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

J Gen Intern Med. 2010 Aug;25(8):780-5. doi: 10.1007/s11606-010-1309-x.


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.

Publication types

  • Controlled Clinical Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Clinical Competence / statistics & numerical data*
  • Computer Simulation
  • Computer-Assisted Instruction
  • Curriculum
  • Educational Measurement
  • Female
  • Heart Auscultation / standards*
  • Heart Diseases / diagnosis*
  • Humans
  • Illinois
  • Learning*
  • Male
  • Models, Educational
  • Program Evaluation
  • Statistics as Topic
  • Statistics, Nonparametric
  • Students, Medical*
  • Teaching*