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Confidential testing of cardiac examination competency in cardiology and noncardiology faculty and trainees: a
Jasminka M Vukanovic-Criley1, Arsen Hovanesyan, Stuart Ross Criley
1Department of Medical Education, St. Mary Medical Center and David Geffen School of Medicine at UCLA, Long Beach, California 90813, USA. jmcriley@gmail.com
Insights
Cardiologists demonstrated superior cardiac examination skills compared to other physicians, though performance declined with more recent training. Early-career faculty scored lower, indicating a need for updated cardiac auscultation training.
Area of Science:
- Cardiology
- Medical Education
- Clinical Skills Assessment
Background:
- Previous studies revealed significant deficiencies in heart sound and murmur identification among medical trainees and physicians.
- A multimedia cardiac examination (CE) test was developed to assess these skills using virtual cardiac patients.
- Prior testing showed internal medicine faculty performed no better than medical students or residents.
Purpose of the Study:
- To evaluate whether cardiologists possess superior cardiac examination skills compared to other physicians.
- To determine if years of clinical practice correlate with performance on a cardiac examination test.
- To assess the efficacy of remote, confidential testing for cardiac examination skills.
Main Methods:
- A 50-question multimedia CE test was administered confidentially at 19 US teaching centers.
- Test scores and demographic data (training level, subspecialty, years in practice) were collected.
- Data from 520 participants including cardiologists, non-cardiology faculty, and trainees were analyzed.
Main Results:
- Cardiology faculty and fellows achieved higher mean scores (86.3% and 77.3%, respectively) than non-cardiology faculty (67.3%) and other trainees (ranging from 59.2% to 63.7%).
- Volunteer cardiologists (86.3%) and full-time cardiologists (82.0%) outperformed private-practice cardiologists (77.0%).
- Faculty scores positively correlated with earlier training and longer practice experience, with lower scores in more recently trained faculty.
Conclusions:
- Academic and volunteer cardiologists demonstrated better cardiac examination skills than other medical faculty.
- Cardiology fellows also outperformed other trainees, but scores decreased in more recently trained faculty.
- Remote testing produced results comparable to proctored assessments, and no significant improvement was noted post-medical school training.
Background:
Many reported studies of medical trainees and physicians have demonstrated major deficiencies in correctly identifying heart sounds and murmurs, but cardiologists had not been tested. We previously confirmed these deficiencies using a 50-question multimedia cardiac examination (CE) test featuring video vignettes of patients with auscultatory and visible manifestations of cardiovascular pathology (virtual cardiac patients). Previous testing of 62 internal medical faculty yielded scores no better than those of medical students and residents.
Hypothesis:
In this study, we tested whether cardiologists outperformed other physicians in cardiac examination skills, and whether years in practice correlated with test performance.
Methods:
To obviate cardiologists' reluctance to be tested, the CE test was installed at 19 US teaching centers for confidential testing. Test scores and demographic data (training level, subspecialty, and years in practice) were uploaded to a secure database.
Results:
The 520 tests revealed mean scores (out of 100 ± 95% confidence interval) in descending order: 10 cardiology volunteer faculty (86.3 ± 8.0), 57 full-time cardiologists (82.0 ± 3.3), 4 private-practice cardiologists (77.0 ± 6.8), and 19 noncardiology faculty (67.3 ± 8.8). Trainees' scores in descending order: 150 cardiology fellows (77.3 ± 2.1), 78 medical students (63.7 ± 3.5), 95 internal medicine residents (62.7 ± 3.2), and 107 family medicine residents (59.2 ± 3.2). Faculty scores were higher in those trained earlier with longer practice experience.
Conclusions:
Academic and volunteer cardiologists outperformed other medical faculty, as did cardiology fellows. Lower scores were observed in more recently trained faculty. Remote testing yielded scores similar to proctored tests in comparable groups previously studied. No significant improvement was seen after medical school with residency training.
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