Internal Medicine Rotation Research Articles

High-value care modeling: Evaluating cost conscious and potentially wasteful behaviors.

42 Background: Value-based care is key to decreasing waste, addressing increasing healthcare costs, and minimizing patient financial toxicity - especially in the treatment of high-cost diagnoses such as cancer. Medical student exposure to role-modeling of high-value care (HVC) behaviors may help shape professional identity formation and have long-term effects on future practices. Our study aimed to investigate the frequency and characteristics of faculty role-modeling of HVC in medical student core clinical rotations. Methods: A cross-sectional survey study was performed with third- and fourth-year medical students on clinical rotations at 11 U.S. medical schools. The survey assessed thirteen variables associated with cost conscious role-modeling behaviors or potentially wasteful role-modeling behaviors, as well as questions characterizing the rotation such behaviors were observed on, demographic information, and organizational culture around HVC. Results: Cost-conscious role-modeling behaviors were observed “sometimes” or “often” between 52.9-70.5% of the time across all clinical rotations, with the exception of observing a student or resident being praised for ordering a cost-effective diagnostic work-up (seen only 25.7% of the time). Potentially wasteful role modeling behaviors were observed “sometimes” or “often” 5%-14.3% of the time, except simultaneously ordering numerous tests before seeing results of initial screening tests (45.1%) and repeating tests rather than attempting to obtain recently performed test results (42.9%). HVC was most often observed on internal medicine rotations (58.3%) and least frequently on surgery rotations (34.5%). Attendings were significantly more likely to model HVC compared to residents/fellows in 5/7 domains. Organizational culture correlated with frequency of HVC behavior observed. Conclusions: HVC role-modeling behaviors, as observed by medical students, are variable across clinical rotations. HVC practices are essential not only within oncology, but across all medical specialties; future studies should strive to identify factors which promote or inhibit HVC modeling and understand differences between HVC education in undergraduate medical curriculum.

The Evolving Stethoscope: Insights Derived from Studying Phonocardiography in Trainees.

Phonocardiography (PCG) is used as an adjunct to teach cardiac auscultation and is now a function of PCG-capable stethoscopes (PCS). To evaluate the efficacy of PCG and PCS, the authors investigated the impact of providing PCG data and PCSs on how frequently murmurs, rubs, and gallops (MRGs) were correctly identified by third-year medical students. Following their internal medicine rotation, third-year medical students from the Georgetown University School of Medicine completed a standardized auscultation assessment. Sound files of 10 different MRGs with a corresponding clinical vignette and physical exam location were provided with and without PCG (with interchangeable question stems) as 10 paired questions (20 total questions). Some (32) students also received a PCS to use during their rotation. Discrimination/difficulty indexes, comparative chi-squared, and McNemar test p-values were calculated. The addition of phonocardiograms to audio data was associated with more frequent identification of mitral stenosis, S4, and cardiac friction rub, but less frequent identification of ventricular septal defect, S3, and tricuspid regurgitation. Students with a PCS had a higher frequency of identifying a cardiac friction rub. PCG may improve the identification of low-frequency, usually diastolic, heart sounds but appears to worsen or have little effect on the identification of higher-frequency, often systolic, heart sounds. As digital and phonocardiography-capable stethoscopes become more prevalent, insights regarding their strengths and weaknesses may be incorporated into medical school curricula, bedside rounds (to enhance teaching and diagnosis), and telemedicine/tele-auscultation efforts.

Distribution of internal medicine rotations among resident physicians in Japan: a nationwide, multicenter, cross-sectional study

BackgroundIn Japan, postgraduate clinical training encompasses a 2-year residency program, including at least 24 weeks of internal medicine (IM) rotations. However, the fragmented structure of these rotations can compromise the training’s quality and depth. For example, a resident might spend only a few weeks in cardiology before moving to endocrinology, without sufficient time to deepen their understanding or have clinical experience. This study examined current patterns and lengths of IM rotations within the Japanese postgraduate medical system. It scrutinized the piecemeal approach—whereby residents may engage in multiple short-term stints across various subspecialties without an overarching, integrated experience—and explored potential consequences for their clinical education.MethodsThis nationwide, multicenter, cross-sectional study used data from self-reported questionnaires completed by participants in the 2022 General Medicine In-Training Examination (GM-ITE). Data of 1,393 postgraduate year (PGY) one and two resident physicians who participated in the GM-ITE were included. We examined the IM rotation duration and number of IM subspecialties chosen by resident physicians during a 2-year rotation.ResultsApproximately half of the participants chose IM rotation periods of 32–40 weeks. A significant proportion of participants rotated in 5–7 internal medicine departments throughout the observation period. Notable variations in the distribution of rotations were observed, characterized by a common pattern where resident physicians typically spend 4 weeks in each department before moving to the next. This 4-week rotation is incrementally repeated across different subspecialties without a longer, continuous period in any single area. Notably, 39.7% of participants did not undertake general internal medicine rotations. These results suggest a narrowed exposure to medical conditions and patient care practices.ConclusionsOur study highlights the need to address the fragmented structure of IM rotations in Japan. We suggest that short, specialized learning periods may limit the opportunity to gain broad in-depth knowledge and practical experience. To improve the efficacy of postgraduate clinical education, we recommend fostering more sustained and comprehensive learning experiences.

