PEDIATRICS Vol. 108 No. 6 December 2001, pp. 1388-1389
Clinical Auscultation Skills in Pediatric Residents
To the Editor—
We read with great interest the article by Gaskin et al entitled "Auscultation Skills in Pediatric Residents," published in Pediatrics.1 Their article is an important contribution to a growing list of studies2,3,4,5,6 describing the suboptimal cardiac auscultation skills among internal medicine, family practice, and pediatric residents. Of additional concern was the small number of pediatric residents (6 of 47) in the Gaskin study who chose a cardiology elective. In an era of competing demands and limited resources, the need to improve auscultation skills as well as general bedside diagnostic skills has never been greater. It is essential these skills be developed, as cardiac auscultation is indeed a cornerstone of both the cardiovascular examination and making an accurate diagnosis. The advent of new technologies has led to greater reliance on high-tech diagnostic tools, as well as the allocation of training time to teach these modalities. New technology is important, but shouldn’t be a substitute for clinical judgement. Now is not the time to let slide the basic skills all practicing physicians should acquire. Despite the time constraints associated with undergraduate and graduate medical education, medical students and house officers need to have incorporated into their training a greater emphasis on fundamental bedside diagnostic skills. Marcus suggested incorporating the physical examination as part of the board certification examination. This could have a positive impact.7 Certainly such action would underscore the importance of acquiring these skills. Gaskin et al suggest there is a trend toward skills improvement with level of training. We agree and believe the ideal time to initiate such training is early in medical school. Subsequent years of training can only serve to enhance fledgling skills acquired early in training. As part of a novel clinical classroom, we have embarked on a skills-builder program for first and second year medical students. Preliminary results from a randomized, controlled study designed to evaluate the effectiveness of this program revealed students who participated in it outperformed nonparticipants in cardiac auscultation and bedside diagnostic skills. Becoming a physician skilled in bedside diagnosis and auscultation is the result of experience, which requires practice, and having mentors willing to train and evaluate. The investment on the part of medical schools, and residency programs should pay off handsomely in developing highly skilled physicians, fewer unnecessary referrals, better utilization of resources, and improved medical care for our patients.
Robin B. McFee, DO, MPH*
Rachel Boykan, BFA
* Department of Preventive Medicine, SUNY/Stony Brook
University Hospital Medical Center, SUNY/Stony Brook
Seabury Adolescent Health
HSC Level 3—UHMC
Stony Brook, NY 11776
PEDIATRICS (ISSN 1098-4275). ©2001 by the American Academy of Pediatrics
