A prospective study on the efficacy of patient simulation in heart and lung auscultation

Abstract

Background: The use of simulation technology for skill training and assessment in medical education has progressively increased over the last decade. Nevertheless, the teaching efficacy of most technologies remains to be fully determined. The aim of this prospective study was to evaluate if a short individual training on a patient simulator could improve heart and lung auscultation skills in undergraduate students.

Methods: A group of fifth-year medical school students, who had trained on a patient simulator in their third year (EXP, n = 55), was compared to a group of fifth-year medical school students who had not previously trained on it (CNT, n = 49). Students were recruited on a voluntary basis. Students were evaluated in terms of their ability to correctly identify three heart (II sound wide split, mitral regurgitation, aortic stenosis) and five lung sounds (coarse crackles, fine crackles, pleural rubs, rhonchi, wheezes), which were reproduced in a random order on the Kyoto-Kagaku patient simulator.

Results: Exposure to patient simulator significantly improved heart auscultation skills, as mitral regurgitation was correctly recognized by 89.7% of EXP students as compared to 71.4% of CNT students (p = 0.02). In addition, a significantly greater percentage of EXP students correctly graphed all the heart diagnoses as compared to CNT students. There were no differences between the groups in lung auscultation.

Conclusions: This study demonstrates that training medical students with a patient simulator, individually for one hour, significantly ameliorated their heart auscultation skills. Our data suggests that patient simulation might be useful for learning auscultation skills, especially when it is combined with graphic sound display.

Keywords: Clinical education; Heart auscultation; Lung auscultation; Medical education; Medical semiotics; Patient simulation; Patient simulators.

Fig. 1

(a) Protocol of the study. (b) Auscultation teaching and training programs undertaken by the control and exposed groups, respectively, during the course of Medical Semiotics. The introduction of an individual 1-h training on the patient simulator took place in the academic year 2015/2016. CNT is for control, EXP is for exposed

Fig. 2

Example of the paper that students had to complete. This is a paper that has been completed by one of the students of the EXP group in their fifth year. Students had to identify and graphically represent three consecutive heart sounds/murmurs and to identify five consecutive lung sounds. Red ticks indicate the diagnoses and graphic representations that were judged correct. Blue crosses indicate the diagnoses and/or graphic representations that were judged incorrect. Reading it clockwise, auscultazione polmone is for pulmonary auscultation, studente is for student, tutore is for tutor, crepitti grossolani is for coarse crackles, crepitii fini is for fine crackles, sibili e fischi is for wheezes, ronchi is for ronchi, sfregamenti pleurici is for pleural rubs. Auscultazione cardiaca is for cardiac auscultation, cognome e nome is for name and surname, caso is for case, sdoppiamento is for II sound split, aorta is for aortic area, polmonare is for pulmonic area, PS3 is for Erb’s point, tricuspidale is for tricuspid area, mitrale is for mitral area, insufficienza mitralica is for mitral regurgitation, and stenosi aortica is for aortic stenosis