Clinical auscultation skills in pediatric residents

Objective. The aim of this study is to determine the level of clinical ausc ultation skills in pediatric residents at Duke University Medical Center. Methods. Forty-seven residents from pediatrics and joint medicine/pediatric s training programs at Duke University Medical Center were enrolled in this study. They were asked to examine the cardiovascular patient simulator, Ha rvey, and report their findings. Five common conditions seen in the pediatr ic population were presented: ventricular septal defect, atrial septal defe ct, pulmonary valve stenosis, combined aortic valve stenosis and insufficie ncy, and innocent systolic ejection murmur. The responses were scored by th e number of features and diagnoses accurately reported. Five pediatric card iologists and cardiologists in training were also asked to participate in a manner similar to the trainees. Results. The mean score of features identified for the resident group was 1 1.4 +/- 2.6 of a possible 19. The diagnostic accuracy was 33%. There was no significant difference between residents by year of training or by type of residency program, although there was a trend toward improved performance with more training. The difference in performance between the pediatric car diology group and the residents group was striking. The condition that was most frequently misdiagnosed was the innocent systolic ejection murmur. Conclusions. The clinical auscultation skills of pediatric residents in thi s study were suboptimal. There was a trend toward improvement as training p rogressed, although not statistically significant. These skills are likely to improve further with increased exposure to patients with cardiovascular disease especially in the ambulatory care setting.