title: What makes medical students better listeners?
abstract: Diagnosing heart conditions by auscultation is an important clinical skill commonly learnt by medical students. Clinical proficiency for this skill is in decline [1], and new teaching methods are needed. Successful discrimination of heartbeat sounds is believed to benefit mainly from acoustical training [2]. From recent studies of auditory training [3,4] we hypothesized that semantic representations outside the auditory cortex contribute to diagnostic accuracy in cardiac auscultation. To test this hypothesis, we analysed auditory evoked potentials (AEPs) which were recorded from medical students while they diagnosed quadruplets of heartbeat cycles. The comparison of trials with correct (Hits) versus incorrect diagnosis (Misses) revealed a significant difference in brain activity at 280-310 ms after the onset of the second cycle within the left middle frontal gyrus (MFG) and the right prefrontal cortex. This timing and locus suggest that semantic rather than acoustic representations contribute critically to auscultation skills. Thus, teaching auscultation should emphasize the link between the heartbeat sound and its meaning. Beyond cardiac auscultation, this issue is of interest for all fields where subtle but complex perceptual differences identify items in a well-known semantic context.
authors.affiliation: Service of Neuropsychology and Neurorehabilitation, Department of Clinical Neuroscience, CHUV, Switzerland.
authors.forename: Rosanna
authors.initials: R
authors.lastname: De Meo
authors.affiliation: The Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology and Department of Clinical Neurosciences, CHUV, Switzerland.
authors.forename: Pawel J
authors.initials: PJ
authors.lastname: Matusz
authors.affiliation: Service of Neuropsychology and Neurorehabilitation, Department of Clinical Neuroscience, CHUV, Switzerland; The Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology and Department of Clinical Neurosciences, CHUV, Switzerland; Department of Ophthalmology, Jules-Gonin Eye Hospital, Lausanne, Switzerland.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Knebel
authors.affiliation: Service of Neuropsychology and Neurorehabilitation, Department of Clinical Neuroscience, CHUV, Switzerland; The Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology and Department of Clinical Neurosciences, CHUV, Switzerland; EEG Brain Mapping Core, Center for Biomedical Imaging (CIBM), Switzerland; Department of Ophthalmology, Jules-Gonin Eye Hospital, Lausanne, Switzerland.
authors.forename: Micah M
authors.initials: MM
authors.lastname: Murray
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: W Reid
authors.initials: WR
authors.lastname: Thompson
authors.affiliation: Service of Neuropsychology and Neurorehabilitation, Department of Clinical Neuroscience, CHUV, Switzerland. Electronic address: Stephanie.Clarke@chuv.ch.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Clarke
mesh_terms: D001307:Auditory Perception / Q000502:physiology*; D002983:Clinical Competence; D006326:Heart Auscultation / Q000592:standards*; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D007858:Learning; D010808:Physical Examination; D013337:Students, Medical