title: Instruction using a high-fidelity cardiopulmonary simulator improves examination skills and resource allocation in family medicine trainees.
abstract: BACKGROUND
  High-fidelity cardiopulmonary simulators have proven promising in various areas of medical education but have yet to be studied in Family Medicine training.
  
  
  METHODS
  A 2-hour curriculum, combining didactic and simulator exposure, and addressing common valvular pathologies, was offered to post-graduate year 1 and 2 Family Medicine residents. Residents' abilities to describe and diagnose four simulated murmurs were assessed before the teaching sessions and 2 to 4 weeks after. Confidence in physical examination skills, as well as the use of echocardiography, was also measured.
  
  
  RESULTS
  Twenty residents participated. Mean composite murmur description scores improved in 95% of residents (P < 0.001), as did mean diagnostic accuracy (from 43.8% to 85.0%; P < 0.001). For pathologic murmurs, the number of echocardiograms recommended did not change, whereas for the nonpathologic murmur, 16 residents who recommended echocardiography presession no longer did postsession (P < 0.001). Mean confidence significantly increased (P < 0.001). The mean satisfaction score for the session was 4.9/5, and all residents recommended that the session be repeated in future years.
  
  
  CONCLUSIONS
  A didactic and simulator-based session is very well received by Family Medicine residents. It significantly improves description and diagnosis of murmurs and reduces unnecessary echocardiogram use without affecting appropriate use.
authors.affiliation: Herbert Ho Ping Kong Centre of Excellence in Education and Practice, Toronto Western Hospital, Toronto, ON, Canada. david.frost@uhn.on.ca
authors.forename: David W
authors.initials: DW
authors.lastname: Frost
authors.forename: Rodrigo B
authors.initials: RB
authors.lastname: Cavalcanti
authors.forename: Diana
authors.initials: D
authors.lastname: Toubassi
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis*; D002983:Clinical Competence; D003198:Computer Simulation; D004521:Educational Measurement; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D010808:Physical Examination / Q000379:methods*; D010821:Physicians, Family / Q000193:education*