December 3, 1997

Cardiac Auscultation Skills of Physicians in Training

Author Affiliations

Mount Sinai Medical Center New York, NY

JAMA. 1997;278(21):1740. doi:10.1001/jama.1997.03550210038025

To the Editor.  —Using a standardized patient assessment, we confirmed the disturbing findings in the article by Drs Mangione and Nieman1 concerning the cardiac examination and substantiate their fears regarding other basic physical diagnostic skills.Nearly 1500 students from 8 New York City medical schools are assessed annually at The Morchand Center for Clinical Competence at the Mount Sinai School of Medicine, and examination results commonly show weaknesses in this area. For the class of 1997, for example, in a standardized patient with shortness of breath, chest pain, and possible aortic dissection, only 4% of 1026 examinees evaluated blood pressures in both upper extremities, 50% auscultated the lungs, and 10% percussed the posterior lung fields. In another standardized patient with signs and symptoms of new-onset diabetes mellitus, only 10% of students checked gross visual acuity, and 28% assessed position sense. Another standardized patient presented with the classic signs and symptoms of acute