Teaching cardiac examination skills. A controlled trial of two methods.
OBJECTIVE
To determine if structured teaching of bedside cardiac examination skills improves medical residents' examination technique and their identification of key clinical findings.


METHODS
Firm-based single-blinded controlled trial.


METHODS
Inpatient service at a university-affiliated public teaching hospital.


METHODS
Eighty Internal Medicine residents.


METHODS
The study assessed 2 intervention groups that received 3-hour bedside teaching sessions during their 4-week rotation using either: (1) a traditional teaching method, "demonstration and practice" (DP) (n=26) or (2) an innovative method, "collaborative discovery" (CD) (n=24). The control group received their usual ward teaching sessions (n=25). The main outcome measures were scores on examination technique and correct identification of key clinical findings on an objective structured clinical examination (OSCE).


RESULTS
All 3 groups had similar scores for both their examination technique and identification of key findings in the preintervention OSCE. After teaching, both intervention groups significantly improved their technical examination skills compared with the control group. The increase was 10% (95% confidence interval [CI] 4% to 17%) for CD versus control and 12% (95% CI 6% to 19%) for DP versus control (both P<.005) equivalent to an additional 3 to 4 examination skills being correctly performed. Improvement in key findings was limited to a 5% (95% CI 2% to 9%) increase for the CD teaching method, CD versus control P=.046, equivalent to the identification of an additional 2 key clinical findings.


CONCLUSIONS
Both programs of bedside teaching increase the technical examination skills of residents but improvements in the identification of key clinical findings were modest and only demonstrated with a new method of teaching.
Smith
Christopher A
CA
Department of Medicine, John H. Stroger Jr. Hospital of Cook County (Cook County Hospital)/Rush Medical College, Chicago, Ill 60612, USA. christopher_smith@rush.edu
Hart
Avery S
AS
Sadowski
Laura S
LS
Riddle
Janet
J
Evans
Arthur T
AT
Clarke
Peter M
PM
Ganschow
Pamela S
PS
Mason
Ellen
E
Sequeira
Winston
W
Wang
Yue
Y
D002309:Cardiology / Q000193:education; D004521:Educational Measurement / Q000379:methods; D006326:Heart Auscultation; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D010808:Physical Examination; D011674:Pulse; D013663:Teaching / Q000379:methods*