The teaching and practice of cardiac auscultation during internal medicine and cardiology training. A nationwide survey.
OBJECTIVE
To assess the time and importance given to cardiac auscultation during internal medicine and cardiology training and to evaluate the auscultatory proficiency of medical students and physicians-in-training.


METHODS
A nationwide survey of internal medicine and cardiology program directors and a multicenter cross-sectional assessment of students' and housestaff's auscultatory proficiency.


METHODS
All accredited U.S. internal medicine and cardiology programs and nine university-affiliated internal medicine and cardiology programs.


METHODS
Four hundred ninety-eight (75.6%) of all 659 directors surveyed; 203 physicians-in-training and 49 third-year medical students.


METHODS
Directors completed a 23-item questionnaire, and students and trainees were tested on 12 prerecorded cardiac events.


METHODS
The teaching and proficiency of cardiac auscultation at all levels of training.


RESULTS
Directors attributed great importance to cardiac auscultation and thought that more time should be spent teaching it. However, only 27.1% of internal medicine and 37.1% of cardiology programs offered any structured teaching of auscultation (P = 0.02). Programs without teaching were more likely to be large, university affiliated, and located in the northeast. The trainees' accuracy ranged from 0 to 56.2% for cardiology fellows (median, 21.9%) and from 2% to 36.8% for medical residents (median, 19.3%). Residents improved little with year of training and were never better than third-year medical students.


CONCLUSIONS
A low emphasis on cardiac auscultation appears to have affected the proficiency of medical trainees. Our study raises concern about the future of this time-honored art and, possibly, other bedside diagnostic skills.
Department of Medicine, Medical College of Pennsylvania, Philadelphia 19129.
S
S
Mangione
L Z
LZ
Nieman
E
E
Gracely
D
D
Kaye
D001291:Attitude of Health Personnel; D002309:Cardiology / Q000193:education*; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003479:Curriculum / Q000706:statistics & numerical data*; D004504:Education, Medical, Undergraduate; D005257:Fellowships and Scholarships; D006326:Heart Auscultation / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D011795:Surveys and Questionnaires; D014481:United States