Auscultation Confidence

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A recent study at Johns Hopkins Hospital in Baltimore, Maryland, showed that cardiology residents were not able to identify 25% of the pathological murmurs presented to them.

How confident is a primary care clinician in identifying and classifying cardiac murmurs? To answer this question, two professions within the primary care sector were surveyed with the help of Altogether 45 physicians (MDs) and 160 chiropractors (DCs) were surveyed. Both groups perform physical assessments as part of their daily routine and see the same population groups (See Figure 1).


Figure 1: Physical assessment services offered by MDs and DCs.

  How often are primary care clinicians confronted with cardiac murmurs?

Identifying S1/S2 and hearing a cardiac murmur are the first steps in classifying a murmur. Although they frequently perform cardiac auscultation, chiropractors indicated that they very seldom hear a cardiac murmur (more than 50%). Only 1,3% indicated that they do hear a cardiac murmur frequently.

Is this due to an absence of cardiac murmurs in their patient population?

Physicians hear cardiac murmurs more frequently, 24,4% indicated frequent to very frequent, but still a bigger percentage indicated that they hear a murmur seldom to very seldom (35,6%).

How confident are they in classifying the murmur?

Classifying cardiac murmurs accurately is a skill that takes years to master. Confidence in cardiac auscultation is built by frequently using a stethoscope and being exposed to heart murmurs. More than 30% of the physicians interviewed indicated that they are confident with their ability to distinguish between innocent and pathological cardiac murmurs, while 46,7% rated their confidence as average.

67,5% of chiropractors rated their confidence as limited.

Can this have a direct impact on the quality of their service?


Figure 2: The relative frequency with which MDs and DCs are confronted with a cardiac murmur. 


Figure 3: The relative confidence in classifying cardiac murmurs.

Sensi was developed to address this confidence gap. More than 90% of both groups indicated that they would consider procuring a device to assist them in improving their cardiac auscultation confidence and accuracy. This will also address possible liability concerns, as more than 50% of both groups indicated that liability is a concern.


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