The aim of this study is to determine the level of clinical auscultation skills in pediatric residents at Duke University Medical Center.
Forty-seven residents from pediatrics and joint medicine/pediatrics training programs at Duke University Medical Center were enrolled in this study. They were asked to examine the cardiovascular patient simulator, Harvey, and report their findings. Five common conditions seen in the pediatric population were presented: ventricular septal defect, atrial septal defect, pulmonary valve stenosis, combined aortic valve stenosis and insufficiency, and innocent systolic ejection murmur. The responses were scored by the number of features and diagnoses accurately reported. Five pediatric cardiologists and cardiologists in training were also asked to participate in a manner similar to the trainees.
The mean score of features identified for the resident group was 11.4 ± 2.6 of a possible 19. The diagnostic accuracy was 33%. There was no significant difference between residents by year of training or by type of residency program, although there was a trend toward improved performance with more training. The difference in performance between the pediatric cardiology group and the residents group was striking. The condition that was most frequently misdiagnosed was the innocent systolic ejection murmur.
The clinical auscultation skills of pediatric residents in this study were suboptimal. There was a trend toward improvement as training progressed, although not statistically significant. These skills are likely to improve further with increased exposure to patients with cardiovascular disease especially in the ambulatory care setting.
Some time ago, the Objective-Structured Clinical Examination (OSCE) was specifically set to not only test but more importantly train junior as well as senior physicians in-training in the clinical aspects of pediatrics and medicine in general. It included history-taking, focused physical exam and evaluation of EKG, x-rays and laboratory reports from live patients (with a proven and established diagnosis) from the clinical practice of associated staff physicians (usually subspecialists) and who were asked to participate (incentives included) in this two day activity. I wonder if the practice has been abandoned for the use of new technologies (specifically the mannikin).
I think that it is telling that when the study of pediatric trainees' skills is undertaken, the skills are tested on a mannikin. While listening to the precordium of a mannikin may be better than nothing,it is certainly not an adequate method for testing pediatric trainees'examining skills in children. These data are dreadfully flawed and should not be used to offer any opinion other than suggesting that pediatric trainee's cannot recognise curious sounds coming from a dummy. Perhaps the trainee's could be tested by genuine patients with genuine physical findings. Valid opinions regarding alterations in training might then be offered.