Assessing bedside cardiologic examination skills using ''Harvey,'' a cardiology patient simulator

Objective: To assess the cardiovascular physical examination skills of emergency medicine (EM) housestaff and attending physicians. Methods: Prospective, cohort assessment of EM housestaff and faculty performance on 3 valvular abnormality simulations (mitral regurgitation, mitral stenosis, and aortic regurgitation) conducted on the cardiology patient simulator, ''Harvey.'' Participants examined each of the 3 study disease simulations and proposed a diagnosis (session I), They were then given a cardiac examination form and repeated the programmed simulations (session II). The examination form was used to prompt physicians to interpret 23 separate cardiac findings for each simulation in a multiple-choice format, Results: Forty-six EM housestaff (PGY1-3) and attending physicians were tested over a 2-month study period, Physician responses did not differ significantly among the different levels of postgraduate training. The overall correct response rates for participants were 59% for aortic regurgitation, 48% for mitral regurgitation, and 17% for mitral stenosis, For aortic regurgitation, recognition of a widened pulse pressure and recognition of diastolic decrescendo murmur were associated with a correct diagnosis (p < 0.01), For mitral regurgitation, correct assessment of the contour of the holosystolic murmur predicted a correct diagnosis (p < 0.001), For mitral stenosis, proper characterization of the mitral area diastolic murmur predicted a correct diagnosis (p < 0.001). Conclusion: Housestaff and faculty had difficulty establishing a correct diagnosis for simulations of 3 common valvular heart diseases, However, accurate recognition of a few critical signs was associated with a comet diagnosis in each simulation. Training programs may need to focus attention on selected key components of the cardiovascular examination to facilitate teaching of physical diagnosis.