title: Self-directed study using MP3 players to improve auscultation proficiency of physicians: a randomized, controlled trial.
abstract: BACKGROUND
  Studies of physicians at all levels of training demonstrate significant deficiencies in cardiac auscultation skills. The best instructional methods to augment these skills are not known.
  
  
  METHODS
  This study was a randomized, controlled trial of 83 noncardiologist volunteers exposed to a 12-week lower cognitive load self-study group using MP3 players containing heart sound audio files compared to a group receiving a 1-time 1-hour higher cognitive load multimedia lecture using the same audio files. The primary outcome measure was change in 15-question posttest score at 4 and 12 weeks as compared to pretest on recognition of identical audio files introduced during training. In the self-study group, the association of total exposure and deliberate practice effort (estimated by standard deviation of files played/mean) to improvement in test score was measured as a secondary end point.
  
  
  RESULTS
  Self-study group participants improved as compared to pretest by 4.42 ± 3.41 answers correct at 12 weeks (5.09-9.51 correct, p < .001), while those exposed to the multimedia lecture improved by an average of 1.13 ± 3.2 answers correct (4.48-5.61 correct, p = .03). In the self-study arm, improvement in the posttest was positively associated with both total exposure (β = 0.55, p < .001) and deliberate practice score (β = 0.31, p = .02).
  
  
  CONCLUSIONS
  A lower cognitive load self-study of audio files improved recognition of cardiac sounds, as compared to multimedia lecture, and deliberate practice strategies improved study efficiency. More investigation is needed to assess transfer of learning to a wider range of cardiac sounds in both simulated and clinical environments.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Donato
authors.forename: Antony G
authors.initials: AG
authors.lastname: Kaliyadan
authors.forename: Thomas
authors.initials: T
authors.lastname: Wasser
mesh_terms: D000328:Adult; D002309:Cardiology / Q000193:education*; D002983:Clinical Competence; D004502:Education, Medical, Continuing / Q000379:methods; D004521:Educational Measurement; D005260:Female; D006326:Heart Auscultation / Q000592:standards*; D006801:Humans; D055539:MP3-Player; D008297:Male; D020377:Self Efficacy
keywords: innovative educational interventions; self-directed learning; simulation