Training included 7 cases with normal and abnormal auscultation findings. The authors randomized 135 first-year medical students using an email referral link in 20 to train using audio-only cases (audio group) or audio with phonocardiogram tracings (combined group). The authors investigated whether using phonocardiograms as visual adjuncts to audio cases improved first-year medical students’ cardiac auscultation performance. There was greater improvement for S(4) compared to S(3) detection.Ĭardiac auscultation skills have proven difficult to train and maintain. While listening to heart sound recordings, viewing acoustic cardiography increased subjects' accuracy in detecting diastolic heart sounds, particularly among more experienced subjects.
Accuracy was superior for S(3) compared to S(4) in all ausculatory groups.
More experienced subjects improved S(3) accuracy by 8% to 18% and S(4) by 15% to 32% (P <. While viewing the acoustic cardiogram, first-year medical students had minimal improvement in S(3) (2%) and S(4) (11%) accuracy. Baseline accuracy for auscultation of S(3)/S(4) did not change with level of experience. Next, subjects listened to each recording in random order while viewing phonocardiographic tracings, and recorded S(3)/S(4) presence.Īn S(3) was present in 21 patients (23%) and an S(4) in 31 patients (34%) by consensus overread in 90 recordings. Using a computer module, each subject listened to the heart sounds alone and documented whether an S(3)/S(4) was present. There were 35 subjects from the following 5 groups participating in this study from 1 teaching institution: first-year medical students (n = 5), fourth-year medical students (n = 5), interns (n = 5), medicine residents (n = 5), cardiology fellows (n = 5), and attendings (n = 10). Two blinded, experienced readers using a consensus method determined the presence of the S(3)/S(4) on each file. We sought to examine whether visual inspection of acoustic cardiographic tracings augments the accuracy of medical students' and physicians' detection of third and fourth heart sounds (S(3), S(4)) compared to auscultation alone.Ī total of 90 adults referred for left heart catheterization underwent digital precordial heart sound recordings by computerized acoustic cardiography. Clinical assessment of diastolic heart sounds is challenging.
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