PURPOSE:The ability of attending physicians to recognize heart murmurs is low. Recent research suggests that cardiac auscultation improves dramatically with intensive repetition. In this study, we measured the effect of listening to intensive repetition of 5 common heart murmurs using a mp3 player in general internists.
METHODS:A group of 255 general internists took a pretest consisting of 5 heart murmurs played in random order. They then listened to audio files of 5 basic murmurs including aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation and innocent systolic murmur on an mp3 player. These audio files consisted of 200 repetitions of each of the five murmurs played during a single 30 minute session while viewing posters with phonocardiograms of each sound. All participants took a post test consisting of the same murmurs played in a random order. The murmurs used in the training session were simulated heart sounds while the murmurs used in both pre and post tests were human heart sounds.
RESULTS:Subjects’ correct answers improved from 53.2 +/- 26% on the pretest to 78.9 +/- 22% on the post test, p< .001 by paired t-test. A formal survey revealed a high degree of acceptance for this type of training.
CONCLUSION:Mp3 players can function effectively to improve cardiac auscultation skill in general internists in a short timeframe. This study suggests a novel approach to improve this important clinical skill using mp3 players.
CLINICAL IMPLICATIONS:Since the USMLE now tests all candidates on their ability to recognize cardiac murmurs on the National Boards, this method of teaching will be valuable to all physicians.
DISCLOSURE:Michael Barrett, Shareholder I own shares in a company called MED-ED Consulting, Inc; Consultant fee, speaker bureau, advisory committee, etc. I received royalties from the American College of Cardiology Foundation; No Product/Research Disclosure Information