Digital devices for teaching cardiac auscultation - a randomized pilot study

Recognizing cardiac murmurs in childhood: a survey of physicians' approaches and knowledge levels

OBJECTIVE

This study aimed to assess physicians' approach to cardiac murmurs and their level of knowledge about this sign, which is a crucial finding in childhood cardiac anomalies.

METHODS

The study intended to include all family physicians in the Adıyaman province of Turkey, but ultimately 150 out of 210 physicians participated and was completed with a percentage response rate of 71%. Participants were asked about their approach to cardiac murmurs, answered knowledge questions, and completed a questionnaire on demographic characteristics. Subsequently, eight heart sounds were played, and participants were asked to identify the nature of each sound.

RESULTS

Family medicine specialists (all scores were p < 0.001) and physicians who completed a pediatric internship lasting over a month (knowledge score p = 0.012, behavioral score p = 0.021, recording score p = 0.01) demonstrated significantly higher knowledge, approach, and recording scores. Age and years in the profession showed a negative correlation with recording scores.

CONCLUSIONS

The study highlights the significant impact of various factors such as gender, specialization, internship duration, experience, and theoretical knowledge on the ability to recognize and approach cardiac murmurs. These findings underscore the importance of incorporating these factors into medical education and development programs, especially those aimed at improving cardiac examination skills.

Review on the Advancements of Stethoscope Types in Chest Auscultation

Stethoscopes were originally designed for the auscultation of a patient's chest for the purpose of listening to lung and heart sounds. These aid medical professionals in their evaluation of the cardiovascular and respiratory systems, as well as in other applications, such as listening to bowel sounds in the gastrointestinal system or assessing for vascular bruits. Listening to internal sounds during chest auscultation aids healthcare professionals in their diagnosis of a patient's illness. We performed an extensive literature review on the currently available stethoscopes specifically for use in chest auscultation. By understanding the specificities of the different stethoscopes available, healthcare professionals can capitalize on their beneficial features, to serve both clinical and educational purposes. Additionally, the ongoing COVID-19 pandemic has also highlighted the unique application of digital stethoscopes for telemedicine. Thus, the advantages and limitations of digital stethoscopes are reviewed. Lastly, to determine the best available stethoscopes in the healthcare industry, this literature review explored various benchmarking methods that can be used to identify areas of improvement for existing stethoscopes, as well as to serve as a standard for the general comparison of stethoscope quality. The potential use of digital stethoscopes for telemedicine amidst ongoing technological advancements in wearable sensors and modern communication facilities such as 5G are also discussed. Based on the ongoing trend in advancements in wearable technology, telemedicine, and smart hospitals, understanding the benefits and limitations of the digital stethoscope is an essential consideration for potential equipment deployment, especially during the height of the current COVID-19 pandemic and, more importantly, for future healthcare crises when human and resource mobility is restricted.

Does Learner Self-Efficacy Influence Accurate Identification of Heart Sound Descriptions?

INTRODUCTION

Although physician assistant (PA) training includes cardiac instruction, there is a lack of theory-based research investigating skill and behavioral development in PA students. The objective of this study was to examine the relationship between self-efficacy and ability to correctly identify heart sounds.

METHODS

A cross-sectional study was conducted among 2 cohorts of PA students at one institution. Students answered self-efficacy items using 5-point Likert-type answers and identified specific heart sounds from text descriptions. Data from 154 students were analyzed using Cronbach's alpha and bivariate statistical tests.

RESULTS

Second-year students identified more heart sounds correctly than first-year students (8 v. 7, Z = -2.64, p = 0.01). Students with more confidence were more likely to correctly identify specific heart sounds.

DISCUSSION

Results are consistent with social cognitive theory showing that self-efficacy may be related to outcome performance in PA students. Educational processes that cultivate self-efficacy may increase proficiency in cardiac auscultation.

Can cardiac auscultation accuracy be improved with an additional app-based learning tool?

Introduction

Many institutions use simulation ‘events’ to instruct cardiac auscultation. Research shows that these ‘one and done’ events limit repetition, are costly and do not incorporate learning science techniques, such as spaced learning and retrieval practice. The Littmann Learning™ mobile app, which has unlimited access to a large library of real patient heart sounds, is a cost‐effective tool that we considered could be leveraged by educators to provide this training.

Methods

This was a quasi‐experimental pre‐ and post‐design consisting of an intervention group (PA22) and a non‐equivalent comparator group (PA21). The intervention group used a novel mobile app cardiac auscultation curriculum (MACAC), while the comparator group received standard didactic instruction. One‐way analyses of variance were used to analyse the data.

