Assessing Housestaff Diagnostic Skills Using a Cardiology Patient Simulator

Clair, E. William St.

doi:10.7326/0003-4819-117-9-751

Cited by 141 publications

(66 citation statements)

References 6 publications

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“…Cardiac auscultation skills in various training programs, including pediatrics, have been documented to be poor. [6][7][8] Four conditions (patent ductus arteriosus, ventricular septal defect, innocent murmur, and pulmonary branch murmur of infancy) accounted for 91% of diagnoses for patients with murmurs. Initially developing stethoscope skills among pediatric residents for the detection of these conditions should fulfill clinical needs frequently.…”

Section: Discussionmentioning

confidence: 99%

Conditions Leading to Pediatric Cardiology Consultation in a Tertiary Academic Hospital

Geggel

2004

Pediatrics

126

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ABSTRACT. Objective. To determine the basis for cardiac consultations for pediatric patients in an academic hospital setting.Methods. The activities of the cardiology consultation service were tabulated for 12 months, from July 2001 to June 2002. Patients were identified from 4 sources, ie, a monthly log of patient encounters maintained by the consultation service, encounter forms submitted to the billing office, consultation notes maintained in a central file, and a departmental list of echocardiography studies. Patients who required clearance for noncardiac surgical procedures were generally evaluated in the cardiology clinic and not by the consultation service. Patient data were obtained from consultation and echocardiography reports and from hospital computer-based records for discharge summaries for inpatient admissions, emergency department encounter summaries, and laboratory reports. For each patient, consultations were tabulated as separate encounters if they occurred on different days in the emergency department, during separate admissions, or for different clinical concerns during a single admission.Results. A total of 2071 consultations were performed for 1724 patients. The age at the time of consultation was 6.6 ؎ 9.3 years (median: 1.2 years; range: 1 day to 60.6 years). A total of 1507 patients (87.4%) had a single consultation; 217 patients (12.6%) had multiple encounters, ranging from 2 to 9, accounting for 564 consultations (27.2%). Clinical concerns included murmurs (18.5%), cardiac function (12.7%), arrhythmias (12.7%), intercurrent illnesses among cardiac patients (11.3%), cyanosis (6.3%), syndromes (5.7%), chest pain (5.2%), syncope/dizziness (4.5%), subacute endocarditis (4.4%), follow-up evaluations of fetal diagnoses (4.3%), Kawasaki disease (3.4%), cor pulmonale (3%), recent cardiac surgery or catheterization (1.6%), cerebrovascular accidents (1.2%), and miscellaneous conditions. Four diagnoses accounted for 91% of murmur evaluations, ie, patent ductus arteriosus, ventricular septal defects, innocent murmurs, and pulmonary branch murmur of infancy. The most common murmur diagnosis in the neonatal intensive care unit was patent ductus arteriosus (68%), in the well-child nursery was ventricular septal defect (64%), and on the medical ward was innocent murmur (62%). The most common basis for evaluation of function was oncologic disease. Among patients evaluated for function, there were 3 new diagnoses of structural congenital heart disease, all involving neonates with aortic arch obstruction. Approximately two-thirds of arrhythmias were supraventricular in origin. The most common arrhythmias requiring treatment were supraventricular tachycardia and atrial flutter/fibrillation, the latter occurring mainly among older patients with structural heart disease. Diagnoses made with fetal echocardiography accounted for 14.3% of newborn consultations and included 83% of patients with cyanotic cardiac disease. Three syndromes accounted for 57% of consultations for this indication, ie, VACTERL associa...

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Section: Discussionmentioning

confidence: 99%

Conditions Leading to Pediatric Cardiology Consultation in a Tertiary Academic Hospital

Geggel

2004

Pediatrics

126

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“…Recent studies evaluating skills in performing physical examinations by medical students, housestaff , and even medical school faculty have uniformly shown a 20% to 80% error rate in recognizing actual or simulated fi ndings (1)(2)(3)(4)(5). Such defi ciencies An underappreciated problem with auscultation Allen B. Weisse, MD can only be exacerbated by improper auscultatory technique such as that described here.…”

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confidence: 96%

An Underappreciated Problem with Auscultation

Weisse¹

2013

Baylor University Medical Center Proceedings

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“…The decline in cardiovascular (CV) physical examination (PE) skills, especially for cardiac auscultation, has been well documented (2) . Studies assessing PE skills have shown important mistake and oversight rates for physicians at all levels of training (3) . Bedside echocardiography can bring important anatomical and hemodynamic information for the management of hospitalized patients.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Ultraportable Cardiac Echocardiography with Physical Examination for Diagnosis and Management during Cardiac Consultation Rounds

Astarcıoğlu¹,

Sen²,

Kılıt³

et al. 2016

Kosuyolu Heart Journal

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Introduction: The purpose of this study was to compare the results of physical examinations (PEs) performed by a cardiologist with the results of point-of-care echocardiography for the diagnosis and management of patients during cardiac consultation rounds. Patients and Methods:In all, 265 hospitalized consecutive patients from non-cardiac units (age, 62 ± 11; male, 56%) were included after complete cardiovascular (CV) examination by a consulting cardiologist. After the PE, the consulting cardiologist imaged each patient using a hand-carried cardiac ultrasound (HCU). All patients subsequently underwent a study with a standard echocardiographic device (SED) as the gold standard, performed on an upper-end platform. Defi nitive diagnosis, management change, and modifying diagnostic workup were also assessed.Results: There were 196 CV fi ndings detected with an SED in this patient population. Of these, PE failed to detect 41% of the overall CV fi ndings and HCU missed 23% of the overall CV pathology. Overall, HCU had an effect on patient treatment decisions in 149 patients (56%); 42% had a change in medical therapy and 21% had a change in their diagnostic workup (most with changes in both). Conclusion:HCU echocardiographic assessment during consultation rounds improved the detection of signifi cant CV pathology. Also, a direct assessment of cardiac function and anatomy at the bedside by an experienced cardiologist with HCU as a routine adjunct to PE results in an important change in clinical management and diagnostic workup during consultation.Key Words: Hand-carried cardiac ultrasound; point-of-care screening Kardiyak Konsültasyonlar Esnasında Tanı ve Tedavide Taşınabilir Ekokardiyografi Cihazları ile Birlikte Fizik Muayenenin Karşılaştırılması ÖZETGiriş: Bu çalışmanın amacı, kardiyak konsültasyon esnasında tanı ve tedavi üzerinde ekokardiyografi sonuç-ları ile kardiyolog tarafından gerçekleştirilen fi zik muayene sonuçlarını karşılaştırmaktır.

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Assessing Housestaff Diagnostic Skills Using a Cardiology Patient Simulator

Cited by 141 publications

References 6 publications

Conditions Leading to Pediatric Cardiology Consultation in a Tertiary Academic Hospital

Conditions Leading to Pediatric Cardiology Consultation in a Tertiary Academic Hospital

An Underappreciated Problem with Auscultation

Comparison of Ultraportable Cardiac Echocardiography with Physical Examination for Diagnosis and Management during Cardiac Consultation Rounds

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