CARDIAC AUSCULTATORY SKILLS OF INTERNAL-MEDICINE AND FAMILY-PRACTICE TRAINEES - A COMPARISON OF DIAGNOSTIC PROFICIENCY

Context.-Medical educators have had a growing sense that proficiency i n physical diagnostic skills is waning, but few data have examined the question critically. Objective, Design, and Setting.-To compare the c ardiac auscultatory proficiency of medical students and physicians in training. A multicenter cross-sectional assessment of students and hou se staff, A total of 8 internal medicine and 23 family practice progra ms of the mid-Atlantic area. Participants.-A total of 453 physicians i n training and 88 medical students. Interventions.-All participants li stened to 12 cardiac events directly recorded from patients, which the y identified by completing a multiple-choice questionnaire. Main Outco me Measures.-Scores were expressed as the percentage of participants, for year and type of training, who correctly identified each event, Cu mulative scores were expressed as the total number of events correctly recognized, An adjusted score was calculated whenever participants se lected not only the correct finding but also findings that are acousti cally similar and yet absent. Results.-Trainees' cumulative scores ran ged between 0 and 7 for both internal medicine and family practice res idents (median, 2.5 and 2.0, respectively), Internal medicine resident s had the highest cumulative adjusted scores for the 6 extra sounds an d for all 12 cardiac events tested (P=.01 and .02, respectively), On a verage, internal medicine and family practice residents recognized 20% of all cardiac events; the number of correct identifications improved little with year of training and was not significantly higher than th e number identified by medical students. Conclusions.-Both internal me dicine and family practice trainees had a disturbingly low identificat ion rate for 12 important and commonly encountered cardiac events. Thi s study suggests a need to improve the teaching and assessment of card iac auscultation during generalists' training, particularly with the a dvent of managed care and its search for more cost-effective uses of t echnology.