Listen Before You Auscultate: An Active-Learning Approach to Bedside Cardiac Assessment
James L. Meisel,
Daniel C. R. Chen,
Gail March Cohen,
Sheilah A. Bernard,
Hugo Carmona,
Emil R. Petrusa,
Isaac O. Opole,
Deborah Navedo,
Vladimir I. Valtchinov,
Ahmed H. Nahas,
Carly M. Eiduson,
Nick Papps
Affiliations
James L. Meisel
Associate Chief of Staff for Education, VA Bedford Healthcare System; Associate Professor of Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine
Daniel C. R. Chen
Assistant Dean of Student Affairs and Clinical Associate Professor of Medicine, General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine
Gail March Cohen
Medical Director, AMA Ed Hub
Sheilah A. Bernard
Associate Professor of Medicine, Cardiovascular Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine
Hugo Carmona
Assistant Professor of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
Emil R. Petrusa
Professor of Surgery, Harvard Medical School, and Department of Surgery, Learning Lab, Massachusetts General Hospital
Isaac O. Opole
Professor of Internal Medicine, Department of Internal Medicine, University of Kansas Medical Center
Deborah Navedo
Director of Education, STRATUS Center for Simulation, Brigham and Women's Hospital
Vladimir I. Valtchinov
Assistant Professor of Radiology, Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, and Department of Biomedical Informatics, Harvard Medical School
Ahmed H. Nahas
Advanced Geriatric Medicine Fellow, New England Geriatric Research Education and Clinical Center, VA Boston Health Care System, and Harvard Medical School Multicampus Geriatrics Fellowship, Beth Israel Deaconess Medical Center; Family Physician and Geriatrician, Family Medicine Clinic, Yakima Valley Farm Workers Clinic
Carly M. Eiduson
Fourth-Year Medical Student, University of Rochester School of Medicine & Dentistry
Introduction Bedside cardiac assessment (BCA) is deficient across a spectrum of noncardiology trainees. Learners not taught BCA well may become instructors who do not teach well, creating a self-perpetuating problem. To improve BCA teaching and learning, we developed a high-quality, patient-centered curriculum for medicine clerkship students that could be flexibly implemented and accessible to other health professions learners. Methods With a constructivist perspective, we aligned learning goals, activities, and assessments. The curriculum used a “listen before you auscultate” framework, capturing patient history as context for a six-step, systematic approach. In the flipped classroom, short videos and practice questions preceded two 1-hour class activities that integrated diagnostic reasoning, pathophysiology, physical diagnosis, and reflection. Activities included case discussions, jugular venous pressure evaluation, heart sound competitions, and simulated conversations with patients. Two hundred sixty-eight students at four US and international medical schools participated. We incorporated feedback, performed thematic analysis, and assessed learners’ confidence and knowledge. Results Low posttest data capture limited quantitative results. Students reported increased confidence in BCA ability. Knowledge increased in both BCA and control groups. Thematic analysis suggested instructional design strategies were effective and peer encounters, skills practice, and encounters with educators were meaningful. Discussion The curriculum supported active learning of day-to-day clinical competencies and promoted professional identity formation alongside BCA ability. Feedback and increased confidence on the late-clerkship posttest suggested durable learning. We recommend approaches to confirm this and other elements of knowledge, skill acquisition, or behaviors and are surveying impacts on professional identity formation-related constructs.
