Cardiac Physical Diagnosis in the Digital Age: An Important but Increasingly Neglected Skill (from Stethoscopes to Microchips)

Conn, Robert D.; O’Keefe, James H.

doi:10.1016/j.amjcard.2009.04.030

Cited by 30 publications

(19 citation statements)

References 20 publications

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“…55 Fortunately, many limitations of the classic mechanical acoustic tool can be easily compensated by modern digital/ computer technology, including the ability to store and play audio and graphic representations of heart, vascular, and pulmonary sounds. 56,57 Such technology offers promise in the classroom, learning lab, and at computer terminals, to provide initial instruction with audio and video files. Medical simulation scenarios with standardized patients or manikins allow learners to integrate acoustic data with related clinical information.…”

Section: Discussionmentioning

confidence: 99%

Technology for Enhancing Chest Auscultation in Clinical Simulation

Ward

Wattier

2011

Respir Care

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The ability to use an acoustic stethoscope to detect lung and/or heart sounds, and then to then communicate one's interpretation of those sounds is an essential skill for many medical professionals. Interpretation of lung and heart sounds, in the context of history and other examination findings, often aids the differential diagnosis. Bedside assessment of changing auscultation findings may also guide treatment. Learning lung and heart auscultation skills typically involves listening to pre-recorded normal and adventitious sounds, often followed by laboratory instruction to guide stethoscope placement, and finally correlating the sounds with the associated pathophysiology and pathology. Recently, medical simulation has become an important tool for teaching prior to clinical practice, and for evaluating bedside auscultation skills. When simulating cardiovascular or pulmonary problems, high-quality lung and heart sounds should be able to accurately corroborate other findings such as vital signs, arterial blood gas values, or imaging. Digital audio technology, the Internet, and high-fidelity simulators have increased opportunities for educators and learners. We review the application of these technologies and describe options for reproducing lung and heart sounds, as well as their advantages and potential limitations.

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Section: Discussionmentioning

confidence: 99%

Technology for Enhancing Chest Auscultation in Clinical Simulation

Ward

Wattier

2011

Respir Care

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“…4 The traditional bedside physical examination has been on the decline within internal medicine for several years for various reasons. [5][6][7][8][9] This increase in ambiguity in diagnosis is potentially unsettling to internal medicine physicians who see a variety of complex presentations and want to "do no harm." Globally, medical education still emphasizes teaching traditional physical examination; however, no patient outcomes data justify application of physical examination techniques learned for commonly encountered clinical conditions.…”

mentioning

confidence: 99%

Point-of-Care Ultrasonography for Primary Care Physicians and General Internists

Bhagra

Tierney

Sekiguchi

et al. 2016

Mayo Clinic Proceedings

186

151

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Point-of-care ultrasonography (POCUS) is a safe and rapidly evolving diagnostic modality that is now utilized by health care professionals from nearly all specialties. Technological advances have improved the portability of equipment, enabling ultrasound imaging to be executed at the bedside and thereby allowing internists to make timely diagnoses and perform ultrasound-guided procedures. We reviewed the literature on the POCUS applications most relevant to the practice of internal medicine. The use of POCUS can immediately narrow differential diagnoses by building on the clinical information revealed by the traditional physical examination and refining clinical decision making for further management. We describe 2 common patient scenarios (heart failure and sepsis) to highlight the impact of POCUS performed by internists on efficiency, diagnostic accuracy, resource utilization, and radiation exposure. Using POCUS to guide procedures has been found to reduce procedure-related complications, along with costs and lengths of stay associated with these complications. Despite several undisputed advantages of POCUS, barriers to implementation must be considered. Most importantly, the utility of POCUS depends on the experience and skills of the operator, which are affected by the availability of training and the cost of ultrasound devices. Additional system barriers include availability of templates for documentation, electronic storage for image archiving, and policies and procedures for quality assurance and billing. Integration of POCUS into the practice of internal medicine is an inevitable change that will empower internists to improve the care of their patients at the bedside.

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“…Clinicians use the cardiovascular physical exam as a non-invasive tool to directly diagnose and assess severity of disease and guide further evaluation. 1 However, multiple studies have documented the weak cardiac physical examination skills of trainees and clinicians. 2,3 The optimal approach to teaching cardiac physical examination remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Simulation-Based Training for Cardiac Auscultation Skills: Systematic Review and Meta-Analysis

et al. 2012

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OBJECTIVES:The current review examines the effectiveness of simulation-based medical education (SBME) for training health professionals in cardiac physical examination and examines the relative effectiveness of key instructional design features. METHODS: Data sources included a comprehensive, systematic search of MEDLINE, EMBASE, CINAHL, PsychINFO, ERIC, Web of Science, and Scopus through May 2011. Included studies investigated SBME to teach health profession learners cardiac physical examination skills using outcomes of knowledge or skill. We carried out duplicate assessment of study quality and data abstraction and pooled effect sizes using random effects. RESULTS: We identified 18 articles for inclusion. Thirteen compared SBME to no-intervention (either single group pre-post comparisons or SBME added to other instruction common to all learners, such as traditional bedside teaching), three compared SBME to other educational interventions, and two compared two SBME interventions. Meta-analysis of the 13 no-intervention comparison studies demonstrated that simulation-based instruction in cardiac auscultation was effective, with pooled effect sizes of 1.10 (95 % CI 0.49-1.72; p<0.001; I 2 =92.4 %) for knowledge outcomes and 0.87 (95 % CI 0.52-1.22; p<0.001; I 2 = 91.5 %) for skills. In sub-group analysis, hands-on practice with the simulator appeared to be an important teaching technique. Narrative review of the comparative effectiveness studies suggests that SBME may be of similar effectiveness to other active educational interventions, but more studies are required. LIMITATIONS: The quantity of published evidence and the relative lack of comparative effectiveness studies limit this review. CONCLUSIONS: SBME is an effective educational strategy for teaching cardiac auscultation. Future studies should focus on comparing key instructional design features and establishing SBME's relative effectiveness compared to other educational interventions.

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Cardiac Physical Diagnosis in the Digital Age: An Important but Increasingly Neglected Skill (from Stethoscopes to Microchips)

Cited by 30 publications

References 20 publications

Technology for Enhancing Chest Auscultation in Clinical Simulation

Technology for Enhancing Chest Auscultation in Clinical Simulation

Point-of-Care Ultrasonography for Primary Care Physicians and General Internists

Simulation-Based Training for Cardiac Auscultation Skills: Systematic Review and Meta-Analysis

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