Use of Simulation Based Training to Enhance Cardiac Auscultation Proficiency.

Matthew Lavoie,Jeffrey Kunz,Bernard Roth

doi:10.15694/mep.2020.000258.1

Abstract

Cardiopulmonary auscultation is an important skill for medical professionals with deficiencies being well documented with broad implications on healthcare. Providing ideal bedside auscultatory teaching presents many difficulties. Simulation has been used as a means to improve cardiac auscultatory training and circumvent some of these limitations. We studied the use of Harvey © simulation in teaching cardiac murmurs and whether there was improvement in short term knowledge, as well as testing long term knowledge retention, as measured through a standardized test. From 2014-2019, 124 medical students in their 2 nd and 3 rd year of school (during the clinical portion of medical school curriculum) rotating through an Internal Medicine rotation completed a 2 hour training course on cardiac auscultation using Harvey © to identify six common cardiac murmurs. The session contained a pretest, didactic session, and posttest. 124 students participated in the auscultatory training session. Of them, 42 (34%) underwent the session a second time at an average of 1.29 months from their first session. There was statistically significant improvement between tests. Notably, the most often missed murmurs were mitral stenosis and benign (innocent) flow murmur. As shown in our study, simulation based cardiac auscultatory education is feasible and likely beneficial in medical education as it can be delivered to a large group of trainees and overcomes the challenges of bedside teaching.

Highlights

Cardiopulmonary auscultation is an important skill for medical professionals with deficiencies being well documented with broad implications on healthcare
We studied the use of Harvey © simulation in teaching cardiac murmurs and whether there were improvements in short and long term knowledge retention, as measured through a standardized test
Studies have used cardiac simulation to teach learners from medical student to attending, with promising results (McKinney et al, 2013). This type of intervention is feasible for medical school and residency programs as it can be delivered to a large group of trainees and overcomes the challenges of bedside teaching

Summary

Introduction

Cardiopulmonary auscultation is an important skill for medical professionals with deficiencies being well documented with broad implications on healthcare. Deficiencies in auscultatory skill throughout medical training have been described This has implications on medical decision making, diagnosis, patient safety, cost effective care, and continuing medical education (Woywodt et al, 2004, Mangione and Nieman, 1997, Mangione et al, 1993). Congenital anomalies such as VSD are identified much earlier than once before This leads to a reduced number of patients with cardiac murmurs and decreased educational opportunity to learn important pathology (Birdane et al, 2012). Providing ideal bedside auscultatory teaching presents many difficulties to include time constraints on students and experts, patient privacy and difficulty in finding a patient with a significant murmur who is agreeable to bedside teaching. Simulation has been used as a means to improve cardiac auscultatory training and circumvent some of these limitations

Methods

Results

Discussion

Conclusion