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.