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首页> 外文期刊>BMC Medical Education >Teaching cardiac auscultation to trainees in internal medicine and family practice: Does it work?
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Teaching cardiac auscultation to trainees in internal medicine and family practice: Does it work?

机译：向受过内科和家庭实习的学员讲授心脏听诊：这行得通吗？

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Background The general proficiency in physical diagnostic skills seems to be declining in relation to the development of new technologies. The few studies that have examined this question have invariably used recordings of cardiac events obtained from patients. However, this type of evaluation may not correlate particularly well with bedside skills. Our objectives were 1) To compare the cardiac auscultatory skills of physicians in training with those of experienced cardiologists by using real patients to test bedside diagnostic skills. 2) To evaluate the impact of a five-month bedside cardiac auscultation training program. Methods 1) In an academic primary care center, 20 physicians (trainees in internal medicine and family practice) and two skilled academic cardiologists listened to 33 cardiac events in 13 patients directly at bedside and identified the cardiac events by completing an open questionnaire. Heart sounds, murmurs and diagnosis were determined beforehand by an independent skilled cardiologist and were validated by echocardiography. Thirteen primary cardiologic diagnoses were possible. 2) Ten of the physicians agreed to participate in a course of 45-minute sessions once a week for 5 months. After the course they listened again to the same patients (pre/post-interventional study). Results 1) The experts were the most skillful, achieving 69% recognition of heart sounds and murmurs and correct diagnoses in 62% of cases. They also heard all of the diastolic murmurs. The residents heard only 40% of the extra heart sounds and made a correct diagnosis in 24% of cases. 2) After the weekly training sessions, their mean percentage for correct diagnosis was 35% [an increase of 66% (p Conclusions The level of bedside diagnostic skills in this relatively small group of physicians in training is indeed low, but can be improved by a course focusing on realistic bedside teaching.
机译：背景技术随着新技术的发展，物理诊断技能的总体熟练程度似乎正在下降。少数研究了这个问题的研究都使用了从患者那里得到的心脏事件的记录。但是，这种类型的评估可能与床边技能没有特别好的关联。我们的目标是：1）通过使用真实的患者测试床边诊断技能，比较训练中的医生和有经验的心脏病医生的心脏听诊技能。 2）评估为期五个月的床旁心脏听诊培训计划的影响。方法1）在一个学术性初级保健中心，有20位医师（内科和家庭实践培训生）和2名熟练的心脏病学专家直接在床旁听了13例患者的33例心脏事件，并通过填写一份公开调查表确定了心脏事件。心音，杂音和诊断是由独立的专业心脏病专家事先确定的，并已通过超声心动图进行了验证。十三项主要的心脏病诊断是可能的。 2）十位医师同意每周一次，每次45分钟，持续5个月。疗程结束后，他们再次聆听了相同的患者（干预前/干预后研究）。结果1）专家最熟练，在62％的病例中获得了69％的心音和杂音识别率和正确的诊断率。他们还听到了所有舒张期杂音。居民仅听到40％的额外心音，并在24％的病例中做出了正确的诊断。 2）在每周的培训之后，他们能够正确诊断的平均百分比为35％[增加66％（p结论）在这个相对较小的医师组中，床边诊断技能的水平确实很低，但是可以通过以下方法提高侧重于实际床头教学的课程。

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