 |
 |
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 July 1993 | Volume 119 Issue 1 | Pages 47-54
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.
Author and Article Information
From the Medical College of Pennsylvania, Philadelphia, Pennsylvania.
ACADEMIA AND CLINIC
The Teaching and Practice of Cardiac Auscultation during Internal Medicine and Cardiology Training: A Nationwide Survey
Requests for Reprints: Salvatore Mangione, MD, Department of Medicine, The Medical College of Pennsylvania, 3300 Henry Avenue, Philadelphia, PA 19129.
This article has been cited by other articles:
|
|
 |
|
  S. Dhuper, S. Vashist, N. Shah, and M. Sokal Improvement of Cardiac Auscultation Skills in Pediatric Residents With Training Clinical Pediatrics, April 1, 2007; 46(3): 236 - 240. [Abstract] [PDF]
|
|
|
|
 |
|
 J. M. Vukanovic-Criley, S. Criley, C. M. Warde, J. R. Boker, L. Guevara-Matheus, W. H. Churchill, W. P. Nelson, and J. M. Criley Competency in cardiac examination skills in medical students, trainees, physicians, and faculty: a multicenter study. Arch Intern Med, March 27, 2006; 166(6): 610 - 616. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. E. Tavel Cardiac Auscultation: A Glorious Past--And It Does Have a Future! Circulation, March 7, 2006; 113(9): 1255 - 1259. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Barrett, C. S. Lacey, A. E. Sekara, E. A. Linden, and E. J. Gracely Mastering Cardiac Murmurs: The Power of Repetition Chest, August 1, 2004; 126(2): 470 - 475. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A Woywodt, A Herrmann, J T Kielstein, H Haller, M Haubitz, and H Purnhagen A novel multimedia tool to improve bedside teaching of cardiac auscultation Postgrad. Med. J., June 1, 2004; 80(944): 355 - 357. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Mangione and F. D. Duffy The Teaching of Chest Auscultation During Primary Care Training: Has Anything Changed in the 1990s? Chest, October 1, 2003; 124(4): 1430 - 1436. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. T. Spencer, A. S. Anderson, A. Bhargava, A. C. Bales, M. Sorrentino, K. Furlong, and R. M. Lang Physician-performed point-of-care echocardiography using a laptop platform compared with physical examination in the cardiovascular patient J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2013 - 2018. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Eledrisi and F. C. Luft We Must Save the Art of Medicine Arch Intern Med, June 12, 2000; 160(11): 1701 - 1702. [Full Text] [PDF]
|
|
|
|
|
|
F. I. Marcus The Lost Art of Auscultation Arch Intern Med, November 8, 1999; 159(20): 2396 - 2396. [Full Text] [PDF]
|
|
|
|
|
|
A. Woywodt, M. Hofer, B. Pilz, W. Schneider, R. Dietz, and F. C. Luft Cardiopulmonary Auscultation: Duo for Strings--Opus 99 Arch Intern Med, November 8, 1999; 159(20): 2477 - 2479. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Narula, Y. Chandrasekhar, and S. Rahimtoola Diagnosis of Active Rheumatic Carditis : The Echoes of Change Circulation, October 5, 1999; 100(14): 1576 - 1581. [Full Text] [PDF]
|
|
|
|
|
|
C. P. Gross, G. B. Donnelly, A. B. Reisman, K. A. Sepkowitz, and M. A. Callahan Resident Expectations of Morning Report: A Multi-institutional Study Arch Intern Med, September 13, 1999; 159(16): 1910 - 1914. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. B. Issenberg, W. C. McGaghie, I. R. Hart, J. W. Mayer, J. M. Felner, E. R. Petrusa, R. A. Waugh, D. D. Brown, R. R. Safford, I. H. Gessner, et al. Simulation Technology for Health Care Professional Skills Training and Assessment JAMA, September 1, 1999; 282(9): 861 - 866. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. MANGIONE and L. Z. NIEMAN Pulmonary Auscultatory Skills During Training in Internal Medicine and Family Practice Am. J. Respir. Crit. Care Med., April 1, 1999; 159(4): 1119 - 1124. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Favaloro A Revival of Paul Dudley White : An Overview of Present Medical Practice and of Our Society Circulation, March 30, 1999; 99(12): 1525 - 1537. [Full Text] [PDF]
|
|
|
|
|
|
M. E. Tavel Cardiac Auscultation : A Glorious Past—But Does It Have a Future? Circulation, March 15, 1996; 93(6): 1250 - 1253. [Full Text]
|
|
|
|
|
|
S. Zoneraich and D. H. Spodick Bedside Science Reduces Laboratory Art : Appropriate Use of Physical Findings to Reduce Reliance on Sophisticated and Expensive Methods Circulation, April 1, 1995; 91(7): 2089 - 2092. [Full Text]
|
|
Article
