A bedside cardiac assessment (BCA) involves taking a patient’s medical history, performing a physical examination, and determining the need for diagnostic testing. Clinicians integrate this information with knowledge of how disease affects body function to update and prioritize differential diagnoses while providing timely and appropriate care. The knowledge, skills, and attitudes required to perform bedside cardiac assessment are well illustrated in the Association of American Medical Colleges’ Core Trusted Professional Activities for Entering Residencies. This skill is in short supply among non-cardiology trainees and often among their faculty instructors.
To improve BCA training, a team of education researchers led by Boston University Chobanian and Avedisian School of Medicine developed a novel model for how it is taught and taught around the world. In a formal thematic analysis, students participating in this new curriculum found the learning strategies effective, and found peer encounters, skill practice, and academic encounters meaningful.
We aim to improve BCA teaching and learning by creating a high-quality, patient-centered curriculum, based on a diagnostic reasoning framework that can be flexibly applied and accessible to a broad spectrum of health professions students.”
James Meisel, MD, associate professor of medicine, is lead author
In the first of a two-year pilot, educators implemented the new curriculum with approximately 268 students who were in six- to eight-week inpatient medicine clerkships at four U.S. and international medical schools.
Miesel explained that the course title, “Listen Before You Auscultate,” has a dual meaning, encouraging students to “listen” to the patient as they describe what brought them to the clinic before “auscultating” (listening to the heart with a stethoscope). . The framework helps the student physician capture the patient history as the context of a six-step, systematic approach. Short video and practice questions are two, one-hour class activities that integrate diagnostic reasoning, pathophysiology, physical diagnosis, and reflection. Activities include simulated conversations with patients including case discussions, jugular venous pulse evaluation, and heart sound competitions.
Compared with a group receiving standardized instruction, students who experienced the new BCA curriculum were more confident in their ability to accurately estimate heart filling pressure; distinguish normal and abnormal points of maximum emotion; Accurately identify the classic murmurs of mitral regurgitation and aortic stenosis, and accurately identify left-sided gallops on cardiac auscultation.
According to Meizel, who is associate chief of education at the Veterans Affairs (VA) Bedford Healthcare System, a CAMed affiliate, this innovative curriculum allows students to participate in active learning, representing everyday clinical skills and clearly incorporating concepts of faith. “It is likely that students who are more confident in their abilities and who feel their learning is meaningful can transfer their abilities to bed, become qualified and eventually complete a cycle where they become instructors who teach BCA skills well,” she added. .
This result is displayed MedAdPortalA MEDLINE-indexed, open-access journal of teaching and learning resources in the health professions, published by the Association of American Medical Colleges (AAMC).
An education pilot grant from the Boston University Medical Campus Faculty Development and Diversity Committee funded part of the development of this educational innovation. This work was also supported in part with resources from the VA Bedford Healthcare System, the VA Boston Healthcare System, and the New England Geriatric Research Education and Clinical Center.