Cardiac Examination Skills

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Heart Examination

Based on findings from a computer-based, multimedia, interactive test, cardiac examination skills do not appear to differ among third-year medical students, resident physicians, faculty members or private practitioners, but may decline after years in practice, according to a study in the March 27 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

Cardiac examination involves many of the senses, as physicians look at and touch the patient and listen to the heart sounds of the patient while considering the individual's history and symptoms, according to background information in the first article. The process is highly effective when performed correctly, but skills appear to be in decline, with one recent study finding serious errors in two-thirds of patients examined. New, high-tech devices, including multimedia CD-ROMs, electronic heart sound simulators and mannequins have been developed to aid in teaching, but none of these can replace contact with and repeated practice on patients, the authors write.

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Jasminka M. Vukanovic-Criley, M.D., Stanford University School of Medicine, California, and colleagues used a 50-question, computer-based multimedia test to evaluate the cardiac examination skills of 860 participants. Of those, 318 were medical students, 289 were resident physicians, 85 were cardiology fellows, 131 were physicians (including faculty members and private practitioners) and 37 were others (including nurses, researchers and administrators). Participants took the test at one of 16 sites in the United States and Venezuela between July 2000 and January 2004.

Average competency scores of third- and fourth-year medical students were significantly higher than those of first- and second-year medical students. However, there was no difference in average score between third- and fourth-year medical students, resident physicians and practicing physicians, including faculty. Cardiology fellows performed significantly better than all other groups.

"Cardiac examination skills do not improve after MS3 (the third year of medical school) and may decline after years in practice, which has important implications for medical decision making, patient safety, cost-effective care and continuing medical education," the authors conclude. "Improvement in cardiac examination competency will require training in simultaneous audio and visual examination in faculty and trainees." (Arch Intern Med. 2006;166:610-616)

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