Comparison of two educational interventions on pediatric resident auscultation skills

Objective. Multiple cross-sectional physician surveys have documented poor cardiac auscultation skills. We evaluated the impact of 2 different educational interventions on pediatric resident auscultation skills. Methods. The auscultation skills of all first-year (PGY1; n = 20) and second-year pediatric residents (PGY2; n = 20) were evaluated at the beginning and end of the academic year. Five patient recordings were presented: atrial septal defect, ventricular septal defect, pulmonary valve stenosis, bicuspid aortic valve with insufficiency, and innocent murmur. Residents were asked to classify the second heart sound, identify a systolic ejection click, describe the murmur, and provide a diagnosis. All PGY1 and most PGY2 (14 of 20) participated on the inpatient cardiology service for 1 month. PGY2 on the cardiology service also attended outpatient clinic. PGY1 did not attend outpatient clinic but were allotted 2 hours/ week to use a self-directed cardiac auscultation computer teaching program. Results. Resident auscultation skills on initial evaluation were dependent on training level (PGYI: 42 [+ or -] 15% correct; PGY2:53 [+ or -] 13% correct), primarily as a result of better classification of second heart sound (PGYI: 45%; PGY2: 63%) and diagnosis of an innocent murmur (PGYI: 35%; PGY2: 65%). There was no difference in the ability to identify correctly a systolic ejection click (20% vs 23%) or to arrive at the correct diagnosis (35% vs 40%). At the end of the academic year, the PGY1 scores improved by 21%, primarily as a result of improved diagnostic accuracy of the innocent murmur (35% to 65%). PGY2 scores remained unchanged (53% vs 51%), regardless of participation in a cardiology rotation (cardiology rotation: 50%; no cardiology rotation: 51%). Combined, diagnostic accuracy was best for ventricular septal defect (55%) and innocent murmur (60%) and worst for atrial septal defect (18%) and pulmonary valve stenosis (15%). However, 40% identified the innocent murmur as pathologic and 21% of pathologic murmurs were diagnosed as innocent. Conclusions. Pediatric resident auscultation skills were poor and did not improve after an outpatient cardiology rotation. Auscultation skills did improve after the use of a self-directed cardiac auscultation teaching program. These data have relevance given the American College of Graduate Medical Education's emphasis on measuring educational outcomes and documenting clinical competencies during residency training. Pediatrics 2004;113:1331-1335; auscultation, murmurs, educational intervention, computer-based learning. ABBREVIATIONS. PGY1, first year pediatric residents; PGY2, second-year pediatric residents; ASD, atrial septal defect; VSD, ventricular septal defect; PVS, pulmonary valve stenosis; BAV/AI, bicuspid aortic valve with aortic regurgitation; S2, second heart sound.
Cardiac murmurs are common in pediatric patients, with an incidence of up to 90%. (1-11) Because METHODS All first-year (PGY1) and second-year pediatric residents (PGY2) were asked to participate in [...]