In defence of auscultation: a glorious future?

Listen Before You Auscultate: An Active-Learning Approach to Bedside Cardiac Assessment

Introduction

Bedside cardiac assessment (BCA) is deficient across a spectrum of noncardiology trainees. Learners not taught BCA well may become instructors who do not teach well, creating a self-perpetuating problem. To improve BCA teaching and learning, we developed a high-quality, patient-centered curriculum for medicine clerkship students that could be flexibly implemented and accessible to other health professions learners.

Methods

With a constructivist perspective, we aligned learning goals, activities, and assessments. The curriculum used a "listen before you auscultate" framework, capturing patient history as context for a six-step, systematic approach. In the flipped classroom, short videos and practice questions preceded two 1-hour class activities that integrated diagnostic reasoning, pathophysiology, physical diagnosis, and reflection. Activities included case discussions, jugular venous pressure evaluation, heart sound competitions, and simulated conversations with patients. Two hundred sixty-eight students at four US and international medical schools participated. We incorporated feedback, performed thematic analysis, and assessed learners' confidence and knowledge.

Results

Low posttest data capture limited quantitative results. Students reported increased confidence in BCA ability. Knowledge increased in both BCA and control groups. Thematic analysis suggested instructional design strategies were effective and peer encounters, skills practice, and encounters with educators were meaningful.

Discussion

The curriculum supported active learning of day-to-day clinical competencies and promoted professional identity formation alongside BCA ability. Feedback and increased confidence on the late-clerkship posttest suggested durable learning. We recommend approaches to confirm this and other elements of knowledge, skill acquisition, or behaviors and are surveying impacts on professional identity formation-related constructs.

Development of a Multi-Channel Wearable Heart Sound Visualization System

A multi-channel wearable heart sound visualization system based on novel heart sound sensors for imaging cardiac acoustic maps was developed and designed. The cardiac acoustic map could be used to detect cardiac vibration and heart sound propagation. The visualization system acquired 72 heart sound signals and one ECG signal simultaneously using 72 heart sound sensors placed on the chest surface and one ECG analog front end. The novel heart sound sensors had the advantages of high signal quality, small size, and high sensitivity. Butterworth filtering and wavelet transform were used to reduce noise in the signals. The cardiac acoustic map was obtained based on the cubic spline interpolation of the heart sound signals. The results showed the heart sound signals on the chest surface could be detected and visualized by this system. The variations of heart sounds were clearly displayed. This study provided a way to select optimal position for auscultation of heart sounds. The visualization system could provide a technology for investigating the propagation of heart sound in the thoracic cavity.

Novice Accuracy in Ultrasound and Stethoscope Study (NAUSS)

INTRODUCTION

The purpose of this noninferiority study was the accurate determination of valvular heart disease, using bedside echocardiogram as compared to stethoscope, by a novice clinician examiner.

METHODS

We conducted a single university, single program study to investigate the use of bedside ultrasound in the hands of a novice clinical user, defined as someone with fewer than 2 years of clinical education. We enrolled 8 examinees with evidence of valvular heart disease to be assessed by 13 subjects.

RESULTS

Descriptive statistics revealed echocardiogram accuracy of 56% compared to 44% accuracy with stethoscope, though not statistically significant. Interestingly, 31% of subjects obtained equal measures with both instruments. Correlation proficiency between both modalities was also observed.

DISCUSSION

There is no statistically significant difference in novice examiner diagnostic accuracy using point-of-care echocardiograms for examination of valvular heart disease when compared with a stethoscope.

Electronic Stethoscope Filtering Mimics the Perceived Sound Characteristics of Acoustic Stethoscope

Electronic stethoscopes offer several advantages over conventional acoustic stethoscopes, including noise reduction, increased amplification, and ability to store and transmit sounds. However, the acoustical characteristics of electronic and acoustic stethoscopes can differ significantly, introducing a barrier for clinicians to transition to electronic stethoscopes. This work proposes a method to process lung sounds recorded by an electronic stethoscope, such that the sounds are perceived to have been captured by an acoustic stethoscope. The proposed method calculates an electronic-to-acoustic stethoscope filter by measuring the difference between the average frequency responses of an acoustic and an electronic stethoscope to multiple lung sounds. To validate the method, a change detection experiment was conducted with 51 medical professionals to compare filtered electronic, unfiltered electronic, and acoustic stethoscope lung sounds. Participants were asked to detect when transitions occurred in sounds comprising several sections of the three types of recordings. Transitions between the filtered electronic and acoustic stethoscope sections were detected, on average, by chance (sensitivity index equal to zero) and also detected significantly less than transitions between the unfiltered electronic and acoustic stethoscope sections ( ), demonstrating the effectiveness of the method to filter electronic stethoscopes to mimic an acoustic stethoscope. This processing could incentivize clinicians to adopt electronic stethoscopes by providing a means to shift between the sound characteristics of acoustic and electronic stethoscopes in a single device, allowing for a faster transition to new technology and greater appreciation for the electronic sound quality.

Case of Supracristal Ventricular Septal Defect and Aortic Regurgitation Detected by Cardiac Auscultation but Missed by Diagnostic Imaging

Imaging technology has diminished the reliance on cardiac auscultation as a definitive diagnostic tool. However, it retains relevance in its immediacy, minimal preparation, and power source independence. We present a case of clinically detected continuous murmur raising specific diagnostic possibilities not accounted for advanced imaging. Further testing revealed a large supracristal ventricular septal defect (VSD) and aortic regurgitation (AR), allowing the surgeon to anticipate combined septal and valvular surgery. This report highlights the value of cardiac auscultation as a guide and validation for imaging. The absence of lesions on imaging is not proof of lesion absence.

Do basic auscultation skills need to be resuscitated? A new strategy for improving competency among nursing students

BACKGROUND

Auscultation of heart and lung sounds is a foundational competency for Registered Nurses (RNs). Precise and timely assessments are important for the early detection and recognition of the deteriorating patient. Studies have shown that improved teaching methods that incorporate emerging technologies and address different learning styles are needed to improve competency in auscultation.

METHOD

Undergraduate nursing students (n = 127) were randomized into treatment and control groups. The control group received the usual preparation in auscultation learning strategies. The treatment group received the usual training plus three auscultation learning sessions that were each 2 h in length (cardiac, pulmonary and mixed sounds).

RESULTS

The virtual auscultation teaching strategy had a significant impact on undergraduate nursing student's competency in recognizing heart murmurs. The treatment group also had increased scores compared to the control group increased scores in distinguishing normal versus abnormal heart and lung sounds, identification of crackles and diminished breath sounds.

CONCLUSION

Virtual auscultation as a teaching strategy was shown to have a positive impact on undergraduate student nurse competence in accurately identifying heart and lung sounds.