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 auscult ation during internal medicine and cardiology training and to evaluate the auscultatory proficiency of medical students and physicians-in-tr aining. Study Design: A nationwide survey of internal medicine and car diology program directors and a multi-center cross-sectional assessmen t of students' and housestaff's auscultatory proficiency. Setting: All accredited U.S. internal medicine and cardiology programs and nine un iversity-affiliated internal medicine and cardiology programs. Partici pants: Four hundred ninety-eight (75.6%) of all 659 directors surveyed ; 203 physicians-in-training and 49 third-year medical students. Inter ventions: Directors completed a 23-item questionnaire, and students an d 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 teachi ng it. However, only 27.1% of internal medicine and 37.1% of cardiolog y programs offered any structured teaching of auscultation (P = 0.02). Programs without teaching were more likely to be large, university af filiated, 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 s tudents. Conclusions: A low emphasis on cardiac auscultation appears t o 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.