La simulazione su manichino migliora l’abilità degli studenti di Medicina nell’auscultazione cardiaca? L’esperienza di Pavia

Does simulation-based training improve cardiac auscultation skills in Medicine students? The Pavia experience Clinical evaluation is the cornerstone of any cardiac diagnosis, although excessive over-specialisation often leads to disregard the value of clinical skills and to overemphasize the approach to instrumental cardiac diagnosis. Time restraints, low availability of typical cardiac patients on whom to perform effective bedside teaching, patients’ respect and the underscoring of the value of clinical skills all lead to a progressive decay in teaching. Simulation-guided cardiac auscultation may improve clinical training in medical students and residents. Harvey© is a mannequin encompassing more than 50 cardiac diagnoses that was designed and developed at the University of Miami (Florida, USA). One of the advantages of Harvey© simulation resides in the possibility of listening, comparing and discussing real murmurs. To objectively assess its teaching performance, the capability to identify 5 different cardiac diagnoses (atrial septal defect, normal young subject, mitral stenosis with tricuspid regurgitation, chronic mitral regurgitation, and pericarditis) out of more than 50 diagnostic possibilities was assessed in 130 III-year medical students (i.e. at the very beginning of the clinical experience) before and after a formal 10-hour teaching session with Harvey©. None of them had previously experienced simulation-based cardiac auscultation. As expected, the overall response was poor in the beginners who correctly identified 11% of the administered cardiac murmurs. After simulation-guided training the capability of correctly recognising cardiac diagnoses was much better (72%; p<0.001 vs baseline). These data underscore the importance of clinical training in order to improve auscultation skills in our academic setting, prompting to redesign teaching curricula. Simulation-based cardiac auscultation should be considered as the missing link between formal lecturing and bedside teaching of heart sounds and murmurs.