Michigan Journal of Medicine

Introduction

It has been well-documented in the literature that cardiac auscultation skills are poor among medical trainees.^1-6 The traditional model of learning the skill of auscultation involves practice with real patients and repetition over the course of one’s medical training. However, such practice with pediatric patients is often limited. Additionally, there are few examples of pediatric-specific heart sounds available to students. As part of the development of a new medical student curriculum, we completed a needs assessment where we sought to determine a subset of important pediatric heart sounds through faculty surveys.

Methods

Five senior faculty members from General Pediatrics, Pediatric Hospital Medicine, Pediatric Cardiology, Pediatric Emergency Medicine, and Family Medicine were invited to participate in the 6-question survey. The survey was administered via Qualtrics software.

Results

All 25 faculty (five per specialty) completed the survey. 20/25 (80%) of the faculty finished training 16 or more years ago with the remaining 5/25 (20%) completing training 11-15 years ago. Collectively, the top five cardiac auscultation findings faculty thought every physician working with pediatric patients should be familiar with were Still’s murmur (N=20), peripheral pulmonary stenosis (PPS) (N=13), benign pulmonary flow (N=12), small/restrictive ventricular septal defect (VSD) (N=12), and large/unrestrictive VSD (N=12). The top three findings faculty encountered in their own clinical practice were Still's murmur (N=20), small/restrictive VSD (N=10), and PPS (N=9). These results had slight variations between specialties. When asked about specific helpful learning experiences, faculty responded that listening to real patients and more realistic audio recordings would be most helpful.

Conclusions

Determining the most useful pediatric auscultation findings for medical students to learn is an important first step towards auscultation skill development. Of the top five auscultation findings identified by our multi-specialty group of senior faculty, three are common benign murmurs and two are pathologic. It is imperative that medical students learn to differentiate between benign and pathologic pediatric auscultation findings. Listening to real patients is the best way to learn the skill of pediatric cardiac auscultation, but we can employ advances in technology, such as digital stethoscopes, to capture heart sounds and improve medical education.

References

1. Kumar, Komal, and W Reid Thompson. “Evaluation of cardiac auscultation skills in pediatric residents.” Clinical pediatrics vol. 52,1 (2013): 66-73. doi:10.1177/0009922812466584

2. Gaskin, P R et al. “Clinical auscultation skills in pediatric residents.” Pediatrics vol. 105,6 (2000): 1184-7. doi:10.1542/peds.105.6.1184.

3. St Clair, E W et al. “Assessing housestaff diagnostic skills using a cardiology patient simulator.” Annals of internal medicine vol. 117,9 (1992): 751-6. doi:10.7326/0003-4819-117-9-751.

4. Mangione, S, and L Z Nieman. “Cardiac auscultatory skills of internal medicine and family practice trainees. A comparison of diagnostic proficiency.” JAMA vol. 278,9(1997): 717-22.

5. Mangione, S. “Cardiac auscultatory skills of physicians-in-training: a comparison of three English-speaking countries.” The American journal of medicine vol. 110,3 (2001): 210-6. doi:10.1016/s0002-9343(00)00673-2.

6. Vukanovic-Criley JM, Criley S, Warde CM, et al. “Competency in cardiac examination skills in medical students, trainees, physicians, and faculty: a multicenter study.” Arch Intern Med. 2006;166(6):610-616. doi:10.1001/archinte.166.6.610.