Comparison of Two Educational Interventions on Pediatric Resident Auscultation Skills
| Autor: | Andrew J. Nowalk, James R. Zuberbuhler, Yuk M. Law, C. Becket Mahnke, Dena Hofkosh |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
medicine.medical_specialty
Pediatrics Cardiology Graduate medical education Heart Auscultation Bicuspid aortic valve medicine Humans Outpatient clinic cardiovascular diseases Child Heart Murmurs medicine.diagnostic_test business.industry Teaching Training level Internship and Residency Auscultation medicine.disease El Niño Pediatrics Perinatology and Child Health Pulmonary valve stenosis Physical therapy Clinical Competence business Computer-Assisted Instruction |
| Zdroj: | Pediatrics. 113:1331-1335 |
| ISSN: | 1098-4275 0031-4005 |
| DOI: | 10.1542/peds.113.5.1331 |
| Popis: | Objective. Multiple cross-sectional physician surveys have documented poor cardiac auscultation skills. We evaluated the impact of 2 different educational interventions on pediatric resident auscultation skills.Methods. The auscultation skills of all first-year (PGY1; n = 20) and second-year pediatric residents (PGY2; n = 20) were evaluated at the beginning and end of the academic year. Five patient recordings were presented: atrial septal defect, ventricular septal defect, pulmonary valve stenosis, bicuspid aortic valve with insufficiency, and innocent murmur. Residents were asked to classify the second heart sound, identify a systolic ejection click, describe the murmur, and provide a diagnosis. All PGY1 and most PGY2 (14 of 20) participated on the inpatient cardiology service for 1 month. PGY2 on the cardiology service also attended outpatient clinic. PGY1 did not attend outpatient clinic but were allotted 2 hours/week to use a self-directed cardiac auscultation computer teaching program.Results. Resident auscultation skills on initial evaluation were dependent on training level (PGY1: 42 ± 15% correct; PGY2: 53 ± 13% correct), primarily as a result of better classification of second heart sound (PGY1: 45%; PGY2: 63%) and diagnosis of an innocent murmur (PGY1: 35%; PGY2: 65%). There was no difference in the ability to identify correctly a systolic ejection click (20% vs 23%) or to arrive at the correct diagnosis (35% vs 40%). At the end of the academic year, the PGY1 scores improved by 21%, primarily as a result of improved diagnostic accuracy of the innocent murmur (35% to 65%). PGY2 scores remained unchanged (53% vs 51%), regardless of participation in a cardiology rotation (cardiology rotation: 50%; no cardiology rotation: 51%). Combined, diagnostic accuracy was best for ventricular septal defect (55%) and innocent murmur (60%) and worst for atrial septal defect (18%) and pulmonary valve stenosis (15%). However, 40% identified the innocent murmur as pathologic and 21% of pathologic murmurs were diagnosed as innocent.Conclusions. Pediatric resident auscultation skills were poor and did not improve after an outpatient cardiology rotation. Auscultation skills did improve after the use of a self-directed cardiac auscultation teaching program. These data have relevance given the American College of Graduate Medical Education's emphasis on measuring educational outcomes and documenting clinical competencies during residency training. |
| Databáze: | OpenAIRE |
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