Confidential Testing of Cardiac Examination Competency in Cardiology and Noncardiology Faculty and Trainees: A Multicenter Study

Background: Many reported studies of medical trainees and physicians have demonstrated major deficiencies in correctly identifying heart sounds and murmurs, but cardiologists had not been tested. We previously confirmed these deficiencies using a 50-question multimedia cardiac examination (CE) test featuring video vignettes of patients with auscultatory and visible manifestations of cardiovascular pathology (virtual cardiac patients). Previous testing of 62 internal medical faculty yielded scores no better than those of medical students and residents. Hypothesis: In this study, we tested whether cardiologists outperformed other physicians in cardiac examination skills, and whether years in practice correlated with test performance. Methods: To obviate cardiologists' reluctance to be tested, the CE test was installed at 19 US teaching centers for confidential testing. Test scores and demographic data (training level, subspecialty, and years in practice) were uploaded to a secure database. Results: The 520 tests revealed mean scores (out of 100 +/- 95% confidence interval) in descending order: 10 cardiology volunteer faculty (86.3 +/- 8.0), 57 full-time cardiologists (82.0 +/- 3.3), 4 private-practice cardiologists (77.0 +/- 6.8), and 19 noncardiology faculty (67.3 +/- 8.8). Trainees' scores in descending order: 150 cardiology fellows (77.3 +/- 2.1), 78 medical students (63.7 +/- 3.5), 95 internal medicine residents (62.7 +/- 3.2), and 107 family medicine residents (59.2 +/- 3.2). Faculty scores were higher in those trained earlier with longer practice experience. Conclusions: Academic and volunteer cardiologists outperformed other medical faculty, as did cardiology fellows. Lower scores were observed in more recently trained faculty. Remote testing yielded scores similar to proctored tests in comparable groups previously studied. No significant improvement was seen after medical school with residency training.