Simulation-based mastery learning improves cardiac auscultation skills in medical students

Abstract

Background: Cardiac auscultation is a core clinical skill. However, prior studies show that trainee skills are often deficient and that clinical experience is not a proxy for competence.

Objective: To describe a mastery model of cardiac auscultation education and evaluate its effectiveness in improving bedside cardiac auscultation skills.

Design: Untreated control group design with pretest and posttest.

Participants: Third-year students who received a cardiac auscultation curriculum and fourth year students who did not.

Intervention: A cardiac auscultation curriculum consisting of a computer tutorial and a cardiac patient simulator. All third-year students were required to meet or exceed a minimum passing score (MPS) set by an expert panel at posttest.

Measurements: Diagnostic accuracy with simulated heart sounds and actual patients.

Results: Trained third-year students (n = 77) demonstrated significantly higher cardiac auscultation accuracy compared to untrained fourth year students (n = 31) in assessment of simulated heart sounds (93.8% vs. 73.9%, p < 0.001) and with real patients (81.8% vs. 75.1%, p = 0.003). USMLE scores correlated modestly with a computer-based multiple choice assessment using simulated heart sounds but not with bedside skills on real patients.

Conclusions: A cardiac auscultation curriculum consisting of deliberate practice with a computer-based tutorial and a cardiac patient simulator resulted in improved assessment of simulated heart sounds and more accurate examination of actual patients.

Figure 1

Performance of simulation-trained third-year students and traditionally trained fourth-year students in cardiac auscultation clinical skills assessments.