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Improving the investigation of suspected respiratory disease
P185 An evaluative study of breath sounds teaching
  1. C F Ramsay
  1. Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK

Abstract

Introduction Recorded breath sounds on CD and electronic stethoscopes that can record and playback sounds open up new possibilities for teaching and analysing factors contributing to breath sounds variability.

Aims Assessment of the intra and inter tutor variability in describing recorded breath sounds and of medical students learning preferences for breath sounds teaching.

Methods Seven tutors (four consultants and three specialist registrars in respiratory medicine) were played twenty-two recorded breath sounds. Tutors were asked to “write down exactly how you would teach a student to describe the breath sounds”. Within the twenty-two recordings five identical breath sounds were played twice, one sound was played at two different volumes and two patients were each played at two differing expiratory efforts. A feedback session with the tutors was subsequently held. A separate student evaluation comprised an anonymous questionnaire at the end of their clinical attachment. Twenty-one students were asked to choose their two preferred methods of learning chest auscultation.

Results All tutors gave a précis of the most important feature(s) rather than structured responses. There was a very large degree of inter-observer variability, which was difficult to quantify partly due to the lack of structured descriptions. Recordings at different expiratory efforts resulted in different descriptions from all tutors. When listening to identical pairs of recorded breath sounds 29% of the tutors' descriptions were concordant, 42% partly concordant and 29% different. Abstract P185 figure 1 shows the intra-tutor variability and students' preferred learning methods. For the vast majority of students, experience examining a patient with a tutor or with a tutor using a recording stethoscope was the preferred learning method. Twelve of the twenty-one students had experience of being taught with a recording stethoscope and ten of these students put it down as one of their two preferences.

Conclusions There was significant intra-tutor variability in describing breath sounds comparable with previous studies in this area. A structured methodology would assist in assessing inter tutor concordance. Both students and tutors preferred teaching with patients to recordings. A recording stethoscope was perceived to be a useful adjunct to teaching by students.

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