Effectiveness of Teaching Cardiac Auscultation to Residents During an Elective Pediatric Cardiology Rotation
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This study aimed to assess the effectiveness of randomized tracks of prerecorded cardiac sounds as a teaching tool for cardiac auscultation. The study focused on recognizing murmurs when present, distinguishing functional from organic murmurs, and detecting heart disease by auscultation. At both pre- and posttesting, 26 residents listened to 15 randomized tracks of live-recorded cardiac sounds and identified key features. The results indicate that the residents improved at detecting any murmur (66% vs 76%, p = 0.007) and functional murmur (37% vs 54%, p = 0.048), and marginally improved at detecting organic murmur (75% vs 84%, p = 0.129). Detection of absence of murmur declined slightly (69% vs 62%, p = 0.723). The posttest difference in identifying organic versus functional murmurs was striking (84% vs 54%, p < 0.001). Detection of heart disease (sensitivity) improved significantly (76% to 86%, p = 0.016), but there was scant improvement in detecting no disease (specificity) (55% vs 59%, p = 0.601). The residents increased in their ability to detect heart disease when present. However, the false-positive rate for a diagnosis of heart disease remained quite high. To ensure that appropriate referrals will be made, teaching should specifically target the confident recognition of functional murmurs.
KeywordsCardiac auscultation Residents Teaching
The authors are most grateful to Mr. Benito Berardo, their research assistant/study coordinator, for his efforts and great skill at writing study documents, preparing test materials including the CDs, meeting timelines for data collection, scoring the results, and generally motivating the project. We also thank Dr. Kenneth Goertz, Chief of Pediatric Cardiology, for his assistance in coding our heart sounds for reliability and validity purposes. This research was supported in part by a grant from the University of Kansas, Department of Pediatrics. Portions of the Methods and Results sections were reported at the Association for the Advancement of Behavior Therapy, Reno, Nevada in November 2002, and at the Pediatric Academic Societies, San Francisco, California in May 2006.