Abstract
To the Editor. —I concur with Drs Mangione and Nieman 1 that cardiac auscultation is a valuable clinical skill that merits added structured teaching for medical students and residents. While their method represents an improvement over the multiplechoice testing that is common to medical school and licensing examinations, identification of digitized cardiac sounds and murmurs is not a sufficient measure of clinical competency for physicians in training. Furthermore, the authors' statements regarding generalist physicians and health care utilization are not supported by the data presented. In an earlier publication, 2 the authors cited a 1959 study by Butterworth and Reppert 3 and concluded that physicians in training today are less skilled in cardiac auscultation than their predecessors. However, comparison of the data is hampered because the assessment of Butterworth and Reppert was a matching exercise and included a different type and number of cardiac events. Pressing their point regarding the present erosion of
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