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Simulation-based Mastery Learning Improves Cardiac Auscultation Skills in Medical Students

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Abstract

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.

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References

  1. Butterworth JS, Reppert EH. Ausculatatory acumen in the general medical population. JAMA. 1960;174:32–4.

    Google Scholar 

  2. Mangione S, Neiman L, Graceley E, Kaye D. The teaching and practice of cardiac auscultation during internal medicine and cardiology training. Ann Intern Med. 1993;119:47–54.

    CAS  PubMed  Google Scholar 

  3. Vukanovic-Criley JM, Criley S, Ward CM, et al. Competency in cardiac examination skills in medical students, trainees, physicians and faculty. Arch Intern Med. 2006;166:610–16.

    Article  PubMed  Google Scholar 

  4. Mangione S, Nieman LZ. Cardiac ausculatation skills of internal medicine and family practice trainees: A comparison of diagnostic proficiency. JAMA. 1997;278:717–22.

    Article  CAS  PubMed  Google Scholar 

  5. Accreditation Council for Graduate Medical Education Outcome Project. Available at: (http://www.acgme.org/Outcome). Accessed February 1, 2010.

  6. Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med. 2004;79(10 Suppl):S70–81.

    Article  PubMed  Google Scholar 

  7. Issenberg SB, McGaghie WC, Gordon DL, et al. Effectiveness of a cardiology review course for internal medicine residents using simulation technology and deliberate practice. Teach Learn Med. 2002;14:223–8.

    Article  PubMed  Google Scholar 

  8. Barrett MJ, Kuzma MA, Seto TC, et al. The power of repetition in mastering cardiac auscultation. Am J Med. 2006;119:73–5.

    Article  PubMed  Google Scholar 

  9. Wayne DB, Butter J, Siddall VJ, et al. Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice. JGIM. 2006;21:251–6.

    Article  PubMed  Google Scholar 

  10. Wayne DB, Barsuk JH, O’Leary KJ, Fudala MJ, McGaghie WC. Mastery learning of thoracentesis skills by internal medicine residents using simulation technology and deliberate practice. J Hosp Med. 2008;3:48–54.

    Article  PubMed  Google Scholar 

  11. Barsuk JH, McGaghie WC, Cohen ER, Balachandran JS, Wayne DB. Use of simulation-based mastery learning to improve the quality of central venous catheter placement in a medical intensive care unit. J Hosp Med. 2009;4:397–403.

    Article  PubMed  Google Scholar 

  12. Barsuk JH, McGaghie WC, Cohen ER, O’Leary KJ, Wayne DB. Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit. Crit Care Med. 2009;37: in press.

  13. Barsuk JH, Ahya SN, Cohen ER, McGaghie WC, Wayne DB. Mastery learning of temporary hemodialysis catheter insertion by nephrology fellows using simulation technology and deliberate practice. Am J Kidney Dis. 2009;54:70–6.

    Article  PubMed  Google Scholar 

  14. Wayne DB, Didwania A, Feinglass J, Fudala MJ, Barsuk JH, McGaghie WC. Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case-control study. CHEST. 2008;133:56–61.

    Article  PubMed  Google Scholar 

  15. Barsuk JH, Cohen ER, Feinglass J, McGaghie WC, Wayne DB. Use of Simulation-based education to reduce catheter-related bloodstream infections. Arch Intern Med. 2009;169:1420–3.

    Article  PubMed  Google Scholar 

  16. Wayne DB, Butter J, Cohen ER, McGaghie WC. Setting defensible standards for cardiac auscultation skills in medical students. Acad Med. 2009;84(10, Suppl):S94–6.

    Article  PubMed  Google Scholar 

  17. Block, JH ed. Mastery Learning: Theory and Practice. New York: Holt, Rinehart and Winston 1971.

  18. McGaghie WC, Miller GE, Sajid A, Telder TV. Competency-Based Curriculum Development in Medical Education. Public Health Paper No. 68, Geneva, Switzerland: World Health Organization 1978.

  19. Des Jarlais DC, Lyles C, Crepaz N, TREND Group. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: The TREND Statement. Am J Pub Health. 2004;94:361–6.

