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Ann Intern Med. 1993 Jul 1;119(1):47-54.

The teaching and practice of cardiac auscultation during internal medicine and cardiology training. A nationwide survey.

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1
Department of Medicine, Medical College of Pennsylvania, Philadelphia 19129.

Abstract

OBJECTIVES:

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.

STUDY DESIGN:

A nationwide survey of internal medicine and cardiology program directors and a multicenter cross-sectional assessment of students' and housestaff's auscultatory proficiency.

SETTING:

All accredited U.S. internal medicine and cardiology programs and nine university-affiliated internal medicine and cardiology programs.

PARTICIPANTS:

Four hundred ninety-eight (75.6%) of all 659 directors surveyed; 203 physicians-in-training and 49 third-year medical students.

INTERVENTIONS:

Directors completed a 23-item questionnaire, and students and trainees were tested on 12 prerecorded cardiac events.

MAIN OUTCOME MEASURES:

The teaching and proficiency of cardiac auscultation at all levels of training.

RESULTS:

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.

CONCLUSIONS:

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.

PMID:
8498764
[Indexed for MEDLINE]

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