Lam M Z C, Lee T J, Boey P Y, Ng W F, Hey H W, Ho K Y, Cheong P Y
Department of Community, Occupational and Family Medicine, National University of Singapore, Block MD3, 16 Medical Drive, Singapore 117597.
Singapore Med J. 2005 Jan;46(1):11-4.
We assessed the accuracy of physician trainees in identifying different cardiac sounds and examined the factors influencing their cardiac auscultation proficiency.
A total of 106 physicians in the Family Medicine Training Programme were asked to identify 10 cardiac sounds played sequentially on the Littmann electronic stethoscope, which functioned as a surrogate patient. Their auscultation accuracy was scored numerically out of a maximum of 10. Demographical data of the physicians was collected prospectively.
The mean (+/-SD) auscultation proficiency score of the study population was 4.0 +/- 1.7. Physicians who graduated in 1994 or earlier fared significantly poorer than those who obtained their Bachelor of Medicine and Bachelor of Surgery degrees between 1995 and 2000 (p-value equals 0.02). Auscultation proficiency was not related to current practice, previous years of primary care, cardiology, internal medicine or paediatric medicine postings, or cumulative years of postings. Normal heart sounds were most accurately identified. Prosthetic cardiac sounds were better identified than other extra-cardiac sounds while systolic murmurs were more accurately identified than diastolic murmurs. Tachycardia had the lowest identification rate.
Our data suggest that cardiac auscultation skill declined with time, being significantly impaired eight years after graduation. We suggest that there is a need for retraining in the form of continuing medical education to address not only new knowledge and skills, but also basic skill competency.
我们评估了实习医生识别不同心音的准确性，并研究了影响他们心脏听诊能力的因素。
共有106名参加家庭医学培训项目的医生被要求识别在 Littmann 电子听诊器上依次播放的10种心音，该听诊器充当模拟患者。他们的听诊准确性以满分10分进行数字评分。前瞻性收集了医生的人口统计学数据。
研究人群的平均（±标准差）听诊能力得分为4.0±1.7。1994年或更早毕业的医生表现明显不如1995年至2000年间获得医学学士和外科学士学位的医生（p值等于0.02）。听诊能力与当前实践、以前的初级保健年限、心脏病学、内科或儿科学科的轮转经历或累计轮转年限无关。正常心音的识别最为准确。人工心音比其他心外音更容易识别，而收缩期杂音比舒张期杂音的识别更准确。心动过速的识别率最低。
我们的数据表明，心脏听诊技能随时间下降，毕业后八年明显受损。我们建议需要通过继续医学教育的形式进行再培训，不仅要解决新知识和技能，还要解决基本技能能力问题。