Learning through connections: clinical participation and interpersonal relationships in longitudinal integrated clerkships and traditional block rotations in Taiwan

BackgroundLongitudinal integrated clerkships (LICs) and traditional block rotations (TBRs) employ different designs that provide various learning experiences for students. In this study, we explored students’ clinical participation and interpersonal interactions in LICs and TBRs at 2 metropolitan hospitals in Taiwan.MethodsIn April 2018, we enrolled 15 LIC and 29 TBR students. We conducted a cross-sectional survey which required the students to outline a typical daily schedule during their internal medicine rotations and draw an ecomap of the clinical team members. With the patient in the center as a reference, the size of each circle in an ecomap indicated the importance of the member; the distances and number of connecting lines between two circles represented the relationship and frequency of interaction, respectively, between the corresponding members. We analyzed the results and compared the responses of the LIC and TBR students.ResultsThe LIC students spent more time on direct patient care and in the outpatient clinic/operation room, whereas the TBR students participated more in educational activities and in observation behind their seniors. In the ecomap analysis, the LIC students had a closer relationship with attending physicians and had better interactions with patients and preceptors than did the TBR students. Conversely, the TBR students felt closer to and interacted more frequently with interns and residents.ConclusionsThe LIC students had more opportunities to care for patients directly and engaged in interactions with patients and attending physicians more frequently than did the TBR students.Trial registrationEthical approval for the study was obtained from the Institutional Review Board of Tri-Service General Hospital (TSGHIRB 2–106–05–018).

Not a Benign (Mis)Label: Penicillin Allergy Education for the Nonallergist.

Up to 20% of the US population carries a penicillin allergy label; however, over 95% of those patients can safely tolerate penicillin. This discrepancy has important personal and public health consequences. There is no published curriculum for medical trainees that covers penicillin allergy history taking, risk assessment, and antibiotic prescribing. We created a 60-minute, interactive curriculum that targeted medical students during their internal medicine rotation. We employed learning strategies including didactics, case-based learning, and role-playing. We compared self-efficacy and knowledge before and after the intervention using paired t tests. A total of 28 medical students participated, with 25 completing both the pre- and postworkshop surveys. There was a statistically significant improvement in student-rated preparedness to prescribe antibiotics to patients with a penicillin allergy label (p < .001) and determine whether a patient has a history of an allergic reaction that was severe or life-threatening (p < .001). There was additionally a statistically significant increase in students' perception that penicillin allergy labels carry important health consequences (p = .005), as well as increase in their total knowledge scores (p = .006). The workshop employs adult learning techniques to improve self-efficacy and knowledge regarding penicillin allergy in medical students. Further work is needed to refine the curriculum, seek external validity, and determine the impact of this workshop on clinical outcomes.

Teaching Sideways: Implementing a Peer-Led Medical Student Orientation Bootcamp and Survival Guide for Internal Medicine Clerkship.