    Article  Google Scholar 

  20. Shadish WR, Cook TD, Campbell DT. Experimental and Quasi-Experimental Designs for Generalized Causal Inference. Boston: Houghton Mifflin; 2002.

    Google Scholar 

  21. Mangione S. The teaching of cardiac auscultation during internal medicine and family medicine training – a national comparison. Acad Med. 1998;73(Supplement):S10–12.

    Article  CAS  PubMed  Google Scholar 

  22. Miami Group. UMedic User Manual. Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, 2007.

  23. Issenberg SB, Petrusa ER, McGaghie WC, et al. Effectiveness of a computer-based system to teach bedside cardiology. Acad Med. 1999;74:S93–5.

    Article  CAS  PubMed  Google Scholar 

  24. Issenberg SB, McGaghie WC, Brown DD, et al. Development of multimedia computer-based measures of clinical skills in bedside cardiology. In: Melnick DE, ed. The Eighth International Ottawa Conference on Medical Education and Assessment Proceedings. Evolving Assessment: Protecting the Human Dimension. Philadelphia: National Board of Medical Examiners; 2000:821–9.

    Google Scholar 

  25. Downing SM. Reliability: on the reproducibility of assessment data. Med Educ. 2004;38:1006–12.

    Article  PubMed  Google Scholar 

  26. Fleiss JL, Levin B, Paik MC. Statistical Methods for Rates and Proportions. 3rd ed. New York: John Wiley & Sons; 2003.

    Google Scholar 

  27. Brennan RL, Prediger DJ. Coefficient kappa: some uses, misuses and alternatives. Educ Psychol Meas. 1981;41:587–699.

    Google Scholar 

  28. Barrett MJ, Lacey CS, Sekara AE, Linden EA, Gracely EJ. Mastering cardiac murmurs – the power of repetition. CHEST. 2004;126:470–5.

    Article  PubMed  Google Scholar 

  29. Choudhry NK, Fletcher RH, Soumerai SB. Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med. 2005;142:260–73.

    PubMed  Google Scholar 

  30. Fletcher RH, Fletcher SW, Wagner EH. Clinical Epidemiology—The Essentials. 3rd ed. Baltimore: Williams & Wilkins; 1996.

    Google Scholar 

  31. Wayne DB, Cohen E, Makoul G, McGaghie WC. The impact of judge selection on standard setting for a patient survey of physician communication skills. Acad Med. 2008;83(10 Suppl):S17–20.

    Article  PubMed  Google Scholar 

  32. Hatala R, Issenberg SB, Kassen B, Cole G, Bacchus CM, Scalese RJ. Assessing cardiac physical examination skills using simulation technology and real patients: a comparison study. Med Educ. 2008;42:628–36.

    Article  PubMed  Google Scholar 

  33. De Geiovanni D, Roberts T, Norman G. Relative effectiveness of high- versus low-fidelity simulation in learning heart sounds. Med Educ. 2009;43:661–8.

    Article  Google Scholar 

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Acknowledgements

We thank the Northwestern medical students who participated in this study for their dedication to patient care and education. We acknowledge Drs. Douglas Vaughan and John X. Thomas for their support and encouragement of this work. Funding was provided through the Augusta Webster, MD Office of Medical Education and Faculty Development. Dr. McGaghie’s contribution was supported in part by the Jacob R. Suker, MD, professorship in medical education at Northwestern University and by grant UL 1 RR025741 from the National Center for Research Resources, National Institutes of Health. The National Institutes of Health had no role in the preparation, review, or approval of the manuscript.

Funding

Office of Medical Education and Faculty Development, Northwestern University Feinberg School of Medicine, Chicago, IL

Conflicts of interests

Dr. McGaghie has been consultant to, and received honorariums from, the Gordon Center for Research in Medical Education at the University of Miami Miller School of Medicine where the "Harvey" mannequin is manufactured. None of the other authors have conflicts of interest, financial interests or relationships or affiliations relevant to the subject matter or materials discussed in this manuscript.

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Correspondence to John Butter MD.

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Butter, J., McGaghie, W.C., Cohen, E.R. et al. Simulation-based Mastery Learning Improves Cardiac Auscultation Skills in Medical Students. J GEN INTERN MED 25, 780–785 (2010). https://doi.org/10.1007/s11606-010-1309-x

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