Cardiac Auscultation: A Practical Review of Technique, Modern Tools, and Strategies to Maintain Diagnostic Competence

Cardiac auscultation remains a fundamental component of the cardiovascular physical examination and an essential skill for diagnosing valvular heart disease. Despite its clinical importance, persistent deficiencies in auscultatory proficiency have been documented among medical students, residents, and practicing clinicians, partly attributable to reduced bedside teaching and an increasing reliance on advanced imaging. This narrative review examined contemporary educational approaches and diagnostic tools designed to improve the teaching and learning of cardiac auscultation. A structured literature search was conducted in PubMed, LILACS, SciELO, CDC Stacks, and medRxiv, identifying 1065 records, of which 20 studies met inclusion criteria after duplicate removal and eligibility screening. Selected studies evaluated interventions targeting knowledge acquisition, diagnostic accuracy, and clinical competence across learners ranging from medical students to practicing physicians. Simulation-based medical education, particularly simulation-based mastery learning, emerged as an effective strategy for improving auscultatory knowledge and skills. High-fidelity simulators, such as the Harvey Cardiology Patient Simulator, provide standardized training environments associated with improved diagnostic accuracy and skill retention. Digital tools support auditory pattern recognition through repeated exposure, while hybrid simulation models enhance realism by integrating clinical interaction. Point-of-care technologies, including handheld echocardiography and digital stethoscopes, may further support learning by linking auscultatory findings with underlying pathophysiology. Evidence supports a multimodal approach combining simulation, digital learning, bedside teaching, and structured assessment, with repeated exposure and deliberate practice appearing essential for achieving and maintaining auscultatory competence.