March 28, 2006

Cardiologists only Docs Getting Heart Exams Right

NEW YORK (Reuters Health) - Cardiologists are better than medical students, residents, and other practicing physicians at performing a bedside heart examination and in accurately identifying abnormal heart sounds, according to the findings of two studies reported in the Archives of Internal Medicine.

Dr. Jasminka M. Vukanovic-Criley, from Stanford University in California, and colleagues compared competency in cardiac examination skills among medical students, residents and various practicing physicians.

A total of 860 participants were included in the study, which focused on four aspects of competency: heart physiology knowledge, auditory skills, visual skills, and integration of auditory and visual skills using computer graphic animations and virtual patient examinations.

Medical students in their third or fourth year of training showed higher competency than those in their first or second year. After the third year of medical school, unless a cardiology "fellowship" was pursued, there was no evidence that cardiac examination skills improved further.

"Cardiac examination skills do not improve after medical school year three and may decline after years in practice, which has important implications for medical decision making, patient safety, cost-effective care, and continuing medical education," the authors conclude.

In the second study, Dr. Andrew D. Michaels, from the University of California at San Francisco, and colleagues assessed the ability of various physicians to detect a third heart sound on physical examination. The presence of a third heart sound often indicates important heart disease that requires further workup.

A total of 100 patients were each evaluated by an internal medicine intern, internal medicine resident, cardiology fellow, and cardiology attending. Their results were compared against those obtained by a phonocardiographic device, a machine that listens to and analyzes heart sounds.

Only the results obtained by cardiology fellows and attendings showed significant agreement with the phonocardiographic results. Moreover, the third heart sounds identified by cardiology fellows and attending were better than those detected by residents and interns in distinguishing various heart abnormalities.

SOURCE: Archives of Internal Medicine, March 27, 2006.