title: Using a multimedia tool to improve cardiac auscultation knowledge and skills.
abstract: OBJECTIVE
  Today's medical school graduates have significant deficits in physical examination skills. Medical educators have been searching for methods to effectively teach and maintain these skills in students. The objective of this study was to determine if an auscultation curriculum centered on a portable multimedia CD-ROM was effective in producing and maintaining significant gains in cardiac auscultatory skills.
  
  
  METHODS
  Controlled cohort study.
  
  
  METHODS
  All 168 third-year medical students at 1 medical school in an academic medical center.
  
  
  METHODS
  Students were tested before and after exposure to 1 or more elements of the auscultation curriculum: teaching on ward/clinic rotations, CD-ROM comprehensive cases with follow-up seminars, and a CD-ROM 20-case miniseries. The primary outcome measures were student performance on a 10-item test of auscultation skill (listening and identifying heart sound characteristics) and a 30-item test of auscultation knowledge (factual questions about auscultation). A subset of students was tested for attenuation effects 9 or 12 months after the intervention.
  
  
  RESULTS
  Compared with the control group (1 month clinical rotation alone), students who were also exposed to the CD-ROM 20-case miniseries had significant improvements in auscultation skills scores (P < .05), but not knowledge. Additional months of clerkship, comprehensive CD-ROM cases, and follow-up seminars increased auscultation knowledge beyond the miniseries alone (P < .05), but did not further improve auscultation skills. Students' auscultation knowledge diminished one year after the intervention, but auscultation skills did not.
  
  
  CONCLUSIONS
  In addition to the standard curriculum of ward and conference teaching, portable multimedia tools may help improve quality of physical examination skills.
authors.affiliation: Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Mich., USA. dstern@umich.edu
authors.forename: D T
authors.initials: DT
authors.lastname: Stern
authors.forename: R S
authors.initials: RS
authors.lastname: Mangrulkar
authors.forename: L D
authors.initials: LD
authors.lastname: Gruppen
authors.forename: A L
authors.initials: AL
authors.lastname: Lang
authors.forename: C M
authors.initials: CM
authors.lastname: Grum
authors.forename: R D
authors.initials: RD
authors.lastname: Judge
mesh_terms: D000704:Analysis of Variance; D016251:CD-ROM; D002983:Clinical Competence; D015331:Cohort Studies; D003194:Computer-Assisted Instruction; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D006326:Heart Auscultation; D006801:Humans; D019212:Multimedia