Simulation-based mastery learning improves cardiac auscultation skills in medical students.

BACKGROUND: Cardiac auscultation is a core clinical skill. However, prior studies show that trainee skills are often deficient and that clinical experience is not a proxy for competence. OBJECTIVE: To describe a mastery model of cardiac auscultation education and evaluate its effectiveness in improving bedside cardiac auscultation skills. DESIGN: Untreated control group design with pretest and posttest. PARTICIPANTS: Third-year students who received a cardiac auscultation curriculum and fourth year students who did not. INTERVENTION: A cardiac auscultation curriculum consisting of a computer tutorial and a cardiac patient simulator. All third-year students were required to meet or exceed a minimum passing score (MPS) set by an expert panel at posttest. MEASUREMENTS: Diagnostic accuracy with simulated heart sounds and actual patients. RESULTS: Trained third-year students (n = 77) demonstrated significantly higher cardiac auscultation accuracy compared to untrained fourth year students (n = 31) in assessment of simulated heart sounds (93.8% vs. 73.9%, p < 0.001) and with real patients (81.8% vs. 75.1%, p = 0.003). USMLE scores correlated modestly with a computer-based multiple choice assessment using simulated heart sounds but not with bedside skills on real patients. CONCLUSIONS: A cardiac auscultation curriculum consisting of deliberate practice with a computer-based tutorial and a cardiac patient simulator resulted in improved assessment of simulated heart sounds and more accurate examination of actual patients.

Does ultrasound training boost Year 1 medical student competence and confidence when learning abdominal examination?

OBJECTIVES: Learning to perform physical examination of the abdomen is a challenge for medical students. Medical educators need to find engaging, effective tools to help students acquire competence and confidence in abdominal examination techniques. This study evaluates the added value of ultrasound training when Year 1 medical students learn abdominal examination. METHODS: The study used a randomised trial with a wait-list control condition. Year 1 medical students were randomised into 2 groups: those who were given immediate ultrasound training, and those for whom ultrasound training was delayed while they received standard instruction on abdominal examination. Standardised patients (SPs) used a clinical skills assessment (CSA) checklist to assess student abdominal examination competence on 2 occasions - CSA-1 and CSA-2 - separated by 8 weeks. Students also estimated SP liver size for comparison with gold-standard ultrasound measurements. Students completed skills confidence surveys. RESULTS: Proficiency in abdominal examination technique acquired from traditional instruction boosted with ultrasound training showed no advantage at CSA-1. However, at CSA-2 the delayed ultrasound training group showed significant improvement. Students uniformly underestimated SP liver sizes and the estimates were not affected by ultrasound training. Student confidence in both groups improved from baseline to CSA-1 and CSA-2. CONCLUSIONS: Ultrasound training as an adjunct to traditional means of teaching abdominal examination improves students' physical examination technique after students have acquired skills with basic examination manoeuvres.

Teaching the mental status examination to medical students by using a standardized patient in a large group setting.

The authors describe their recent experience in using a standardized patient (SP) to illustrate the mental status examination (MSE) to 170 second-year medical students in a large classroom setting. An SP was trained to portray a patient with schizophrenia who was interviewed during the MSE lecture. A six-question survey was distributed to the students to evaluate how the students felt about the learning experience. Results show that the majority of students felt that using an SP in a large classroom setting helped them to understand the material better and was a useful teaching tool. Follow-up studies are under way to objectively measure students' integration and retention of the lecture material.