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December 3, 1997

Cardiac Auscultation Skills of Physicians in Training

Author Affiliations

University of Miami School of Medicine Miami, Fla
Emory University School of Medicine Atlanta, Ga
University of Iowa Hospital and Clinics Iowa City

JAMA. 1997;278(21):1740-1741. doi:10.1001/jama.1997.03550210038026

To the Editor.  —We agree with Drs Mangione and Nieman1 that the burden of teaching and testing these essential skills rests today primarily with medical schools and that repetition through simulation is a logical remedy.The 30-year experience of our 11-center consortium for medical education, including Harvey, the cardiology patient simulator, and the UMedic multimedia computer system (MCS; University of Miami, Miami, Fla) should lend credibility to our plan to remedy the problem. The teaching effectiveness of Harvey, a full-size mannequin that realistically simulates all the bedside findings of 27 cardiac conditions, has been documented in a National Heart, Lung, and Blood Institute—supported study2 involving 208 senior medical students at 5 institutions. Those trained with Harvey scored significantly higher on posttests involving actual patients (P<.03). The MCS, which also emphasizes bedside skills,3 has been integrated into the 4-year curriculum at 6 centers, involving 1586 students, with very high acceptance.