title: Brief group training of medical students in focused cardiac ultrasound may improve diagnostic accuracy of physical examination.
abstract: BACKGROUND
  Physical examination and auscultation can be challenging for medical students. The aim of this study was to investigate whether a brief session of group training in focused cardiac ultrasound (FCU) with a pocket-sized device would allow medical students to improve their ability to detect clinically relevant cardiac lesions at the bedside.
  
  
  METHODS
  Twenty-one medical students in their clinical curriculum completed 4 hours of FCU training in groups. The students examined patients referred for echocardiography with emphasis on auscultation, followed by FCU. Findings from physical examination and FCU were compared with those from standard echocardiography performed and analyzed by cardiologists.
  
  
  RESULTS
  In total, 72 patients were included in the study, and 110 examinations were performed. With a stethoscope, sensitivity to detect clinically relevant (moderate or greater) valvular disease was 29% for mitral regurgitation, 33% for aortic regurgitation, and 67% for aortic stenosis. FCU improved sensitivity to detect mitral regurgitation (69%, P < .001). However, sensitivity to detect aortic regurgitation (43%) and aortic stenosis (70%) did not improve significantly. Specificity was ≥89% for all valvular diagnoses by both methods. For nonvalvular diagnoses, FCU's sensitivity to detect moderate or greater left ventricular dysfunction (90%) was excellent, detection of right ventricular dysfunction (79%) was good, while detection of dilated left atrium (53%), dilated right atrium (49%), pericardial effusion (40%), and dilated aortic root (25%) was less accurate. Specificity varied from 57% to 94%.
  
  
  CONCLUSIONS
  After brief group training in FCU, medical students could detect mitral regurgitation significantly better compared with physical examination, whereas detection of aortic regurgitation and aortic stenosis did not improve. Left ventricular dysfunction was detected with high sensitivity. More extensive training is advised.
authors.affiliation: Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Stokke
authors.affiliation: Faculty of Medicine, University of Oslo, Oslo, Norway; Division of Cardiology, Vestfold Hospital Trust, Tønsberg, Norway.
authors.forename: Vidar
authors.initials: V
authors.lastname: Ruddox
authors.affiliation: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Sebastian I
authors.initials: SI
authors.lastname: Sarvari
authors.affiliation: Division of Cardiology, Vestfold Hospital Trust, Tønsberg, Norway.
authors.forename: Jan E
authors.initials: JE
authors.lastname: Otterstad
authors.affiliation: Division of Cardiology, Vestfold Hospital Trust, Tønsberg, Norway.
authors.forename: Erlend
authors.initials: E
authors.lastname: Aune
authors.affiliation: Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway. Electronic address: thor.edvardsen@medisin.uio.no.
authors.forename: Thor
authors.initials: T
authors.lastname: Edvardsen
mesh_terms: D000368:Aged; D002309:Cardiology / Q000193:education*; D002983:Clinical Competence; D004452:Echocardiography; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D008297:Male; D009664:Norway; D010808:Physical Examination / Q000379:methods*; D011871:Radiology / Q000193:education*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013663:Teaching
keywords: Diagnostic accuracy; Focused cardiac ultrasound; Medical students; Physical examination; Pocket sized