The teaching and practice of cardiac auscultation during internal medicine and cardiology training. A nationwide survey.

OBJECTIVES

To assess the time and importance given to cardiac auscultation during internal medicine and cardiology training and to evaluate the auscultatory proficiency of medical students and physicians-in-training.

STUDY DESIGN

A nationwide survey of internal medicine and cardiology program directors and a multicenter cross-sectional assessment of students' and housestaff's auscultatory proficiency.

SETTING

All accredited U.S. internal medicine and cardiology programs and nine university-affiliated internal medicine and cardiology programs.

PARTICIPANTS

Four hundred ninety-eight (75.6%) of all 659 directors surveyed; 203 physicians-in-training and 49 third-year medical students.

INTERVENTIONS

Directors completed a 23-item questionnaire, and students and trainees were tested on 12 prerecorded cardiac events.

MAIN OUTCOME MEASURES

The teaching and proficiency of cardiac auscultation at all levels of training.

RESULTS

Directors attributed great importance to cardiac auscultation and thought that more time should be spent teaching it. However, only 27.1% of internal medicine and 37.1% of cardiology programs offered any structured teaching of auscultation (P = 0.02). Programs without teaching were more likely to be large, university affiliated, and located in the northeast. The trainees' accuracy ranged from 0 to 56.2% for cardiology fellows (median, 21.9%) and from 2% to 36.8% for medical residents (median, 19.3%). Residents improved little with year of training and were never better than third-year medical students.

CONCLUSIONS

A low emphasis on cardiac auscultation appears to have affected the proficiency of medical trainees. Our study raises concern about the future of this time-honored art and, possibly, other bedside diagnostic skills.