For hundreds of years, the stethoscope has forged a bond—literally and figuratively—between doctor and patient. Nevertheless, this tool has landed on medicine’s “endangered species” list, increasingly marginalized in favor of more technologically advanced diagnostic testing that is more expensive and less personal.
In concert, the stethoscope’s role in medical training has similarly been deemphasized, as medical students and residents—not to mention young attendings, too—all fail to develop the once prized skill of cardiac auscultation. Yet it was the stethoscope that first attracted me to cardiology, and this experience clearly shaped my conviction that the physical exam is in dire need of resuscitation. So began the premise for my Harvard Macy project in 2015.
Using a series of ten internet-based modules previously created by a now emeritus University of Michigan cardiology professor, I arrived in Boston with a curriculum for cardiac auscultation geared toward internal medicine residents on the general cardiology inpatient service. As luck would have it, my small group included an internal medicine resident, who provided directed feedback on the project’s perceived value but also on the outdated technology, the reality of nonexistent inpatient time conducive to such an exercise, and the tension between simulated learning and bedside learning. Channeling my inner Kern and Kotter, I returned home to Ann Arbor to create a needs assessment and informally polled medical students, residents, and cardiology faculty as to the utility of auscultation. The residents and faculty provided candid feedback and forced me to rethink my project entirely. Rather than focus on the physical examination, they first wanted didactics focusing on basic cardiac pathology—arrhythmias, devices, hemodynamic monitoring, etc. This became the basis for a successful fellow-created, fellow-taught CCU didactic series that has been extremely well received. As for the physical exam modules, they have found a home within the medical school, where I received protected time during the cardiac pathophysiology block and introduced a modernized but abridged curriculum. As I work on these modules, I continue to think of ways to adapt them for residents as originally intended.
However, my Macy experience did not end there. Energized by the conference, I returned to Ann Arbor and helped to create a Clinician-Educator Pathway within our cardiology fellowship. Shaped by my experience in Boston and my local mentors at Michigan, we created a track that combined seminars, teaching opportunities, and education-focused scholarship. Currently, we are trying to expand the pathway to all trainees within the larger department of graduate medical education.
As a result of the cardiology fellowship pathway experience, I was then asked by the American College of Cardiology to create a national conference for cardiology fellows interested in medical education. That conference will now run parallel to and interface with one of the ACC’s annual CME courses in Montana next February. Invited fellows will attend a presenter “bootcamp” and then partner with a distinguished educator to deliver a case presentation to the CME audience. In April, I will then help to run a "Clinician-Educator" bootcamp for cardiology fellows at the national American College of Cardiology meeting in Chicago. The doors that have opened to me as a result of my Macy experience are simply incredible!
Editor’s Note: This blog is part of a new series entitled “Taking Harvard Macy Back Home” in which we will feature stories of the evolution of scholars’ projects after completion of Harvard Macy Institute courses.
Craig Alpert
