by Playfuls Staff |
26th March 2007
Patients
rely on their physicians to recognize signs of trouble, yet for common heart
murmurs, that ability is only fair at best. Fortunately, the solution is
simple: listening repeatedly. In fact, intensive repetition — listening at
least 400 times to each heart sound [more] — significantly improved the
stethoscope abilities of doctors, according to a study presented today at the American College of Cardiology's annual meeting.
After
demonstrating last year that medical students greatly improved their
stethoscope skills by listening repeatedly to heart sounds on their iPods, lead
investigator Michael Barrett, M.D., clinical associate professor of medicine
and cardiologist at Temple University School of Medicine and Hospital, set out
to test the technique on practicing physicians.
During a
single 90-minute session, 149 general internists listened 400 times to five
common heart murmurs including aortic stenosis, aortic regurgitation, mitral
stenosis, mitral regurgitation and innocent systolic murmur. Previous studies
have found the average rate of correct heart sound identification in physicians
is 40 percent. After the session, the average improved to 80 percent.
Proficiency
with a stethoscope — and the ability to recognize abnormal heart sounds — is a
critical skill for identifying dangerous heart conditions and minimizing
dependence on expensive medical tests.
"It's
important to know when to order a costly echocardiogram or stress test,"
said Barrett. "Plus, internists are now tested on this skill for board
recertification. Requirements for residents and other specialists are sure to
follow."
Listening
to the heart, known as cardiac auscultation, is, Barrett believes, a technical
skill and therefore best learned through intensive drilling and repetition, not
by traditional methods, usually a classroom lecture or demonstration in medical
school and then on the job. "You don't build this proficiency by
osmosis," Barrett said.
Barrett
will lead another study of physicians, this time cardiologists, at the American College
of Cardiology meeting in New Orleans
on March 25 and 26 at 9 a.m. After the physicians' baseline stethoscope skills
are tested, they will receive an iPod loaded with various heart sounds. After
listening 400 times to each sound, they will be tested again to measure their
improvement.
Temple
University School of Medicine, where Barrett teaches, recently started a
four-year curriculum on cardiac auscultation that relies on different types of
simulators, including iPods, to teach medical students this important but
vanishing skill.
For each
year of medical school, heart sounds are posted online, allowing students to
download them to an iPod or mp3 player. After listening repeatedly to the audio
files, students' skills are tested.
Since the
release of Barrett's first study with medical students, the demand for
recordings of heart sounds has been intense. Thanks to a partnership with the American College of Cardiology, Barrett's heart
sounds can now be accessed online and are available on CD.
He
foresees a day in the near future when doctors are listening to heart sounds
during their work commute.
"There
are two times when a busy practitioner can learn a new skill: at professional
meetings and during their work commute," observed Barrett. Consequently,
he advised the ACC to make the CDs car-friendly and about the length of an
average commute.
