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December 3, 1997

Cardiac Auscultation Skills of Physicians in Training

JAMA. 1997;278(21):1740. doi:10.1001/jama.1997.03550210038024

To the Editor.  —Apparently every generation of physicians rediscovers its own ineptitude. Drs Mangione and Nieman1 are apparently disturbed that both internal medicine and family practice trainees were so strikingly wrong at identifying 12 important and commonly encountered cardiac events. Rarely has the cliche "So what else is new?" been so apt.Thirty-five years ago, one of my duties as chief medical resident in a prestigious New York City teaching hospital was to arrange teaching rounds for practicing physicians who served on our voluntary teaching faculty. Almost none of the physicians who were responsible for teaching students and residents could regularly recognize the murmur of mitral regurgitation. Austin Flint and Graham Steell murmurs were loftily discussed but never identified. I was secretly amused at how often atrial fibrillation at a rate of 80 beats per minute was identified either as regular sinus rhythm or at best as premature beats.Medical educators are