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Teaching Cardiac Murmurs: the Power of Repetition FREE TO VIEW

Carolyn S. Lacey, MD; Michael J. Barrett, MD
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Drexel University College of Medicine, Travis AFB, CA


Chest. 2003;124(4_MeetingAbstracts):85S. doi:10.1378/chest.124.4_MeetingAbstracts.85S
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PURPOSE:  A previous study demonstrated that medical students significantly improved their proficiency in identifying cardiac murmurs when they were monitored listening to 250 or 500 consecutive repetitions of four basic cardiac murmurs. This follow-up study was performed to determine if students could achieve similar results using serial repetitions of the same cardiac murmurs in unmonitored settings.

METHODS:  Twenty-nine second year medical students at an urban East Coast medical school were randomized to receive an audio CD containing 250 repetitions of four left-sided valvular lesions (AS, AR, MS, MR) in a consecutive or serial pattern. Students were instructed to listen to it one to two times in unmonitored sessions. Two tests of proficiency were given, a pretest and a final test, at which students were asked to identify the timing and the lesion in 10 recorded cardiac murmurs.

RESULTS:  Twenty-nine students were available for analysis at study completion. Sixteen students received a CD with consecutive repetitions (Group A) and thirteen received a CD with serial repetitions (Group B). In total, the twenty-nine students demonstrated a pretest score of 23.4 +/- 11.4% and a final test score of 83.1 +/- 16.5%. Group A demonstrated a pretest proficiency score (Mean +/- SD) of 21.3 +/-11.4% and a final test score of 84.4 +/- 14.6%. Group B demonstrated a pretest score of 26.2 +/- 10.4% and a final test score of 81.5 +/- 19.1%. Both Groups demonstrated a statistically significant rise in their scores compared to baseline (p<0.001), but no statistical difference was observed between each group (p>0.1).CONCLUSIONS: Medical students demonstrated dramatic improvement in identifying cardiac murmurs in an unmonitored setting using 250 repetitions of each murmur in both the serial and consecutive fashion.

CLINICAL IMPLICATIONS:  These results suggest that cardiac auscultation is, in part, a technical skill requiring repetition to be mastered. Also, the results suggest that the number of repetitions was more important than the pattern of repetitions.

DISCLOSURE:  C.S. Lacey, None.

Monday, October 27, 2003

2:30 PM - 4:00 PM




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