Teaching cardiac auscultation to trainees in internal medicine and family practice: Does it work?

1) In an academic primary care center, 20 physicians (trainees in internal medicine and family practice) and two skilled academic cardiologists listened to 33 cardiac events in 13 patients directly at bedside and identified the cardiac events by completing an open questionnaire. Heart sounds, murmurs and diagnosis were determined beforehand by an independent skilled cardiologist and were validated by echocardiography. Thirteen primary cardiologic diagnoses were possible.2) Ten of the physicians agreed to participate in a course of 45-minute sessions once a week for 5 months. After the course they listened again to the same patients (pre/post-interventional study).1) The experts were the most skillful, achieving 69% recognition of heart sounds and murmurs and correct diagnoses in 62% of cases. They also heard all of the diastolic murmurs. The residents heard only 40% of the extra heart sounds and made a correct diagnosis in 24% of cases. 2) After the weekly training sessions, their mean percentage for correct diagnosis was 35% [an increase of 66% (p < 0.05)].The level of bedside diagnostic skills in this relatively small group of physicians in training is indeed low, but can be improved by a course focusing on realistic bedside teaching.Cardiac auscultation is considered as an important tool for doctors in obtaining a precise cardiovascular evaluation and ensuring a cost-effective approach in outpatient-based medicine [1-6].Several recent studies evaluating the performance of clinicians in training have shown disappointing results for cardiac auscultation [7-10]. All of these studies, however, assessed the auscultatory performance of clinicians by using exclusively recordings of events obtained from patients. But since it does not test the real bedside diagnostic skills, this kind of evaluation may not be appropriate. Furthermore, even though medical educators are calling for additional teaching [11], we do not have any information about the possible impact of a beds