Transitioning from classroom learning to clerkships presents a challenge for medical students because there is often sparse preparation material on how to effectively contribute to the medical team as a clerkship student. Although some medical schools have implemented transition-to-clerkship sessions, they often are led by faculty and lack the practical and contemporary guidance from students who have recently completed clerkships themselves. Using a sideways mentorship approach, we implemented a 1-hour near-peer Internal Medicine (IM) clerkship orientation bootcamp at our medical school and wrote an accompanying survival guide to teach students how to function as part of a medical team and to increase the transparency of student expectations and evaluations during the clerkship. The 1-hour session covered the following core topics: clerkship logistics, how to gather/present clinical information, a resident/student question-and-answer panel, and how to contribute to the medical team. A postclerkship medical student and second-year IM resident conducted the bootcamp for four student cohorts (105 students total) during the January to December 2022 clerkship year before the IM rotation of each cohort. After the bootcamp, students received a copy of the survival guide to solidify concepts covered in the session. A preclerkship survey included questions to assess student confidence in 10 core IM clerkship domains pre- and postbootcamp. Both pre- and postclerkship surveys asked students to provide feedback on bootcamp strengths and weaknesses. Wilcoxon signed rank tests revealed a significant increase in postbootcamp student confidence rating for all 10 clerkship domains in the early clerkship cohort and in the late clerkship cohort for all of the domains, except finding clinical reference resources (P = 0.15). The bootcamp had the largest effect size (r) on student confidence in both early and late clerkship cohorts for the following clerkship domains: familiarity with IM clerkship evaluation (early: r = 0.61, P < 0.001; late: r = 0.56, P = 0.002), identification of ways to contribute to the medical team (early: r = 0.58, P < 0.001; late: r = 0.63, P < 0.001), and prerounding/chart checking (early r = 0.52, P < 0.001; late: r = 0.55, P = 0.001). The percentage of students rating the helpfulness of both the bootcamp and survival guide as a 3 to 5 on a 5-point Likert scale in the postclerkship survey was highest for the following domains: being familiar with the structure of a subjective, objective, assessment, and plan presentation (88% and 97%), prerounding/chart checking (82% and 95%), writing progress notes (82% and 92%), and identifying ways to contribute to the medical team (82% and 95%). Students commented that the main strengths of the bootcamp included its specific tips on synthesizing and presenting clinical information and its transparency about student expectations and experiences. A structured student-led bootcamp can increase clerkship preparation in core domains. The bootcamp is now part of mandatory clerkship didactics at our medical school, given its success during the 2022 clerkship year, and its content is continuing to be expanded upon by postclerkship students and residents. In addition, the format of the bootcamp also is being adapted to other clerkships, including surgery and obstetrics/gynecology.

Patients Are More Than Their Educational Value

I will never shake the memory of one of the first patients I worked with during clinical rotations. I was excited to begin my internal medicine rotation in my third year, marking my initiation into the world of inpatient care. On my first day, the residents on my team introduced themselves and discussed which patients would provide the best learning opportunities for students. That's how I ended up caring for John Doe.

Restructuring an internal medicine rotation to take on a fully virtual experience in a resource-limited setting: A mixed-methods study

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, medical schools in the Philippines accelerated the adoption of virtual learning. Course developers were challenged to provide equal opportunities for clinical exposure given the differential access of students to technology. This study describes the modifications in the course design of an internal medicine rotation for third-year medical students and the perceptions of the faculty and students toward these changes. MATERIALS AND METHODS: Course evaluations by students and faculty were reviewed. Using a concurrent mixed-methods approach, we analyzed the quantitative and qualitative responses and triangulated the results of the faculty and student surveys. RESULTS: Shifting to a virtual learning platform decreased the number of student–patient interactions. Observing a telemedicine consultation done by faculty substituted for real patient encounters. In consideration of students with limited Internet access, synchronous activities were made nongraded. The survey response rate was 51% (93/181) for students and 34% (32/94) for faculty. Survey participants indicated high overall satisfaction toward the virtual course with a general agreement between students and faculty respondents in most domains. Recurrent themes were the demand for more patient encounters, more synchronous activities, and better evaluation tools. Only the faculty were critical of technical issues, such as audibility and Internet connectivity. CONCLUSION: The experiences of a single institution in redesigning and implementing an undergraduate medical course in internal medicine for a fully virtual platform were described. Strategies for augmenting patient exposure and tailored clinical assessment tools are needed to improve stakeholder satisfaction. In resource-limited settings, access to appropriate technology must be considered to ensure equitable learning.

An Electronic Medical Record Pocket Guide for Incoming Internal Medicine Interns: Perceptions and Impact on Patient Information Gathering.

