Skills of primary healthcare physicians in paediatric cardiac auscultation

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.

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.