Comments on “The Impact of SARS on Medical House Staff …”

To the Editor:—We were moved by the honest account by Rambaldini et al.¹ of the impact of Severe Acute Respiratory Syndrome (SARS) on medical house staff in the university hospitals in Toronto. As medical educationists faced with the same catastrophic outbreak in Singapore, we identified with the reported struggles and barriers to traditional clinical teaching, and fully agreed with the authors' call for new strategies to deal with future health threats.

In line with the authors' suggestion that more creative educational mechanisms be developed, we would like to share our experience with an innovative method employed to teach cardiac auscultation during the SARS crisis in Singapore.² Clinicians in full personal protective equipment used electronic stethoscopes to record the heart sounds of patients with echocardiographically proven heart disease at the 6 classically taught precordial positions for cardiac examination. Cardiologists validated the sounds, which were then used to teach students in simulated “bedside” sessions. Students took turns to act as “patient” and “auscultator.” While the auscultator simulated the clinical examination routine on his/her “patient,” the soundtrack corresponding to each area of auscultation was played through the stethoscope earpieces. Students thus learned to examine real people while picking up real auscultatory signs, a process similar to actual patient encounters. Peer-to-peer teaching helped to overcome the shortage of teaching staff. Soundtracks could be downloaded, stored, “beamed” from one stethoscope to another, and reused to teach large groups of students, thus maximizing the limited clinical material available. Objective outcome measures and subjective feedback proved that the method was effective and well-received by the students. Since then, we have applied this simulated learning method in retraining doctors in basic skill competency during continuing medical education.³

Although this new teaching method was developed in response to the SARS crisis, we have seen that there are applications in modern everyday medicine as well. With patients becoming less tolerant of multiple examinations, illustrative clinical signs becoming rarer with effective disease prevention strategies, and teaching resources growing increasingly limited, more innovative educational strategies are clearly needed. Rather than waiting for the next public health crisis, we believe that the time to develop and apply these new teaching methods is now. We thus join voices with the authors in urging educationists everywhere to think creatively in developing new teaching methods, and to start doing so without delay.