The transition from medical student to intern is associated with a significant increase in workloads and responsibilities. This includes using the electronic medical record (EMR), which can lead to challenges in information gathering and patient care; however, no formal residency interventions exist in the use of an EMR for information gathering, with most EMR training occurring in the clinical setting. The present study aimed to improve information gathering on patient care and enhance the confidence of Internal Medicine interns in information gathering. We performed a pre- and postprospective study in July 2021. All of the Internal Medicine interns at our community hospital were included. A pre- and postassessment to evaluate interns' confidence was distributed to participants during orientation week and at the end of the inpatient Internal Medicine rotation. A pre- and postconfidence assessment was collected at the beginning and end, respectively, of each intern's inpatient Internal Medicine rotation. Seventeen (85%) interns completed both the preassessment and postassessment. Use of an EMR guide led to a significant increase in completeness of patient information gathering (preassessment: 73.2% ± 18.4% vs post-EMR guide: 94.7% ± 7.4%, P < 0.001) and in intern confidence (P = 0.001). The use of an EMR guide was well received among Internal Medicine interns and led to increased completeness in patient information gathering. Residency programs may benefit from developing an EMR guide to improving the transition of interns during residency.

Rethinking Anatomy: How Radiology Can Revitalize Medical School Anatomy Courses

A third-year medical student on an internal-medicine rotation is sent to the emergency department to see a new patient admitted for abdominal pain. On her way, she starts to develop her differential diagnosis, works through the questions she will ask, and considers how she can effectively present the patient to her team on rounds. As part of her presentation, she suggests that the team order an abdominal CT with contrast.

Mapping lifestyle medicine in undergraduate medical education: a lever for enhancing the curriculum

BackgroundIn 2017, the Bipartisan Policy Center called for inclusion of lifestyle medicine (LM) in undergraduate medical education. Recognizing the requirement that lifestyle medicine should be an integral and integrated part of the curriculum, we undertook an in-depth mapping process to determine the extent of LM teaching at our Faculty, staff perceptions and the impact on medical students.MethodsThe study utilized mixed methodology. In Phase 1 (Mapping) structured analysis of course syllabi were conducted followed by observation of teaching sessions throughout the pre-clinical and clinical years, recording content, the degree of coverage, and time allocated to LM Medicine. In Phase 2 (Impact and perceptions), students’ attitudes and confidence in LM counselling were ascertained by questionnaire (scale 1–4) on completion of second and fourth year of studies. Interviews were conducted with course coordinators.ResultsPhase 1: Students received 58 hours of LM teaching, 49 hours pre-clinical and 9 clinical; 42 hours were dedicated to theoretical knowledge and 16 hours to teaching practical skills related to lifestyle behavior change. Nutrition received the most attention (18 hours), alcohol, sleep, smoking and sexuality the least. On completion of the internal medicine rotation, students (n = 48) agreed that LM guidance should be part of the physician’s role and that patients expected their physicians to be role models (mean ± sd; 3.4 ± 0.7). Students were fairly confident about providing general LM counselling (3.3 ± 1.1); but less so for exercise (3.0 ± 1.2), nutrition (2.7 ± 1.1), stress (2.5 ± 1.0), sleep (2.2 ± 1.2), and sexuality (2.1 ± 1.2). Staff recognized the importance of LM but reported time limitations and the need to bring in external experts to teach LM as challenges.ConclusionsReal-time mapping of teaching is a valuable way to ascertain teaching in practice. Based on our mapping process, redesign of curricula is needed to integrate more competency-based, experiential teaching, particularly in the clinical years.

The Impact of Online Learning In The Internal Medicine Rotation Among Medical Clerks During The Covid 19 Pandemic and Lockdown

Background: The impact of online learning during internal medicine rotation among graduating medical students was evaluated during COVID 19 pandemic. Objectives: The study aimed to gauge acceptability of a self-directed learning, recognize frustrations, identify coping mechanisms, assess rate of learning, evaluate study habits and appraise level of readiness in handling actual patients later in practice among graduating medical clerks. Methodology: An ambispective cohort design study involving both retrospective and prospective follow-up of respondents. The retrospective component involved blended learners with clinical experience (Group 1). The prospective component included online learner with clinical experience (Group 2) and online learner without clinical experience. Results: Group 1 showed that they favor pure traditional learning over pure online learning in contrast to the other 2 groups which rated acceptability of online learning high. All groups had high levels of frustration with their inability to experience actual patient exposure, had moderate to high level of coping mechanisms, and rated high the traditional learning and blended learning methodologies. In contrary, all groups rated low to moderate contributions of online learning to their learning. Group 3 had a significantly higher mean overall readiness score compared to the two other groups. Conclusion: The study showed the different levels of impact of online learning to the different population of medical clerks in terms of its acceptability as an alternative way of learning. Actual patient exposure is of main concern while different coping mechanisms maximize knowledge acquisition. Key words: Online learning, self directed, COVID 19 pandemic, Medical clerks

