Repetition reverses med students' stethoscope shortcomings

January 18, 2006

Repetition appears to be key in improving medical students' woeful lack of stethoscope skills, a handicap that often continues into patient practice. A new study in the January issue of the American Journal of Medicine shows that when medical students listened to heart sounds up to 500 times, they significantly honed their ability to identify specific problems such as a heart murmur or heart failure.

Long bothered by this lack of proficiency with the stethoscope, lead author Michael Barrett, M.D., clinical associate professor of medicine and cardiologist at Temple University School of Medicine and Hospital, said such skills are critical to 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. Managed care will not continue to tolerate this scattershot approach," said Barrett. "Plus, internists are now tested on this skill for board recertification. Requirements for residents and other specialists are sure to follow."

In previous studies, the rate of accurate heart sound identification ranged from 20 percent of medical students to fewer than 40 percent of internists. Traditional teaching methods for stethoscope skills -- classroom lectures -- have proven inadequate.

"We hypothesized that cardiac auscultation is more of a technical skill and thus could be mastered through the use of intensive repetition," said Barrett. For the study, 80 third-year medical students listened to an average of 500 repetitions each of six abnormal heart sounds (aortic stenosis, aortic regurgitation, mitral regurgitation, mitral stenosis, and S3 and S4 gallops) that mimicked heart conditions, such as narrowing of the heart valves and heart failure. The researchers gave CDs to the students, who typically converted the sounds to MP3 files so they could listen on their iPods.

With repetition, proficiency improved from approximately 39 percent to 89 percent. Students in the control group, who did not undergo the repetition, showed no improvement.

Currently, Barrett is studying the impact of electronic stethoscopes as patient simulators on residents' abilities to accurately identify specific heart sounds. He will report his preliminary findings at the American College of Cardiology meeting in Atlanta in March.

Barrett has published more than 40 articles on cardiac auscultation and echocardiography.
MP3 of the heart sounds:

Temple University

Related Heart Failure Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Machining the heart: New predictor for helping to beat chronic heart failure
Researchers from Kanazawa University have used machine learning to predict which classes of chronic heart failure patients are most likely to experience heart failure death, and which are most likely to develop an arrhythmic death or sudden cardiac death.

Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications
A new guide from emergency medicine doctors details the potentially deadly cardiovascular complications COVID-19 can cause.

Autoimmunity-associated heart dilation tied to heart-failure risk in type 1 diabetes
In people with type 1 diabetes without known cardiovascular disease, the presence of autoantibodies against heart muscle proteins was associated with cardiac magnetic resonance (CMR) imaging evidence of increased volume of the left ventricle (the heart's main pumping chamber), increased muscle mass, and reduced pumping function (ejection fraction), features that are associated with higher risk of failure in the general population

Transcendental Meditation prevents abnormal enlargement of the heart, reduces chronic heart failure
A randomized controlled study recently published in the Hypertension issue of Ethnicity & Disease found the Transcendental Meditation (TM) technique helps prevent abnormal enlargement of the heart compared to health education (HE) controls.

Beta blocker use identified as hospitalization risk factor in 'stiff heart' heart failure
A new study links the use of beta-blockers to heart failure hospitalizations among those with the common 'stiff heart' heart failure subtype.

Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.

Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.

How the enzyme lipoxygenase drives heart failure after heart attacks
Heart failure after a heart attack is a global epidemic leading to heart failure pathology.

Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.

Read More: Heart Failure News and Heart Failure Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to