Teaching cardiac auscultation using simulated heart sounds and small-group discussion.

BACKGROUND AND OBJECTIVES Several educators have reported poor identification of abnormal cardiac sounds by primary care residents. Practice and review with cardiology patient simulators and prerecorded heart sounds has been shown to increase the accuracy of diagnosis by medical students and residents. METHODS The participants were 15 members of an urban family practice residency. The residents were presented with simulated heart sounds and were asked to identify them in a pretest and posttest. Between the tests, participants were invited to three separate teaching sessions that involved a discussion of cardiac auscultatory findings and a review of audiotaped similar heart sounds. Residents who were unable to attend the teaching sessions formed a control group. RESULTS The pretest identification rate was 36% for the heart sounds. This improved to 62% for all residents after the intervention. Higher rates of improvement were demonstrated by the residents who attended one or more teaching sessions, compared with the residents who attended no teaching sessions. CONCLUSIONS Small-group discussion and repetitive auscultation of simulated heart sounds can improve the cardiac auscultatory proficiency of family practice residents.