The development of a new cardiac auscultation test: How do screening and diagnostic skills differ?

Abstract

Background: Newly qualified doctors are expected to be able to conduct a cardiac auscultation unassisted, but studies show conflicting results regarding cardiac auscultation skills.

Methods: A two-part test instrument was designed containing innovative recordings of heart sounds from patients with common cardiac murmurs as well as healthy controls. A total number of 109 participants were tested, representing four levels of clinical experience. The content validity of the test instrument was studied by a postal questionnaire to 114 clinical teachers at the University Hospital of Aarhus, Denmark.

Results: A significant correlation was found between level of experience and the ability to diagnose the conditions from which the murmurs originated (r = 0.45, P < 0.0001). No correlation was found between level of experience and the ability to identify persons with cardiac murmurs from healthy controls. All groups showed a tendency to interpret healthy heart sounds as cardiac murmurs.

Conclusions: Diagnostic ability was found to correlate positively with clinical experience, whereas the ability to distinguish cardiac murmurs from normal heart sounds seems independent of clinical experience.

Additional information

Notes on contributors

Tommy Nielsen

TOMMY NIELSEN, MD, is Research Assistant at Unit of Medical Education, Faculty of Health Sciences at the University of Aarhus.

Henning Mølgaard

HENNING MØLGAARD, MD, DMSc is Senior Cardiologist at Skejby Sygehus, Aarhus University Hospital. He is specialised in heart valve diseases and cardiac in compensation.

Charlotte Ringsted

CHARLOTTE RINGSTED, MD, PhD, MHPE, is Professor of Medical Education Copenhagen University, Faculty of Health Science and director of Center for Clinical Education, Copenhagen University Hospital, Rigshospitalet.

Berit Eika

BERIT EIKA, MD, MHPE, MI, Ph.D. is professor of medical education at the University of Aarhus. She is director of Unit of Medical Education at the Faculty of Health Sciences which provides staff development courses and skills training for medical students and young doctors.