PURPOSE: Only 21% of medical students can accurately recognize heart sounds. Previous work has demonstrated that listening to high-grade repetition of abnormal heart sounds in a classroom dramatically improves proficiency in cardiac auscultation. This study explores whether similar results can be obtained by delivering training completely over the internet and eliminating the classroom aspect entirely.
METHODS: Group A contained 235 third-year medical students who logged onto a website and took an online, computer-based test in cardiac auscultation. They then downloaded a one-hour digital mp3 file containing auditory recognition exercises of 5 basic murmurs (AS, AR, MS, MR, Innocent-Murmur) and 2 extra heart sounds (S3, S4). The file contained 200 repetitions of each sound. After listening to the file, students returned to the website one week later to take an online post-test. For both tests, students listened to the heart sounds in a randomized sequence, selecting the correct answer from a menu. Group B contained 84 different third-year students who took their pretest in a classroom using a portable stereo system. They then downloaded the same one-hour, digital mp3 file that group A used, and later returned to the classroom to take a proctored post-test.
RESULTS: Group A’s average pretest scores (31.5 ±20.9%) increased significantly to 80.5 ±16.31% on the post-test (p<.001, paired t-test). Group B’s pretest scores (27.5 ±15.7%) increased to 81.8 ±15.7% (p<.001). No difference existed between the two groups (P=NS, unpaired t-tests).
CONCLUSION: Training in cardiac auscultation can be accomplished using an internet web site containing a computerized test and audio-file of auditory recognition exercises. Results obtained in a virtual setting are as effective as those acquired in a proctored classroom.
CLINICAL IMPLICATIONS: This study supports the hypothesis that cardiac auscultation can be taught effectively using the internet alone, and has large implications for the geographic- and cost-effectiveness of this teaching strategy.
DISCLOSURE: Katherine Thomas, Other Dr. Michael Barrett receives royalities from Stethoscope.com, consulting fees from AstraZeneca and owns stock in MED-ED Consulting, Inc.