title: The teaching of chest auscultation during primary care training: has anything changed in the 1990s?
abstract: OBJECTIVE
  To survey the teaching time and importance given to cardiopulmonary auscultation during internal medicine (IM) and family practice (FP) residencies, and to compare current practices to those of the early 1990s.
  
  
  METHODS
  A nationwide mail survey of IM and FP program directors (PDs).
  
  
  METHODS
  All Accreditation Council for Graduate Medical Education-accredited IM and FP residencies.
  
  
  METHODS
  A total of 538 of 939 PDs (57.5%).
  
  
  RESULTS
  In contrast to the early 1990s, when there had been no significant difference in teaching practices between IM and FP programs, more IM than FP residencies taught cardiopulmonary auscultation in 1999 (cardiac auscultation: IM residencies, 48%; FP residencies, 29.2% [p < 0.001]; pulmonary auscultation: IM residencies, 23.7%; FP residencies, 12.2% [p < 0.001]). Across the decade there also had been a significant increase in the percentage of IM programs offering structured education in chest auscultation (cardiac auscultation increase, 27.1 to 48% [p < 0.001]; pulmonary auscultation increase, 14.1 to 23.7% [p < 0.02]), but no significant changes for FP residencies. IM PDs gave more clinical importance to auscultation and expressed a greater desire for expanded teaching than did their counterparts in FP programs.
  
  
  CONCLUSIONS
  This study indicates a significant gain over the last decade in the percentage of IM residencies offering structured teaching of cardiopulmonary auscultation. This same gain did not occur for FP programs. Whether these differences in attitudes and teaching practices will translate into improved auscultatory proficiency of IM trainees will need to be determined.
authors.affiliation: Department of Medicine, Center for Research in Medical Education and Health Care, and Clinical Skills Center of Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA. salvatore.mangione@mail.tju.edu
authors.forename: Salvatore
authors.initials: S
authors.lastname: Mangione
authors.forename: F Daniel
authors.initials: FD
authors.lastname: Duffy
mesh_terms: D001314:Auscultation / Q000639:trends; D006326:Heart Auscultation / Q000639:trends*; D006801:Humans; D007396:Internship and Residency; D008168:Lung / Q000503:physiopathology; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D014481:United States