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Correspondence |

Simulator Training for Recognition of Murmurs: Give a Kid a Hammer? FREE TO VIEW

Geoffrey R. Norman, PhD; David A. Cook, MD
Author and Funding Information

From the Department of Clinical Epidemiology and Biostatistics (Dr Norman), McMaster University; and the Department of Medicine and Medical Education (Dr Cook), Mayo Clinic College of Medicine.

Correspondence to: Geoffrey R. Norman, PhD, MDCL 3519, McMaster University, 1200 Main St W, Hamilton, ON L8N 3Z5, Canada; e-mail: norman@mcmaster.ca


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(5):1257-1258. doi:10.1378/chest.10-3178
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To the Editor:

In their recent article in CHEST (February 2011), Fraser et al1 demonstrated that students who have just listened to a mitral regurgitation on a high-cost, high-fidelity patient manikin simulator (“Harvey”) can recognize mitral regurgitation in a real patient more accurately than can students who heard other abnormal heart sounds on Harvey during training. We wish to issue a cautionary note. The evidence presented does not constitute an endorsement of simulator training, except as compared with no training. If, as we suspect, the students had little or no exposure to murmurs prior to the study (in their 8 h with standardized [healthy] patients and 2 days on the ward), then we might expect the students who heard the simulated mitral regurgitation would diagnose mitral regurgitation the next time they heard any murmur and, consequently, do better than students in the comparison groups who heard some other abnormality. Consistent with this interpretation, students who heard aortic regurgitation did not do significantly better than students who heard no murmur. The authors also describe a pilot study in which students who had practiced on aortic stenosis did worse on a case of mitral regurgitation than students who had heard no abnormalities.

We also disagree with the authors’ claim that we are lacking well-designed studies demonstrating that simulator training can improve performance on real patients.1 Going back nearly four decades, Aberg et al2 showed comparable diagnostic skill (on real patients with mitral stenosis and aortic stenosis) following 2 h of patient-based clinical teaching vs 1 h of training with an electronic heart-sound generator. A more recent study found a marginal gain in students’ recognition of clinical findings but no difference in their diagnostic accuracy or clinical skill (as tested on real patients) using Harvey-based training in comparison with training using an audio compact disc.3

In summary, although this study shows that a high-fidelity simulator can enhance recognition of a murmur, it also shows that the skill apparently does not generalize. More important, it does not address whether the same learning could result from much less costly approaches.

Fraser K, Wright B, Girard L, et al. Simulation training improves diagnostic performance on a real patient with similar clinical findings. Chest. 2011;1392:376-381. [CrossRef] [PubMed]
 
Aberg H, Johansson R, Michaëlsson M. Phonocardiosimulator as an aid in teaching auscultation of the heart. Br J Med Educ. 1974;84:262-266. [CrossRef] [PubMed]
 
de Giovanni D, Roberts T, Norman G. Relative effectiveness of high- versus low-fidelity simulation in learning heart sounds. Med Educ. 2009;437:661-668. [CrossRef] [PubMed]
 

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References

Fraser K, Wright B, Girard L, et al. Simulation training improves diagnostic performance on a real patient with similar clinical findings. Chest. 2011;1392:376-381. [CrossRef] [PubMed]
 
Aberg H, Johansson R, Michaëlsson M. Phonocardiosimulator as an aid in teaching auscultation of the heart. Br J Med Educ. 1974;84:262-266. [CrossRef] [PubMed]
 
de Giovanni D, Roberts T, Norman G. Relative effectiveness of high- versus low-fidelity simulation in learning heart sounds. Med Educ. 2009;437:661-668. [CrossRef] [PubMed]
 
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