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How grace notes and timpani can teach you to detect abnormal sounds in the body

Thomas C. Duffy collaborates with the School of Nursing on music-based instruction in auscultation
June 12, 2014

Thomas DuffyYale-China Review
Spring 2014

Yale-China will convene a conference titled “Looking is Not Seeing and Listening is Not Hearing” at Xiangya School of Medicinte from June 4–6, 2014 based on the cross-discipline research of Yale professors Linda H. Pellico from Yale School of Nursing and Thomas C. Duffy from the Yale School of Music. The report below describes the research that serves as the basis for the conference

Most people are happy to tell you the name of their current favorite song. If you prod them,  some will sing a few bars of the chorus or verse of the: song. Even if they are in a crowded mall full of random sounds, ears will immediately prick up when those first familiar notes cut through the cacophony.

But imagine if the only way that you had ever heard this favorite song was to have a professor lecture to you about the song: its pitch, its time signature, its rhythm, its chord progressions, and so on. After the lecture, would it be possible to identify the song when you actually heard it? Some especially conceptual attendees may be able to identify the piece, but for the vast majority, identification would be quite difficult.

It is just this sort of scenario that medical researchers have been challenging in recent years. The challenge for medical educators has been to train medical professionals in successful techniques of observation and auscultation (listening to body sounds) so that they will correctly identify patient abnormalities.

Linda H. Pellico and Thomas C. Duffy are unlikely collaborators: Pellico is an associate professor of nursing at Yale, Duffy is a professor of msic at Yale. A number of years ago, Pellico had used visual training in museums to increase the ability of nurse trainees to attend to and identify elements in visual examinations of patients. The success of that research in increasing participants’ observational abilities made her think that similar musical training would benefit practitioners in discriminating physical sounds. Through a number of contacts, Pellico found in Duffy someone who was interested in developing this kind of cross-disciplinary approach.

As the researchers examined medical literature for work on training of medical professionals in this area of observations, several issues emerged. First, physical assessment training of course takes place, but it is primarily didactic: in other words, the training is lecture-based. Second, research has found that doctors and nurses only physically assess about half of their patients, and use only a fraction of the assessment skills in which they had been “trained.” Attempts at museum-based visual training, rather than simple lecture, to aid pr-practice nurses and doctors to identify physical issues in diagnosis was highly successful. However, there was no similar research in auditory training to identify, for example, heart sounds, bowel sounds, and lung sounds, a skill called auscultation. Thus the purpose of their research was “to develop a creative, yet practical method for teaching auscultation” (Duffy, Pellico, Fennie and Swan, 2013, p. 235).

In their study, the researchers enrolled 78 students from an acccleratcd master’s program for non-nursing college graduates to receive either music auditory training (MAT)—the new pedagogical method—or traditional assessment training (TAT) during their first week of nursing school. The subjects were divided at random among the two groups, and were given a pretest. “The pretest consisted of identifying which organ was associated with specific body sounds, as well as interpretation of 25 sounds (lung, heart, bowel)” (Duffy. Pellico. Et al, p. 236). After the pretest, TAT participants received lectures, a medical-surgical nursing course which induded descriptions of auscultative abnormalities, did 180 hours of supervised clinical experience. MAT participants also participated in the same lectures, courses, and clinical experiences, but also “‘were exposed, during a two-hour session, to music created by the second author that replicated the aural phenomena of the body’s sounds, specifically heart, lung, and bowel sounds” (p. 236). The sounds were presented along with visual notational diagrams of each sound’s rhythm, articulation, speed and volume. The participants were coached through musical tasks that made them discriminate between various frequencies, volumes and rhythms; moreover, participants received training in distinguishing measures of frequency, volume, and rhythm. Finally, because nursing  students are typically taught sounds in isolation, a “masking exercise” was conducted to help participants to identify spedfic sounds within a field of other sounds. The results of the study were extremely positive. The participants in the MAT group corrtcdy idcntifitd organ sounds at a much higher rate than those in the TAT group, and they were also able to discriminate specific sounds far more successfully (see Tables 1–3). To be fair, all participants in the study increased in their abilities to correctly identify the source of body sounds, and specific kinds of sounds. However, on most measures the MAT participants increased their proficiency at a higher rate than participants who only received the TAT training.

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