This study assessed physician performance in detecting the apical S3 g
allop using a cardiology patient simulator, Six physicians (two cardio
logy fellows, two medicine residents, and two attending physicians) pe
rformed two sets of 24 cardiac examinations that included the presence
or absence of an apical S3 gallop, All the examiners were able to sig
nificantly alter the prior odds of an apical S3 gallop's being present
, but the cardiology fellows had higher sensitivities, Sensitivity was
lower for detecting soft S3 gallops, and specificity was lower when a
diastolic murmur was also present, Physician performance in detecting
apical S3 gallops is variable, but can be excellent.