The Teaching and Practice of Cardiac Auscultation during Internal Medicine and Cardiology Training: A Nationwide Survey

Abstract

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.