title: Effectiveness of teaching cardiac auscultation to residents during an elective pediatric cardiology rotation.
abstract: This study aimed to assess the effectiveness of randomized tracks of prerecorded cardiac sounds as a teaching tool for cardiac auscultation. The study focused on recognizing murmurs when present, distinguishing functional from organic murmurs, and detecting heart disease by auscultation. At both pre- and posttesting, 26 residents listened to 15 randomized tracks of live-recorded cardiac sounds and identified key features. The results indicate that the residents improved at detecting any murmur (66% vs 76%, p = 0.007) and functional murmur (37% vs 54%, p = 0.048), and marginally improved at detecting organic murmur (75% vs 84%, p = 0.129). Detection of absence of murmur declined slightly (69% vs 62%, p = 0.723). The posttest difference in identifying organic versus functional murmurs was striking (84% vs 54%, p < 0.001). Detection of heart disease (sensitivity) improved significantly (76% to 86%, p = 0.016), but there was scant improvement in detecting no disease (specificity) (55% vs 59%, p = 0.601). The residents increased in their ability to detect heart disease when present. However, the false-positive rate for a diagnosis of heart disease remained quite high. To ensure that appropriate referrals will be made, teaching should specifically target the confident recognition of functional murmurs.
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Kansas Medical Center, Kansas City, 66160, USA. lmattiol@kumc.edu
authors.forename: Leone F
authors.initials: LF
authors.lastname: Mattioli
authors.forename: John M
authors.initials: JM
authors.lastname: Belmont
authors.forename: Ann McGrath
authors.initials: AM
authors.lastname: Davis
mesh_terms: D002309:Cardiology / Q000193:education*; D002983:Clinical Competence; D006326:Heart Auscultation; D006337:Heart Murmurs / Q000175:diagnosis; D006347:Heart Sounds; D006801:Humans; D007396:Internship and Residency; D010372:Pediatrics / Q000193:education*; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric