Kumar Komal, Thompson W Reid
Johns Hopkins University, Baltimore, MD 21287, USA.
Clin Pediatr (Phila). 2013 Jan;52(1):66-73. doi: 10.1177/0009922812466584. Epub 2012 Nov 26.
Auscultation skills are in decline, but few studies have shown which specific aspects are most difficult for trainees. We evaluated individual aspects of cardiac auscultation among pediatric residents using recorded heart sounds to determine which elements pose the most difficulty.
Auscultation proficiency was assessed among 34 trainees following a pediatric cardiology rotation using an open-set format evaluation module, similar to the actual clinical auscultation description process.
Diagnostic accuracy for distinguishing normal from abnormal cases was 73%. Findings most commonly correctly identified included pathological systolic and diastolic murmurs and widely split second heart sounds. Those least likely to be identified included continuous murmurs and clicks. Accuracy was low for identifying specific diagnoses.
Given time constraints for clinical skills teaching, this suggests that focusing on distinguishing normal from abnormal heart sounds and murmurs instead of making specific diagnoses may be a more realistic goal for pediatric resident auscultation training.
听诊技能正在下降，但很少有研究表明哪些具体方面对实习生来说最困难。我们使用录制的心音评估儿科住院医师心脏听诊的各个方面，以确定哪些要素构成最大困难。
在34名实习生完成儿科心脏病学轮转后，使用一种开放式评估模块评估听诊熟练度，该模块类似于实际临床听诊描述过程。
区分正常与异常病例的诊断准确率为73%。最常被正确识别的发现包括病理性收缩期和舒张期杂音以及第二心音广泛分裂。最不容易被识别的包括连续性杂音和喀喇音。识别具体诊断的准确率较低。
鉴于临床技能教学的时间限制，这表明专注于区分正常与异常心音及杂音而非进行具体诊断，可能是儿科住院医师听诊训练更现实的目标。
