Butter J, McGaghie WC, Cohen ER, Kaye M, Wayne DB. Simulation-based mastery learning improves cardiac auscultation skills in medical students

Augusta Webster, MD Office of Medical Education and Faculty Development, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 03/2010; 25(8):780-5. DOI: 10.1007/s11606-010-1309-x
Source: PubMed


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.
To describe a mastery model of cardiac auscultation education and evaluate its effectiveness in improving bedside cardiac auscultation skills.
Untreated control group design with pretest and posttest.
Third-year students who received a cardiac auscultation curriculum and fourth year students who did not.
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.
Diagnostic accuracy with simulated heart sounds and actual patients.
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.
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.

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Available from: John Butter, Aug 21, 2014
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    • "To transfer a skill successfully, students must learn to adjust their performance to the variety of conditions in real clinical situations [12,13]. Few studies have shown that simulation training improves participants’ performance on real patients [14,15], and no studies have investigated UC performance. "
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    • "focused, repetitive practice; (2) rigorously measuring performance to provide feedback and encourage learners to correct errors through repeated practice; and (3) evaluating learners to certify mastery and promote them to the next task (McGaghie et al. 2011). In clinical medicine, deliberate practice has previously been applied mainly to procedural and physical exam skills, such as advanced cardiac life support (Wayne et al. 2008), central line insertion (Barsuk et al. 2009), and cardiac auscultation (Butter et al. 2010). "
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