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Abstract
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.