title: Variation in effectiveness of a cardiac auscultation training class with a cardiology patient simulator among heart sounds and murmurs.
abstract: BACKGROUND
  Effectiveness of simulation-based education in cardiac auscultation training is controversial, and may vary among a variety of heart sounds and murmurs. We investigated whether a single auscultation training class using a cardiology patient simulator for medical students provides competence required for clinical clerkship, and whether students' proficiency after the training differs among heart sounds and murmurs.
  
  
  METHODS
  A total of 324 fourth-year medical students (93-117/year for 3 years) were divided into groups of 6-8 students; each group participated in a three-hour training session using a cardiology patient simulator. After a mini-lecture and facilitated training, each student took two different tests. In the first test, they tried to identify three sounds of Category A (non-split, respiratory split, and abnormally wide split S2s) in random order, after being informed that they were from Category A. They then did the same with sounds of Category B (S3, S4, and S3+S4) and Category C (four heart murmurs). In the second test, they tried to identify only one from each of the three categories in random order without any category information.
  
  
  RESULTS
  The overall accuracy rate declined from 80.4% in the first test to 62.0% in the second test (p<0.0001). The accuracy rate of all the heart murmurs was similar in the first (81.3%) and second tests (77.5%). That of all the heart sounds (S2/S3/S4) decreased from 79.9% to 54.3% in the second test (p<0.0001). The individual accuracy rate decreased in the second test as compared with the first test in all three S2s, S3, and S3+S4 (p<0.0001).
  
  
  CONCLUSIONS
  Medical students may be less likely to correctly identify S2/S3/S4 as compared with heart murmurs in a situation close to clinical setting even immediately after training. We may have to consider such a characteristic of students when we provide them with cardiac auscultation training.
authors.affiliation: Office of Medical Education, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: kagaya@med.tohoku.ac.jp.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kagaya
authors.affiliation: Graduate Medical Education Center, Tohoku University Hospital, Sendai, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Tabata
authors.affiliation: Graduate Medical Education Center, Tohoku University Hospital, Sendai, Japan.
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Arata
authors.affiliation: Office of Medical Education, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Kameoka
authors.affiliation: Office of Medical Education, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Ishii
mesh_terms: D002309:Cardiology / Q000193:education* / Q000379:methods; D004501:Education, Medical; D005260:Female; D006326:Heart Auscultation; D006337:Heart Murmurs / Q000175:diagnosis*; D006347:Heart Sounds; D006801:Humans; D008297:Male; D000066908:Simulation Training; D013337:Students, Medical
keywords: Cardiac auscultation; Cardiology patient simulator; Heart murmurs; Heart sounds; Medical education