Confidential Testing of Cardiac Examination Competency in Cardiology and Noncardiology Faculty and Trainees: A Multicenter Study

Abstract

Background: Many reported studies of medical trainees and physicians have demonstrated major deficiencies in correctly identifying heart sounds and murmurs, but cardiologists had not been tested. We previously confirmed these deficiencies using a 50-question multimedia cardiac examination (CE) test featuring video vignettes of patients with auscultatory and visible manifestations of cardiovascular pathology (virtual cardiac patients). Previous testing of 62 internal medical faculty yielded scores no better than those of medical students and residents. Hypothesis:In this study, we tested whether cardiologists outperformed other physicians in cardiac examination skills, and whether years in practice correlated with test performance. Methods: To obviate cardiologists' reluctance to be tested, the CE test was installed at 19 US teaching centers for confidential testing. Test scores and demographic data (training level, subspecialty, and years in practice) were uploaded to a secure database. Results: The 520 tests revealed mean scores (out of 100 ± 95% confidence interval) in descending order: 10 cardiology volunteer faculty (86.3 ± 8.0), 57 full-time cardiologists (82.0 ± 3.3), 4 private-practice cardiologists (77.0 ± 6.8), and 19 noncardiology faculty (67.3 ± 8.8). Trainees' scores in descending order: 150 cardiology fellows (77.3 ± 2.1), 78 medical students (63.7 ± 3.5), 95 internal medicine residents (62.7 ± 3.2), and 107 family medicine residents (59.2 ± 3.2). Faculty scores were higher in those trained earlier with longer practice experience. Conclusions: Academic and volunteer cardiologists outperformed other medical faculty, as did cardiology fellows. Lower scores were observed in more recently trained faculty. Remote testing yielded scores similar to proctored tests in comparable groups previously studied. No significant improvement was seen after medical school with residency training.

Development of a hospitalist‐led‐and‐directed physical examination curriculum

“…For example, cardiac examination skills have been shown to improve during the early years of medical school and then plateau by the third year, with no measurable improvement through residency or beyond without fellowship training. [1][2][3] Despite efforts by residency programs to promote bedside teaching, many general medicine faculty shy away due to lack of confidence and comfort in teaching physical diagnosis. 4 The presence of hospitalists increases satisfaction among trainees with inpatient teaching, 5 and medical faculty's ability has been shown to positively impact medical students' test scores.…”

A novel bedside cardiopulmonary physical diagnosis curriculum for internal medicine postgraduate training

“…In general, performance on the assessment peaks during the third year of medical school, compared to other medical school years, internal medicine residency and general practice. Only cardiology fellows and cardiology faculty outperform other groups on the assessment [20][21][22]. Incoming interns from 2015-2016 and 2016-2017 took the CE two weeks prior to the start of intern year and at the midpoint of the year.…”

“…It is not surprising that less time at the bedside has contributed to a measurable decline in physical exam skills [13][14][15][16][17], in part due to a decreased emphasis on physical diagnosis teaching and practice [7,15,18,19]. Alarmingly, some studies have shown that physical exam skills, particularly cardiovascular exams skills, peak during medical school and decline during residency and beyond [20][21][22]. Physical exam findings directly and immediately affect patient outcomes; a decline in exam skills could have adverse effects on patient care [23,24].…”

“…Cardiovascular physical exam skills peak during medical school and decline thereafter in non-cardiologists [20][21][22], providing an important opportunity for an educational intervention. The curriculum Advancing Bedside Cardiopulmonary Examination Skills (ACE), was developed to improve the cardiopulmonary physical diagnosis skills of trainees in a large internal medicine training program.…”

Physical Examination Education in Graduate Medical Education—A Systematic Review of the Literature

“…Despite decades of pleas to reprioritize PE, 9 GME training in aspects of PE is underemphasized whenever formally assessed. [10][11][12][13][14] Furthermore, residents' examination skills in many contexts, including cardiovascular, pulmonary, breast, rheumatologic, and genitourinary systems, among others, [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] are suboptimal.…”