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\u201cWe aimed to improve BCA teaching and learning by developing a high-quality, patient-centered curriculum, based upon a diagnostic reasoning framework that could be flexibly implemented and accessible to a wide spectrum of health professions learners,\u201d explains lead author James Meisel<\/a>, MD, associate professor of medicine.<\/p>\nIn the first of a two-year pilot, the educators implemented the new curriculum with approximately 268 students who were on a six-to-eight-week inpatient medicine clerkships at four U.S. and international medical schools.<\/p>\n
Meisel explains that the curriculum\u2019s title, \u201cListen Before You Auscultate,\u201d has double meaning, encouraging the learner to \u201clisten\u201d to the patient as they describe what brought them to medical attention before \u201causcultating\u201d (listening to the heart with a stethoscope). The framework helps the student clinician capture the patient\u2019s history as context for a six-step, systematic approach. Short videos and practice questions preceded two, one-hour class activities that integrated diagnostic reasoning, pathophysiology, physical diagnosis, and reflection. Activities included case discussions, jugular venous pulse evaluation, and a heart sounds competition along with simulated conversations with patients.<\/p>\n
When compared to a group that received standard instruction, the students who experienced the new BCA curriculum were more confident in their abilities to estimate right heart filling pressures accurately; distinguish normal and abnormal points of maximal impulse; identify classic murmurs of mitral regurgitation and aortic stenosis accurately and identify left-sided gallops on cardiac auscultation accurately.<\/p>\n
According to Meisel, who also is associate chief of staff for education at Veterans Affairs (VA) Bedford Healthcare system, a Chobanian & Avedisian School of Medicine affiliate, this novel curriculum provides students an opportunity to participate in active learning, representing day-to-day clinical competencies and explicitly incorporating notions of trust. \u201cIt is likely that students who are more confident in their abilities and who experience their learning as meaningful are more likely to transfer their abilities to the bedside, become competent and eventually complete a cycle in which they become instructors who teach BCA abilities well,\u201d he added.<\/p>\n