Can cardiac auscultation accuracy be improved with an additional app-based learning tool?

Sarah Garvick, Chris Gillette, Hong Gao, Nathan Bates, Joshua Waynick, Sonia Crandall, Sarah Garvick, Chris Gillette, Hong Gao, Nathan Bates, Joshua Waynick, Sonia Crandall

Abstract

Introduction: Many institutions use simulation 'events' to instruct cardiac auscultation. Research shows that these 'one and done' events limit repetition, are costly and do not incorporate learning science techniques, such as spaced learning and retrieval practice. The Littmann Learning™ mobile app, which has unlimited access to a large library of real patient heart sounds, is a cost-effective tool that we considered could be leveraged by educators to provide this training.

Methods: This was a quasi-experimental pre- and post-design consisting of an intervention group (PA22) and a non-equivalent comparator group (PA21). The intervention group used a novel mobile app cardiac auscultation curriculum (MACAC), while the comparator group received standard didactic instruction. One-way analyses of variance were used to analyse the data.

Results: A total of 174 PA students participated in the study. There was a significant (p < 0.001) difference in knowledge and auscultation scores between those who did and did not complete the MACAC. PA22 didactic year knowledge scores were 4.11 and 2.96 points higher than PA21 didactic and clinical year knowledge scores (p < 0.001, d = 1.61 and p < 0.001, d = 1.32), respectively. On average, PA22 didactic year auscultation scores were 0.83 points higher than PA21 clinical year scores (p < 0.001, d = 0.6).

Conclusion: Results indicate that students in their didactic year achieved proficiency in clinically identifying heart sounds, despite not having access to a mannequin simulator and not having an opportunity to identify these sounds bedside. Overall, a MACAC may be an effective method to teach cardiac auscultation to medical learners.

Conflict of interest statement

The authors do not identify any conflicts of interest or have any financial disclosures to report. Specifically, the authors do not have any marketing or financial agreements with Littmann Learning™.

© 2022 The Authors. The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd.

References

    1. Coffey S, Roberts‐Thomson R, Brown A, et al. Global epidemiology of valvular heart disease. Nat Rev Cardiol. 2021;18(12):853‐864. 10.1038/s41569-021-00570-z
    1. Thoenes M, Bramlage P, Zamorano P, et al. Patient screening for early detection of aortic stenosis (AS)‐review of current practice and future perspectives. J Thorac Dis. 2018. Sep;10(9):5584‐94.
    1. Mangrulkar R, Judge R, Chapman C, et al. Professional skill builder: Mastering cardiac auscultation in under 4 hours. MedEdPORTAL. 2017;(13):10577.
    1. Arangalage D, Abtan J, Gaschignard J, et al. Implementation of a large‐scale simulation‐based cardiovascular clinical examination course for undergraduate medical students—A pilot study. BMC Med Educ. 2019;19(1):361. 10.1186/s12909-019-1750-4
    1. Legget ME, Toh MY, Meintjes A, Fitzsimons S, Gamble G, Doughty R. Digital devices for teaching cardiac auscultation—A randomized pilot study. Med Educ Online. 2018;23:1. 10.1080/10872981.2018.1524688
    1. Bernardi S, Giudici F, Leone MF, et al. A prospective study on the efficacy of patient simulation in heart and lung auscultation. BMC Med Educ. 2019;19(1):275. 10.1186/s12909-019-1708-6
    1. Laerdal , Laerdal medical: Harvey cardiopulmonary patient simulator. [Internet] 2021. [cited 2021 April 9]. Available at:
    1. Storm BC, Bjork RA, Storm JC. Optimizing retrieval as a learning event: When and why expanding retrieval practice enhances long‐term retention. Mem Cognit. 2010;38(2):244‐53. 10.3758/MC.38.2.244
    1. Carpenter SK, Cepeda NJ, Rohrer D, Kang SHK, Pashler. Using spacing to enhance diverse forms of learning: Review of recent research and implications for instruction. Educ. Psychol Rev. 2012;24:369‐78.
    1. Cavigloli O, Sumaracki M, Weinstein Y. Understanding How We Learn: A Visual Guide. 1st ed. Routledge; 2018.
    1. Barrett MJ, Lacey CS, Sekara AE, Linden EA, Gracely EJ. Mastering cardiac murmurs: The power of repetition. Chest. 2004;126(2):470‐5.
    1. Vukanovic‐Criley JM, Criley S, Warde CM, et al. Competency in cardiac examination skills in medical students, trainees, physicians, and faculty: A multicenter study. Arch Intern Med. 2006;166(6):610‐6.
    1. Finley JP, Caissie R, Nicol P, Hoyt B. International trial of online auditory training programme for distinguishing innocent and pathological murmurs. J Paediatr Child Health. 2015;51(8):815‐9. 10.1111/jpc.12839
    1. Kagaya Y, Tabata M, Arata Y, Kameoka J. “Variation in effectiveness of a cardiac auscultation training class with a cardiology patient simulator among heart sounds and murmurs”. J Cardiol 2017;70:2 192‐198. 10.1016/j.jjcc.2016.10.011
    1. Thoenes M, Agarwal A, Grundmann D, et al. Narrative review of the role of artificial intelligence to improve aortic valve disease management. J Thorac Dis. 2021;13(1):396‐404. 10.21037/jtd-20-1837
    1. Wynter L, Burgess A, Kalman E, Heron JE, Bleasel J. Medical students: what educational resources are they using? BMC Med Educ. 2019;19(36):1‐8. 10.1186/s12909-019-1462-9
    1. Mesquita CT, Reis JC, Simões LS et al. Digital stethoscope as an innovative tool on the teaching of auscultatory skills. Arq Bras Cardiol. 2013;100(2):187‐189. 10.5935/abc.20130033. PMID: 23503829.
    1. The Economic Times . 98% of Gen Z now own a smartphone. 2017. [cited 2021 Oct 20]. Available from:
    1. Littmann Learning . The apps for auscultation education. [Internet] 2021. [cited 2021 March 23]. Available from:
    1. American Academy of Physician Assistants . What is a PA. [Internet] 2021. [cited 2020 Apr 6]. Available from:
    1. National Commission on Certification of Physician Assistants . Exam content blueprint organ areas. 2021. [cited 2021 May 18]. Available from:
    1. Lee DK. Alternatives to p value: Confidence interval and effect size. Korean J Anesthesiol. 2016;69(6):555‐62. 10.4097/kjae.2016.69.6.555
    1. Multak N, Spear S. A multi‐institutional study using simulation to teach cardiopulmonary physical examination and diagnosis skills to physician assistant students. J Physician Assist Educ. 2015;26(2):70‐6.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi