NEW YORK - Cardiologists are better adapted to detect abnormal heart sounds and perform better bedside heart examinations than medical students residents or general physicians, according to two studies appearing in the March 27 issue of the Archives of Internal Medicine.
In the first study conducted at Stanford University in California, Dr. Jasminka M. Vukanovic-Criley and colleagues evaluated the cardiac examination skills of medical students, residents and other practicing physicians.
This study, which had 860 participants, graded the doctors based on the knowledge of the normal physiology of the heart, auditory skills in recognizing any abnormal sound not associated with a healthy heart, visual skills and a combination of auditory and visual skills in arriving at a competent diagnosis. It was found that medical students who were in their third and fourth years fared better than their counterparts in the first and second year of their training.
However, unless these medical students pursued a cardiology fellowship after the completion of their training, there was no improvement in their skills. "Cardiac examination skills do not improve after medical school year three and may decline after years in practice, which has important implications for medical decision making, patient safety, cost-effective care, and continuing medical education," the authors wrote.
In the second study conducted at the University of California at San Francisco, Dr. Andrew D. Michaels and colleagues focused on the ability of the physicians to detect the presence of a third heart sound during a cardiac examination.
An internal medicine intern, internal medicine resident, cardiology fellow, and cardiology attending- in that order- were asked to evaluate 100 patients. Their findings were analyzed after a comparison with the findings of a phonocardiographic device. This is a machine that searches for and analyzes heart sounds.
In the current study, it was found that only cardiology fellows and attending were able to find abnormal sounds as detected by the device. A third heart sound is an abnormal occurrence that indicates the presence of underlying heart disease. Only those with significant training are able to detect its presence, which is important in arriving at an accurate diagnosis.
