To the Editor.
—While I strongly believe that cardiac auscultation is a skill worth honing, I disagree with the conclusions of Drs Mangione and Nieman1 that a deficiency in the skills they tested might be a serious problem and that board-certification examinations for primary care specialties should include evaluation of these skills.Any physician practicing rural medicine or who has visited Third World physicians knows the value of keen physical examination skills—especially auscultation. However, where most physicians in the United States practice, the rules are different. While this study examined the ability of residents to identify specific cardiac sounds, it did not show what proportion of those residents tested either did not notice any abnormality or did not generally recognize a pathologic sound. This ability to identify the presence of an abnormality is much more important that the ability to identify what the abnormality is. Even presuming the auscultation
Nadoolman W. Cardiac Auscultation Skills of Physicians in Training. JAMA. 1997;278(21):1739. doi:10.1001/jama.1997.03550210037021
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