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      Cardiac auscultation training of medical students: a comparison of electronic sensor-based and acoustic stethoscopes

      research-article
      1 , 2 , 2 ,
      BMC Medical Education
      BioMed Central

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          Abstract

          Background

          To determine whether the use of an electronic, sensor based stethoscope affects the cardiac auscultation skills of undergraduate medical students.

          Methods

          Forty eight third year medical students were randomized to use either an electronic stethoscope, or a conventional acoustic stethoscope during clinical auscultation training. After a training period of four months, cardiac auscultation skills were evaluated using four patients with different cardiac murmurs. Two experienced cardiologists determined correct answers. The students completed a questionnaire for each patient. The thirteen questions were weighted according to their relative importance, and a correct answer was credited from one to six points.

          Results

          No difference in mean score was found between the two groups (p = 0.65). Grading and characterisation of murmurs and, if present, report of non existing murmurs were also rated. None of these yielded any significant differences between the groups.

          Conclusion

          Whether an electronic or a conventional stethoscope was used during training and testing did not affect the students' performance on a cardiac auscultation test.

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          Most cited references9

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          Cardiac auscultatory skills of physicians-in-training: a comparison of three English-speaking countries.

          Cardiac auscultation is suffering from a declining interest caused by competing diagnostic technology and, possibly, inadequate teaching and testing of physicians-in-training. Because access to technology, traditional teaching practices, and methods of trainees' assessment vary among different countries, we speculated that trainees' proficiency in auscultation might also vary. We tested the cardiac auscultatory skills of 314 internal medicine residents (189 from the United States, 89 from Canada, and 36 from England) from 14 programs. All participants were asked to listen by stethophones to 12 prerecorded cardiac events and to answer a multiple-choice questionnaire. They also completed a survey concerning attitudes toward cardiac auscultation and auscultatory teaching received during training. Mean (+/- SD) identification scores for the 12 cardiac events ranged from 0% to 58% for American trainees (mean 22% +/- 12%), 0% to 58% for Canadians (mean 26% +/- 13%), and 0% to 42% for British trainees (mean 20% +/- 12%). Canadians' cumulative scores were slightly but significantly greater than those of American (P = 0.02) and British house officers (P = 0.05). British house officers improved the most during the 3 years of training (P < 0.05). Canadian and British trainees had received more auscultatory teaching during medical school and residency; they had also used audiotapes more frequently (all P < 0.001). Auscultatory proficiency was poor in all three countries. Although there were slight differences among countries, the most striking finding was the consistent inaccuracy of all trainees. This suggests that variables other than teaching and testing affect proficiency.
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            The teaching and practice of cardiac auscultation during internal medicine and cardiology training. A nationwide survey.

            To assess the time and importance given to cardiac auscultation during internal medicine and cardiology training and to evaluate the auscultatory proficiency of medical students and physicians-in-training. A nationwide survey of internal medicine and cardiology program directors and a multicenter cross-sectional assessment of students' and housestaff's auscultatory proficiency. All accredited U.S. internal medicine and cardiology programs and nine university-affiliated internal medicine and cardiology programs. Four hundred ninety-eight (75.6%) of all 659 directors surveyed; 203 physicians-in-training and 49 third-year medical students. Directors completed a 23-item questionnaire, and students and trainees were tested on 12 prerecorded cardiac events. The teaching and proficiency of cardiac auscultation at all levels of training. Directors attributed great importance to cardiac auscultation and thought that more time should be spent teaching it. However, only 27.1% of internal medicine and 37.1% of cardiology programs offered any structured teaching of auscultation (P = 0.02). Programs without teaching were more likely to be large, university affiliated, and located in the northeast. The trainees' accuracy ranged from 0 to 56.2% for cardiology fellows (median, 21.9%) and from 2% to 36.8% for medical residents (median, 19.3%). Residents improved little with year of training and were never better than third-year medical students. A low emphasis on cardiac auscultation appears to have affected the proficiency of medical trainees. Our study raises concern about the future of this time-honored art and, possibly, other bedside diagnostic skills.
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              Clinical auscultation skills in pediatric residents.

              The aim of this study is to determine the level of clinical auscultation skills in pediatric residents at Duke University Medical Center. Forty-seven residents from pediatrics and joint medicine/pediatrics training programs at Duke University Medical Center were enrolled in this study. They were asked to examine the cardiovascular patient simulator, Harvey, and report their findings. Five common conditions seen in the pediatric population were presented: ventricular septal defect, atrial septal defect, pulmonary valve stenosis, combined aortic valve stenosis and insufficiency, and innocent systolic ejection murmur. The responses were scored by the number of features and diagnoses accurately reported. Five pediatric cardiologists and cardiologists in training were also asked to participate in a manner similar to the trainees. The mean score of features identified for the resident group was 11.4 +/- 2.6 of a possible 19. The diagnostic accuracy was 33%. There was no significant difference between residents by year of training or by type of residency program, although there was a trend toward improved performance with more training. The difference in performance between the pediatric cardiology group and the residents group was striking. The condition that was most frequently misdiagnosed was the innocent systolic ejection murmur. The clinical auscultation skills of pediatric residents in this study were suboptimal. There was a trend toward improvement as training progressed, although not statistically significant. These skills are likely to improve further with increased exposure to patients with cardiovascular disease especially in the ambulatory care setting.
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                Author and article information

                Journal
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                1472-6920
                2005
                9 May 2005
                : 5
                : 14
                Affiliations
                [1 ]University of Oslo, Faculty of Medicine, Oslo, Norway
                [2 ]Department of Cardiology, Ullevål University Hospital, Oslo, Norway
                Article
                1472-6920-5-14
                10.1186/1472-6920-5-14
                1131903
                15882458
                0f36bc52-0366-48d4-bc43-4d307e211fec
                Copyright © 2005 Høyte et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 1 March 2005
                : 9 May 2005
                Categories
                Research Article

                Education
                Education

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