Teaching Cardiac Examination Skills

A Controlled Trial of Two Methods

Authors

  • Christopher A. Smith MD,

    1. Department of Medicine, John H. Stroger Jr. Hospital of Cook County (Cook County Hospital)/Rush Medical College, Chicago, Ill, USA
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  • Avery S. Hart MD,

    1. Department of Medicine, John H. Stroger Jr. Hospital of Cook County (Cook County Hospital)/Rush Medical College, Chicago, Ill, USA
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  • Laura S. Sadowski MD, MPH,

    1. Department of Medicine, John H. Stroger Jr. Hospital of Cook County (Cook County Hospital)/Rush Medical College, Chicago, Ill, USA
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  • Janet Riddle MD,

    1. Departments of Medical Education and Internal Medicine, University of Illinois at Chicago College of Medicine, Chicago, Ill, USA.
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  • Arthur T. Evans MD, MPH,

    1. Department of Medicine, John H. Stroger Jr. Hospital of Cook County (Cook County Hospital)/Rush Medical College, Chicago, Ill, USA
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  • Peter M. Clarke MD,

    1. Department of Medicine, John H. Stroger Jr. Hospital of Cook County (Cook County Hospital)/Rush Medical College, Chicago, Ill, USA
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  • Pamela S. Ganschow MD,

    1. Department of Medicine, John H. Stroger Jr. Hospital of Cook County (Cook County Hospital)/Rush Medical College, Chicago, Ill, USA
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  • Ellen Mason MD,

    1. Department of Medicine, John H. Stroger Jr. Hospital of Cook County (Cook County Hospital)/Rush Medical College, Chicago, Ill, USA
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  • Winston Sequeira MD,

    1. Department of Medicine, John H. Stroger Jr. Hospital of Cook County (Cook County Hospital)/Rush Medical College, Chicago, Ill, USA
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  • Yue Wang PhD

    1. Department of Medicine, John H. Stroger Jr. Hospital of Cook County (Cook County Hospital)/Rush Medical College, Chicago, Ill, USA
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The authors have no conflicts of interest to declare for this article.Address correspondence and requests for reprints to Dr. Smith: Department of Medicine, John H. Stroger Jr. Hospital of Cook County (Cook County Hospital)/Rush Medical College, 1900 W. Polk St., Room 1518, Chicago, IL 60612 (e-mail: christopher_smith@rush.edu).

Abstract

OBJECTIVE: To determine if structured teaching of bedside cardiac examination skills improves medical residents' examination technique and their identification of key clinical findings.

DESIGN: Firm-based single-blinded controlled trial.

SETTING: Inpatient service at a university-affiliated public teaching hospital.

PARTICIPANTS: Eighty Internal Medicine residents.

METHODS: The study assessed 2 intervention groups that received 3-hour bedside teaching sessions during their 4-week rotation using either: (1) a traditional teaching method, “demonstration and practice” (DP) (n=26) or (2) an innovative method, “collaborative discovery” (CD) (n=24). The control group received their usual ward teaching sessions (n=25). The main outcome measures were scores on examination technique and correct identification of key clinical findings on an objective structured clinical examination (OSCE).

RESULTS: All 3 groups had similar scores for both their examination technique and identification of key findings in the preintervention OSCE. After teaching, both intervention groups significantly improved their technical examination skills compared with the control group. The increase was 10% (95% confidence interval [CI] 4% to 17%) for CD versus control and 12% (95% CI 6% to 19%) for DP versus control (both P<.005) equivalent to an additional 3 to 4 examination skills being correctly performed. Improvement in key findings was limited to a 5% (95% CI 2% to 9%) increase for the CD teaching method, CD versus control P=.046, equivalent to the identification of an additional 2 key clinical findings.

CONCLUSIONS: Both programs of bedside teaching increase the technical examination skills of residents but improvements in the identification of key clinical findings were modest and only demonstrated with a new method of teaching.

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