Cardiac auscultation skills among medical trainees

Background

Many experts suspect there has been a gradual decline in cardiac auscultation skills among physicians, though no studies have examined this hypothesis over time. We sought to better evaluate the long-term change in medical trainees' cardiac auscultation skills.

Methods

We performed a repeated cross-sectional study to analyze medical trainee performance on a cardiac auscultation simulation test over an 11-year period. The simulation tests involved identifying pre-recorded heart sounds and murmurs. Test results were analyzed with linear regression to evaluate temporal trends in scores. Performance on individual heart sounds and murmurs was also analyzed.

Results

We included results from 411 simulation tests representing 348 medical students (84.7%), 37 residents (9.0%), and 26 cardiology fellows (6.3%). The overall average test score was 7.7 points (SD 2.5). Test scores declined over time for all trainees by 0.15 points per year (P=0.003). Fellows performed better than medical students by an average of 2.1 points (P < 0.001), while residents performed better than medical students by an average of 1.1 points (P = 0.008). Overall performance on individual heartsounds and murmurs was variable with no significant change in performance over time.

Conclusion

Medical student trainees at an academic medical center had declining cardiac auscultation skills over time, with a possible similar decline noted among internal medicine residents and cardiology fellows. This study underscores the importance of broad investment in strategies for teaching cardiac auscultation to preserve and improve this essential skill.