BU researchers find that new curriculum’s focus on patient trust makes learning bedside cardiac assessment meaningful

(Boston)—The patient–doctor relationship is built upon trust in not only doctors’ knowledge and skills but also attitudes. Over time, notions of trust in medical education have focused increasingly on trainees becoming “entrustable” to proficiently complete important professional tasks.

In a new study recently published in the online journal Advances in Medical Education and Practice, researchers from Boston University Chobanian & Avedisian School of Medicine explored medical students’ experience of participating in a curriculum that encouraged them to explore attitudes like trust, even while learning how to complete the important task of caring for patients with heart problems.

The study was part of a two-year project, funded partly by an education pilot grant from the BUMC Faculty Development Committee, in which educators implemented a new curriculum with 268 students on six-to-eight-week inpatient medical clerkships at four U.S. and international medical schools, including Boston University.

“There was something we couldn't quite put our hands on about the way we were teaching bedside cardiac assessment,” said corresponding author James Meisel, MD, MHPE, associate professor of medicine and associate chief of staff for education at Veterans Affairs Bedford Healthcare System. Meisel said researchers realized that knowledge, skills and attitudes worked together, something not typically taught. “And that’s what we endeavored to teach,” he said.

In the study, researchers undertook a six-month qualitative exploration of BU medical students’ experience of the first year of the curriculum. “The bedside cardiac assessment curriculum taught humility alongside hard clinical skills, such as physical examination skills,” said Meisel. “Students reported that human interaction meaningfully contributed to successful learning. In particular, humility was the key to patient-centered communication and building trust. This suggests the curriculum may help students develop identities as trustworthy professionals.”

In the first learning module, a videotaped patient set the stage by asking provocatively, ‘Why should I trust your clinical skills?’” Students were encouraged to think and reflect before using their stethoscopes, to listen to the patient describe what brought them to seek medical attention. The idea is to capture the patient’s history, both diagnostically and as part of the human condition, before proceeding with a six-step systematic approach to the cardiac assessment.

Educators used short videos and practice questions preceding two, one-hour class activities integrating diagnostic reasoning, pathophysiology, jugular venous pulse evaluation and heart sounds, along with simulated patient conversations. 

To better understand students’ experience, researchers asked 67 BU students to complete open-ended questions after they’d participated in the two class activities. They then analyzed student responses, looking for recurring themes. The analysis suggested that the learning strategies were effective and that learning with peers, skills practice and interacting with educators were meaningful. The analysis also revealed several opportunities to improve the curriculum, which the authors incorporated into its final version.

Taken with the authors’ 2023 analysis that participants were more confident in their bedside cardiac assessment abilities, the current study suggest that the curriculum supports the development of “confident humility,” a trait that The Coalition for Physician Accountability’s Undergraduate Medical Education-Graduate Medical Education Review Committee deems critical to the transition from medical school to residency training.

“Our hope is that the key take home from our work is that humility, patient centeredness and opportunities for professional identity formation are recognized by curriculum developers, by researchers, by trainees, as opportunities to expand the role of trustworthiness throughout health professions education at all levels,” Meisel said.

Meisel cautioned that, given the limitations of a relatively small dataset, researchers could not explore further nuances.

“We intended this educational experience to bring notions of trust full circle, to help students appreciate Francis Peabody‘s aphorism, ‘The secret of care of the patient is caring for the patient,’” said Meisel. “We anticipate that this work will stimulate conversations around expanded roles of trust in medical education.”

The Bedside Cardiac Assessment curriculum is available through OpenBU. The authors expect to complete an update to the site, making components of the educational resource more easily accessible to health professions trainees and program directors globally, by September 2025.

Other BU authors included, Sheilah Bernard, MD, Hugo Carmona, MD, and the late Gail March Cohen, PhD.