Integrated secure messaging to enhance medical education: a mixed methods study

BackgroundInstant messaging applications and texting are useful for educating and communicating with medical students; however, they present patient privacy concerns and do not address the challenge of student inclusion in patient care communication. EMR-integrated secure messaging offers an opportunity to include students on team communication, enhance their medical education, and ensure patient privacy.MethodsBetween July 2019 through March 2020, we performed a mixed method study to evaluate use of EPIC® Secure Chat as a means of enhancing student education and team communication. We promoted use of secure messaging in orientation, performed a pre- and post-rotation survey to assess perceptions of Secure Chat effect on communication, and directly reviewed and categorized messages.ResultsTwenty-four 3rd and 4th year students completed the pre-rotation survey, and 22 completed the post-rotation survey. Twelve (50%) students reported the quality of communication with faculty was either good or very good prior to internal medicine rotation, while 20 (91%) reported this post-rotation (p-value 0.001). There was a similar improvement in communication with ancillary staff. Nineteen (86%) students felt that secure messaging improved their communication with faculty. On message review, threads were frequently logistical, but also often included discussions of patient management.ConclusionsStudents viewed Secure Chat as having a favorable effect on their communication with team members and reported communication on internal medicine to be improved compared to prior rotations. Messages included students on important patient care conversations. Secure messaging offers a novel medium to improve team communication, enhance student education, and maintain patient privacy.

Effects of using an abdominal simulator to develop palpatory competencies in 3rd year medical students

BackgroundMedical school faculty are hard pressed to provide clerkship students with sufficient opportunity to develop and practice their capacity to perform a competent clinical examination, including the palpatory examination of the abdomen. We evaluated the impact of training with an abdominal simulator, AbSim, designed to monitor the depth, location, and thoroughness of their palpation and to provide concurrent and summative feedback regarding their performance.MethodsAll third-year medical students were given the opportunity to develop their palpatory skills with the AbSim simulator during the family medicine rotation. The performance of those who studied with the simulator was measured by its sensors, before and after a training session that included visual feedback regarding the depth and coverage of the student’s manual pressure. Additionally, all students reported their confidence in their evolving abdominal palpation skills at the beginning and end of the rotation.Results119 (86.9%) of 137 students filled out the initial questionnaire, and 73 (61.3%) studied with the abdominal simulator. The training produced a highly significant improvement in their overall performance (4 measures, p’s < 0.001). Pre-training performance (depth calibration and thoroughness of coverage) was not related to the number of months of previous clinical rotations nor to previous internal medicine or surgery rotations. There was little relation between students’ confidence in their abdominal examination skills and objective measures of their palpatory performance; however, students who chose the training started with less confidence, and became more confident after training.ConclusionsGuided abdominal simulator practice increased medical students’ capacity to perform an abdominal examination with more appropriate depth and thoroughness of palpation. Interpretation of changes in confidence are uncertain, because confidence was unrelated to objectively measured performance. However, students with low initial confidence in their abdominal examination seemed to be more likely to choose to study with the abdominal simulator.

ICRE Top Research Abstracts

ICRE Top Research Abstracts

Development and Implementation of a Web-Based Learning Environment for an Inpatient Internal Medicine Team: Questionnaire Study.

BackgroundThe notion of anytime, anyplace communication is characteristic of the current generation of learners. Such communications have facilitated the growth and integration of a blended or hybrid learning platform in multiple educational settings. However, there are limited reports on the use of an anytime, anyplace communication platform in clinical inpatient medical education.ObjectiveThe setting of a high-demand inpatient clinical rotation is ideal for the use of collaborative software, and this integration is expected to positively influence medical education. The purpose of this study is to evaluate medical students’ and residents’ educational experiences with incorporating a simple, web-based content management and file sharing platform into an internal medicine inpatient rotation.MethodsDuring an inpatient internal medicine rotation, faculty and learners jointly used collaborative software for educational purposes, and a postrotation survey tool was used to measure the educational influence of the software.ResultsBased on the results of the postrotation survey, the integration of a collaborative software application during clinical rotations improved the learning experience. Learning climate, the communication of rotation goals, and self-directed learning all scored favorably, but feedback from the survey participants was mixed. The learners enthusiastically accepted the practical use of this tool for both communication and information sharing.ConclusionsThis generation of learners is accustomed to frequent electronic communication. Based on our survey, these learners appear to be highly receptive to this web-based intervention design for improving clinical education during active patient care. Adding effective blended learning features to a traditional clinical setting is achievable.

