose one answer, but be careful because there were also cases where you had to select two.

According to the website for the ECG certification exam, the level of difficulty for test-takers is “those who have basic to intermediate ECG reading skills, including general clinical physicians, cardiovascular medical professionals, etc.”

The level for Level 4 test-takers is “those who have basic ECG reading skills, including medical professionals who have worked in the cardiovascular field for several years, medical students interested in ECG, etc.”

Clearly, I was more suited for Level 4, but I applied for Level 3 without any particular reason.

You might be able to skip Level 4 and go straight to Level 3, so being aggressive is also an option.

This test only comes once a year, so let’s show what we’ve worked hard for!

At the exam venue, just before the test, I was flipping through the reading materials I mentioned earlier. However, I didn’t want to feel rushed right before the exam, so I mostly observed the other test-takers (^○^).

There were many people looking at predicted question sets, some costing around 3,000 yen and were slightly outdated for Level 2 and 3.

Also, as I mentioned in (3), some people were looking at the 6,000 yen “Perfect Manual for Reading ECGs” by Gando-Sha and the 7,000 yen “Competence ECG” by the Japanese Society of Arrhythmias in Cardiology.

In my personal opinion, when it comes to question sets and reference books, I think it’s best to choose something that you feel is good for yourself, something that you can complete until the end, and something that feels easy to understand.

What’s important is to repeat and complete the reference books or textbooks you chose to study.

I chose a book that was cheap and thin, but I think it was a good one.

I thought about buying the predicted question sets to get to know the exam format better, but I found only one type available, which was several years old and had mixed reviews, so I didn’t end up buying them.

(5)What I felt when I passed the 3rd level ECG test

Efforts are not wasted! However, even if you study hard, it is still disappointing if you don’t pass because ultimately, the results are everything.

Even before the results came out, I was asked by my seniors, “Did you fail?” and “Does the ECG certification actually help in the field?” but now that I’ve passed, everything is all good (^○^).

I can write about my hard work on my resume, so I hope to use it for job hunting and career changes in the future.

Personally, there are few things that can show my efforts and be recognized, so I was very happy and gained confidence.

(6)Certificate of Passing and Certification Badge

When you pass the exam, you will receive the Certificate of Passing about two months after the exam date.

The pass/fail notification shows the score ranking. The score rankings range from A to E as follows:
A= 50-45 points, B= 44-40 points, C= 39-30 points, D= 29-20 points, E= 19-0 points.

I’m embarrassed to say that I got a C rank. Since pass/fail is determined within the C rank, I passed by the skin of my teeth (laughs).

When you pass, you also receive a nice certification badge (I wonder where to put it).

When I received the Certificate of Passing and Certification Badge, I felt the reality of passing and was very happy!

(7)Voices of ECG test passers

I would like to introduce the voices of those who passed the ECG test that I talked to.

● 4th level pass: 21-year-old female (3rd year nursing school student)
I’m still a nursing student, but I took and passed the ECG test for the 4th level. Although I’m not hoping to work in the cardiovascular system department, there are other departments that use ECG, so I took the test because I thought it would become a basic technique. After passing the national nursing exam and becoming a nurse, I hope it will be useful. I also want to challenge other qualifications.

● 3rd level pass: 26-year-old female (working as a nurse)
There were few people around me who had obtained the ECG certification, so I took the test because I thought it would be beneficial for my career. Looking back now, it was a good opportunity to study ECG. Even in my usual work, the way I look at ECG has changed.


Thank you for reading this far.

I have also written various articles on nursing job hunting and career changes, salary (income), and qualifications required for nurses. I would be very happy if you could take a look!

Thank you for your continued support!

Study methods for passing the national nursing exam.
A nursing information website run by active nurses who have experienced job changes, covering topics such as employment, salaries (income), qualifications (exams), and the basics of nursing.

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