Teaching Cardiac Auscultation: Effectiveness of a Patient-Centered Teaching Conference on Improving Cardiac Auscultatory Skills

March, S. Kimara; Bedynek, Julius L.; Chizner, Michael A.

doi:10.4065/80.11.1443

Cited by 49 publications

(29 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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.…”

mentioning

confidence: 74%

An Underappreciated Problem with Auscultation

Weisse¹

2013

Baylor University Medical Center Proceedings

View full text Add to dashboard Cite

mentioning

confidence: 74%

An Underappreciated Problem with Auscultation

Weisse¹

2013

Baylor University Medical Center Proceedings

View full text Add to dashboard Cite

“…24,25 Relying on stethoscope auscultation alone is extremely challenging, since these sounds are often very soft with low amplitude in close proximity to louder, high-frequency first and second heart sounds. The teaching strategy of intensive repetition requires that students listen to heart sound recordings over 500 times in order to achieve ausculatory proficiency.…”

Section: Discussionmentioning

confidence: 99%

Experienced Clinicians Improve Detection of Third and Fourth Heart Sounds by Viewing Acoustic Cardiography

Michaels

Khan

Moyers

2010

Clinical Cardiology

View full text Add to dashboard Cite

Background: Clinical assessment of diastolic heart sounds is challenging. Hypothesis: We sought to examine whether visual inspection of acoustic cardiographic tracings augments the accuracy of medical students' and physicians' detection of third and fourth heart sounds (S 3 , S 4 ) compared to auscultation alone. Methods: A total of 90 adults referred for left heart catheterization underwent digital precordial heart sound recordings by computerized acoustic cardiography. Two blinded, experienced readers using a consensus method determined the presence of the S 3 /S 4 on each file. There were 35 subjects from the following 5 groups participating in this study from 1 teaching institution: first-year medical students (n = 5), fourth-year medical students (n = 5), interns (n = 5), medicine residents (n = 5), cardiology fellows (n = 5), and attendings (n = 10). Using a computer module, each subject listened to the heart sounds alone and documented whether an S 3 /S 4 was present. Next, subjects listened to each recording in random order while viewing phonocardiographic tracings, and recorded S 3 /S 4 presence. Results: An S 3 was present in 21 patients (23%) and an S 4 in 31 patients (34%) by consensus overread in 90 recordings. Baseline accuracy for auscultation of S 3 /S 4 did not change with level of experience. While viewing the acoustic cardiogram, first-year medical students had minimal improvement in S 3 (2%) and S 4 (11%) accuracy. More experienced subjects improved S 3 accuracy by 8% to 18% and S 4 by 15% to 32% (P < .05). Accuracy was superior for S 3 compared to S 4 in all ausculatory groups. Conclusions: While listening to heart sound recordings, viewing acoustic cardiography increased subjects' accuracy in detecting diastolic heart sounds, particularly among more experienced subjects. There was greater improvement for S 4 compared to S 3 detection. BackgroundThe atrial and ventricular gallop was first described in the literature by Potain in 1880. 1 The low-pitched third heart sound (S 3 ) is known as the ventricular gallop, and occurs 0.12 to 0.16 seconds after the second heart sound in diastole. The S 3 is caused by the sudden deceleration of rapid diastolic filling into a distended or incompliant ventricle.2 The fourth

show abstract

“…Fortunately, cardiac auscultation is a skill that can be taught. Teaching interventions involving repetition of heart sounds, such as with recordings and multimedia tools, have been found to effectively improve auscultatory skills [10–13], but teaching that is solely theoretical is thought to be ineffective [14]. …”

Section: Introductionmentioning

confidence: 99%

Digital devices for teaching cardiac auscultation - a randomized pilot study

Legget

Toh

Meintjes

et al. 2018

Medical Education Online

View full text Add to dashboard Cite

Background: Competent cardiac auscultation is a declining skill. Digital stethoscopes and hand-held echocardiography (HHE) are modern devices which may improve the accuracy of heart murmur recognition and diagnosis. Their incremental value compared to conventional examination has not been evaluated in depth.Objectives: Our aim was to quantify the utility of digital stethoscopes and HHE as teaching aids to improve medical students’ diagnostic accuracy in the evaluation of heart murmurs using a novel clinically weighted scoring system.Design: This pilot study involved eight medical students and eight patients with heart murmurs. Four patients were examined at 2 sessions, 1 week apart. Medical students were randomised into two groups: the ‘intervention group’ examined patients with a standard and digital stethoscope, and then received demonstration of the valvular lesion with HHE to illustrate the diagnosis. The ‘control group’ used a standard stethoscope only and were taught using traditional methods. Students’ scores were compared to a ‘gold standard’ derived from a consensus of auscultation findings of three cardiologists.Results: Overall the mean percent correct of total possible score was 65.4% (SD8.4). Using a mixed models ANOVA approach to repeated measures, the mean [95% CI] increase from training to validation period for the control group was 2.5% [−11.5, 16.5] P(Tukey) = 0.95 and 15.8% [1.7,29.8] P(Tukey) = 0.027 for the intervention group. Between the validation and training sessions for both groups, there was an increase of 9.1% [1.82, 16.4] in scores (p = 0.018). The mean [95% CI] difference in scores of the control and intervention groups was 1.9% [−5.4, 9.2] (p = 0.59). The Cohen’s effect size estimate was 0.9.Conclusion: Digital stethoscopes and hand-held echo may be useful devices for teaching cardiac auscultation. This pilot study provides a novel study design, a heart murmur grading system, and data that will help develop definitive studies to assess new teaching techniques for cardiac auscultation using digital technology.

show abstract

Teaching Cardiac Auscultation: Effectiveness of a Patient-Centered Teaching Conference on Improving Cardiac Auscultatory Skills

Cited by 49 publications

References 30 publications

An Underappreciated Problem with Auscultation

An Underappreciated Problem with Auscultation

Experienced Clinicians Improve Detection of Third and Fourth Heart Sounds by Viewing Acoustic Cardiography

Digital devices for teaching cardiac auscultation - a randomized pilot study

Contact Info

Product

Resources

About