This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Cardiac Diagnostic Tests  • Alert me on articles by topic

by Jonathan Keroes and David Lieberman, for Windows XP and Macintosh OSX or later, one CD-ROM, headphones required, $149, ISBN 0-7817-8442-5, Philadelphia, Pa, Lippincott Williams & Wilkins, 2006.

JAMA. 2007;297:217-218.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Cardiac auscultation is a fundamental yet exceedingly difficult-to-master clinical skill. Acquisition of auscultatory skills has declined steadily over the last several decades, a phenomenon attributed to several factors, including less patient contact in the hospital, availability of high-tech gadgetry (echocardiogram with Doppler, cardiac magnetic resonance, cardiac computed tomography), and scarcity of competent clinical instruction. Strategies to teach this important diagnostic modality using the time-honored methods of repetition and practice include audio recordings, multimedia CD-ROMs, books used in tandem with these resources, and mannequins. Nothing, however, can replace patient contact—the thrill of listening to an actual person and making a clinical diagnosis—or the gratification of teaching this skill to younger physicians.

Many have sounded alarm bells about the decline and fall of competence and acuity in auscultation.¹ Improving auscultation proficiency requires repetition: in one study, medical students needed 500 repetitions to master four basic cardiac murmurs.² A recent multicenter study concluded . . . [Full Text of this Article]

M. Saleem Seyal, MD, Reviewer
River Cities Cardiology
Jeffersonville, Ind
msaleems@aol.com