title: Comparison of two educational interventions on pediatric resident auscultation skills.
abstract: OBJECTIVE
  Multiple cross-sectional physician surveys have documented poor cardiac auscultation skills. We evaluated the impact of 2 different educational interventions on pediatric resident auscultation skills.
  
  
  METHODS
  The auscultation skills of all first-year (PGY1; n = 20) and second-year pediatric residents (PGY2; n = 20) were evaluated at the beginning and end of the academic year. Five patient recordings were presented: atrial septal defect, ventricular septal defect, pulmonary valve stenosis, bicuspid aortic valve with insufficiency, and innocent murmur. Residents were asked to classify the second heart sound, identify a systolic ejection click, describe the murmur, and provide a diagnosis. All PGY1 and most PGY2 (14 of 20) participated on the inpatient cardiology service for 1 month. PGY2 on the cardiology service also attended outpatient clinic. PGY1 did not attend outpatient clinic but were allotted 2 hours/week to use a self-directed cardiac auscultation computer teaching program.
  
  
  RESULTS
  Resident auscultation skills on initial evaluation were dependent on training level (PGY1: 42 +/- 15% correct; PGY2: 53 +/- 13% correct), primarily as a result of better classification of second heart sound (PGY1: 45%; PGY2: 63%) and diagnosis of an innocent murmur (PGY1: 35%; PGY2: 65%). There was no difference in the ability to identify correctly a systolic ejection click (20% vs 23%) or to arrive at the correct diagnosis (35% vs 40%). At the end of the academic year, the PGY1 scores improved by 21%, primarily as a result of improved diagnostic accuracy of the innocent murmur (35% to 65%). PGY2 scores remained unchanged (53% vs 51%), regardless of participation in a cardiology rotation (cardiology rotation: 50%; no cardiology rotation: 51%). Combined, diagnostic accuracy was best for ventricular septal defect (55%) and innocent murmur (60%) and worst for atrial septal defect (18%) and pulmonary valve stenosis (15%). However, 40% identified the innocent murmur as pathologic and 21% of pathologic murmurs were diagnosed as innocent.
  
  
  CONCLUSIONS
  Pediatric resident auscultation skills were poor and did not improve after an outpatient cardiology rotation. Auscultation skills did improve after the use of a self-directed cardiac auscultation teaching program. These data have relevance given the American College of Graduate Medical Education's emphasis on measuring educational outcomes and documenting clinical competencies during residency training.
authors.affiliation: Division of Pediatric Cardiology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA. christopher.mahnke@haw.tamc.amedd.army.mil
authors.forename: C Becket
authors.initials: CB
authors.lastname: Mahnke
authors.forename: Andrew
authors.initials: A
authors.lastname: Nowalk
authors.forename: Dena
authors.initials: D
authors.lastname: Hofkosh
authors.forename: James R
authors.initials: JR
authors.lastname: Zuberbuhler
authors.forename: Yuk M
authors.initials: YM
authors.lastname: Law
mesh_terms: D002309:Cardiology / Q000193:education; D002648:Child; D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D006326:Heart Auscultation; D006337:Heart Murmurs / Q000175:diagnosis; D006801:Humans; D007396:Internship and Residency; D010372:Pediatrics / Q000193:education*; D013663:Teaching / Q000379:methods