Journal of General Internal Medicine

, Volume 25, Issue 8, pp 780–785 | Cite as

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

  • John Butter
  • William C. McGaghie
  • Elaine R. Cohen
  • Marsha Kaye
  • Diane B. Wayne
Original Article



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.

Key words

Cardiac Auscultation simulation medical students learning 



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.


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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Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • John Butter
    • 1
    • 2
  • William C. McGaghie
    • 1
  • Elaine R. Cohen
    • 2
  • Marsha Kaye
    • 1
  • Diane B. Wayne
    • 2
  1. 1.Augusta Webster, MD Office of Medical Education and Faculty DevelopmentNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Department of MedicineNorthwestern University Feinberg School of MedicineChicagoUSA

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