Abstract
IntroductionCardiac auscultation skills have proven difficult to train and maintain. The authors investigated whether using phonocardiograms as visual adjuncts to audio cases improved first-year medical students’ cardiac auscultation performance.MethodsThe authors randomized 135 first-year medical students using an email referral link in 2018 and 2019 to train using audio-only cases (audio group) or audio with phonocardiogram tracings (combined group). Training included 7 cases with normal and abnormal auscultation findings. The assessment included feature identification and diagnostic accuracy using 14 audio-only cases, 7 presented during training, and 7 alternate versions of the same diagnoses. The assessment—administered immediately after training and repeated 7 days later—prompted participants to identify the key features and diagnoses for 14 audio-only cases. Key feature scores and diagnostic accuracy were compared between groups using repeated measures ANOVA.ResultsMean key feature scores were statistically significantly higher in the combined group (70%, 95% CI 67–75%) compared to the audio group (61%, 95% CI 56–66%) (F(1,116) = 6.144, p = 0.015, ds = 0.45). Similarly, mean diagnostic accuracy in the combined group (68%, 95% CI 62–73%) was significantly higher than the audio group, although with small effect size (59%, 95% CI 54–65%) (F(1,116) = 4.548, p = 0.035, ds = 0.40). Time on task for the assessment and prior auscultation experience did not significantly impact performance on either measure.DiscussionThe addition of phonocardiograms to supplement cardiac auscultation training improves diagnostic accuracy and heart sound feature identification amongst novice students compared to training with audio alone.Supplementary InformationThe online version of this article (10.1007/s40037-020-00646-5) contains supplementary material, which is available to authorized users.
Highlights
Cardiac auscultation skills have proven difficult to train and maintain
The addition of phonocardiograms to supplement cardiac auscultation training improves diagnostic accuracy and heart sound feature identification amongst novice students compared to training with audio alone
Diagnostic accuracy was higher in the combined group (68%, 95% CI 62–73%) compared to the audio group (59%, 95% CI 54–65%) a difference of 8% that reflected a small effect size (F(1,116) = 4.548, p = 0.035, ds = 0.40)
Summary
Cardiac auscultation skills have proven difficult to train and maintain. The authors investigated whether using phonocardiograms as visual adjuncts to audio cases improved first-year medical students’ cardiac auscultation performance. Initial investigations using phonocardiography as a curricular tool showed improvements in students’ ability to distinguish innocent from abnormal heart murmurs [8] and resident and attending physicians’ ability to recognize diastolic gallops (e.g., S3 and S4) [9] and to accurately identify underlying diagnoses [10] These benefits may be due to improved learning of heart sounds that are both seen and heard compared to training by listening alone. Studies in multimedia learning explain these performance gains by two principles: contiguity, that proximity of different pieces of information are mutually reinforcing, and signaling, that one modality cues essential material in another modality to improve learning [15] This would suggest that deliberate application of training models that combine different sensory inputs—such as the sound and waveforms that make up a phonocardiogram tracing—may improve learning outcomes
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