Impact of On-Site Hospital Medicine Curriculum on Preceptor Perception of Rotation.

To assess the feasibility of an on-site, case-based curriculum delivered by preceptors and to assess preceptors' perceptions of the impact of the curriculum on rotation performance and ability to teach. Hospital medicine preceptors were surveyed before and after curriculum deployment using a previously developed survey. Preceptors had positive perceptions of the impact of the curriculum. Rotation performance for health care systems topics had the greatest increase. Curriculum delivery through on-site, case-based teaching might be well received by preceptors. Despite increased demands on preceptor time, preceptor response to the introduction of a structured curriculum during the second-year internal medicine rotation was positive. Use of preceptor-delivered, preprepared, case-based curricular content might be a tool worth testing in further contexts.

Comparison of Student Pharmacists’ Clinical Interventions by Semester During APPE Internal Medicine and Critical Care Rotations

Background: Students contribute to health care through clinical interventions made during rotations. Previous studies assessed student interventions through cost savings instead of student progression throughout the year. Objective: The purpose of this project is to assess clinical interventions made by student pharmacists completing internal medicine and critical care rotations during their Advanced Pharmacy Practice Experiences (APPE) year to determine whether there is a difference in the number and type of interventions between three 3-block rotations, rotation type, and participation in a concentrated learning experience. Methods: Student clinical interventions from 2013 to 2018 were collected. Interventions were organized into categories and subcategories. The primary end point was the difference in the number of interventions between rotation blocks 1 to 3, 4 to 6, and 7 to 9. Secondary objectives compared interventions based on rotation type and participation in a concentrated learning experience. Descriptive statistics and Fisher’s exact tests were conducted. Results: A total of 848 interventions were analyzed. Average student interventions were 39 in blocks 1 to 3, 18 in blocks 4 to 6, and 62 in blocks 7 to 9. Interventions were significantly above the median for students in blocks 1 to 3 and blocks 7 to 9 compared to blocks 4 to 6 (P = .048 and P = .036), respectively. Interventions were significantly above the median for students completing critical care rotations (P = .03). No significant difference was noted in the number of interventions above the median based on participation in a concentrated learning experience (P = .34). Conclusions: Although a difference exists in the number of interventions made during 3 semesters, more research is needed to assess the relationship of rotation block, student program, and rotation type to intervention number.

Contribution of an Early Internal Medicine Rotation to the Clinical Reasoning Learning for Young Residents.

Clinical reasoning is the cornerstone of medical practice, and achieving this competence depends on a large number of factors. Internal medicine departments provide junior doctors with plentiful and varied patients, offering a comprehensive basis for learning clinical reasoning.In order to evaluate the usefulness of an early rotation at internal medicine departments, we compared, via script concordance tests, the evolution of residents’ clinical reasoning after an initial internal medicine rotation compared to rotations through other medical specialties.Twenty-two residents were tested after six months of their internal medicine rotation and compared to twenty-five residents that had the first rotation in another specialty (control). We showed a significant difference in the improvement of the script concordance tests scores (p=0.015) between the beginning and the end of their first rotation between the internal medicine and the control groups, and this implies the lower improvement of clinical reasoning skills and spontaneous learning slope of the junior doctors in other departments.

Use of Simulation Based Training to Enhance Cardiac Auscultation Proficiency.

Cardiopulmonary auscultation is an important skill for medical professionals with deficiencies being well documented with broad implications on healthcare. Providing ideal bedside auscultatory teaching presents many difficulties. Simulation has been used as a means to improve cardiac auscultatory training and circumvent some of these limitations. We studied the use of Harvey © simulation in teaching cardiac murmurs and whether there was improvement in short term knowledge, as well as testing long term knowledge retention, as measured through a standardized test. From 2014-2019, 124 medical students in their 2 nd and 3 rd year of school (during the clinical portion of medical school curriculum) rotating through an Internal Medicine rotation completed a 2 hour training course on cardiac auscultation using Harvey © to identify six common cardiac murmurs. The session contained a pretest, didactic session, and posttest. 124 students participated in the auscultatory training session. Of them, 42 (34%) underwent the session a second time at an average of 1.29 months from their first session. There was statistically significant improvement between tests. Notably, the most often missed murmurs were mitral stenosis and benign (innocent) flow murmur. As shown in our study, simulation based cardiac auscultatory education is feasible and likely beneficial in medical education as it can be delivered to a large group of trainees and overcomes the challenges of bedside teaching.