Canadian Journal of Cardiology

046 15 Minute Reinforcement Test Restores Murmur Recognition Skills in Medical Students


      Accurate recognition of innocent and pathological murmurs is an important auscultatory skill but is poorly performed by medical students and practitioners. We have previously shown that murmur recognition can be rapidly taught to 90% accuracy with computer based auditory training but the skill declines within 2 months without reinforcement.


      Subjects: 36 second year medical students (17 controls and 19 study group). Students were given a randomized test of 20 recordings requiring identification of murmurs as innocent or pathological, then performed an auditory training program for about an hour. The program presents murmurs randomly in groups of four with the subject identifying them as normal or abnormal. Difficulty increases as the subject progresses through 7 levels, with the requirement of 6 consecutive correct answers before advancing level, as with video games. 22 students were contacted after one year for late retesting on 20 murmur recordings and a mastery-style reinforcement program: any student scoring less than 90% took a reinforcement 20 item test, and if the score on that test was less than 90%, the student took a final 20 item test.


      With initial auditory training the study group improved from 79.7 (45-100%) to 92.1% (70-100%) (P.005) but after two months declined to 84.2% (65-100%) (P.015) which was a non significant increase over the pre test scores. Controls had no change over 2 months. The 1 year followup test mean was 81% (55-100) a significant decline from the 2 month post test. Only 6 students achieved the 90% level at this test, but after 1st and 2nd reinforcement tests an additional 6 and 2 students respectively reached 90%. The mean final score achieved by all students was 90% (70-100).


      Most medical students can rapidly restore satisfactory murmur recognition skills with a brief reinforcement test one year after their auditory training. As with other clinical skills, reinforcement is essential for skill maintenance. It can be brief but the optimal timing is unknown.
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