• John Butter, William C McGaghie, Elaine R Cohen, Marsha Kaye, and Diane B Wayne.
• Augusta Webster, MD Office of Medical Education and Faculty Development, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. JButter@nmff.org
• J Gen Intern Med. 2010 Aug 1; 25 (8): 780785780-5.

BackgroundCardiac 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.ObjectiveTo describe a mastery model of cardiac auscultation education and evaluate its effectiveness in improving bedside cardiac auscultation skills.DesignUntreated control group design with pretest and posttest.ParticipantsThird-year students who received a cardiac auscultation curriculum and fourth year students who did not.InterventionA 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.MeasurementsDiagnostic accuracy with simulated heart sounds and actual patients.ResultsTrained 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.ConclusionsA 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.

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