Results

A total of 174 PA students participated in the study. There was a significant (p < 0.001) difference in knowledge and auscultation scores between those who did and did not complete the MACAC. PA22 didactic year knowledge scores were 4.11 and 2.96 points higher than PA21 didactic and clinical year knowledge scores (p < 0.001, d = 1.61 and p < 0.001, d = 1.32), respectively. On average, PA22 didactic year auscultation scores were 0.83 points higher than PA21 clinical year scores (p < 0.001, d = 0.6).

Conclusion

Results indicate that students in their didactic year achieved proficiency in clinically identifying heart sounds, despite not having access to a mannequin simulator and not having an opportunity to identify these sounds bedside. Overall, a MACAC may be an effective method to teach cardiac auscultation to medical learners.

Real-World Verification of Artificial Intelligence Algorithm-Assisted Auscultation of Breath Sounds in Children

Objective: Lung auscultation plays an important role in the diagnosis of pulmonary diseases in children. The objective of this study was to evaluate the use of an artificial intelligence (AI) algorithm for the detection of breath sounds in a real clinical environment among children with pulmonary diseases. Method: The auscultations of breath sounds were collected in the respiratory department of Shanghai Children's Medical Center (SCMC) by using an electronic stethoscope. The discrimination results for all chest locations with respect to a gold standard (GS) established by 2 experienced pediatric pulmonologists from SCMC and 6 general pediatricians were recorded. The accuracy, sensitivity, specificity, precision, and F1-score of the AI algorithm and general pediatricians with respect to the GS were evaluated. Meanwhile, the performance of the AI algorithm for different patient ages and recording locations was evaluated. Result: A total of 112 hospitalized children with pulmonary diseases were recruited for the study from May to December 2019. A total of 672 breath sounds were collected, and 627 (93.3%) breath sounds, including 159 crackles (23.1%), 264 wheeze (38.4%), and 264 normal breath sounds (38.4%), were fully analyzed by the AI algorithm. The accuracy of the detection of adventitious breath sounds by the AI algorithm and general pediatricians with respect to the GS were 77.7% and 59.9% (p < 0.001), respectively. The sensitivity, specificity, and F1-score in the detection of crackles and wheeze from the AI algorithm were higher than those from the general pediatricians (crackles 81.1 vs. 47.8%, 94.1 vs. 77.1%, and 80.9 vs. 42.74%, respectively; wheeze 86.4 vs. 82.2%, 83.0 vs. 72.1%, and 80.9 vs. 72.5%, respectively; p < 0.001). Performance varied according to the age of the patient, with patients younger than 12 months yielding the highest accuracy (81.3%, p < 0.001) among the age groups. Conclusion: In a real clinical environment, children's breath sounds were collected and transmitted remotely by an electronic stethoscope; these breath sounds could be recognized by both pediatricians and an AI algorithm. The ability of the AI algorithm to analyze adventitious breath sounds was better than that of the general pediatricians.

Integration of ultrasound in medical School: Effects on Physical Examination Skills of Undergraduates

INTRODUCTION

Ultrasound (US) imaging has rapidly increased its application in almost every medical field. Many universities worldwide provide teaching of US for undergraduates in their curricula. Emerging evidence is supporting the use of ultrasonography to improve also non-US skills and knowledge of medical students.

OBJECTIVES

The purpose of this review is to understand if the integration of US lessons into medical students' curriculum improves their learning of physical examination and enhances their skills when performing it.

METHODS

We performed a systematic review of literature by searching three electronic medical databases. We included studies of any level of evidence published in peer-reviewed journals. Evaluated data were extracted using the PICO framework and critically analyzed. PRISMA guidelines were applied; we excluded all the articles evaluated with serious risk of bias and/or low methodological quality.

RESULTS

We included 15 articles, accounting for more than 1643 medical students involved from five different countries and 14 various academical institutions. Eight out of nine studies (88.9%) reported an improvement of practical physical examination scores by students exposed to ultrasound lectures. Eleven out of eleven studies (100%), which administered self-assessment questionnaires, reported strong agreement among students that ultrasound lectures helped them learning and understanding the physical exam and improved their confidence and skills.

CONCLUSIONS

Increasing evidence shows that incorporating ultrasound in medical students' curriculum might improve their ability and confidence when learning and performing a physical exam. This significant tendency needs to be corroborated at a deeper level by further studies.