Background: Effectiveness of simulation-based education in cardiac auscultation training is controversial, and may vary among a variety of heart sounds and murmurs. We investigated whether a single auscultation training class using a cardiology patient simulator for medical students provides competence required for clinical clerkship, and whether students' proficiency after the training differs among heart sounds and murmurs. Methods: A total of 324 fourth-year medical students (93-117/year for 3 years) were divided into groups of 6-8 students; each group participated in a three-hour training session using a cardiology patient simulator. After a mini-lecture and facilitated training, each student took two different tests. In the first test, they tried to identify three sounds of Category A (non-split, respiratory split, and abnormally wide split S2s) in random order, after being informed that they were from Category A. They then did the same with sounds of Category B (S3, S4, and S3 + S4) and Category C (four heart murmurs). In the second test, they tried to identify only one from each of the three categories in random order without any category information. Results: The overall accuracy rate declined from 80.4% in the first test to 62.0% in the second test (p < 0.0001). The accuracy rate of all the heart murmurs was similar in the first (81.3%) and second tests (77.5%). That of all the heart sounds (S2/S3/S4) decreased from 79.9% to 54.3% in the second test (p < 0.0001). The individual accuracy rate decreased in the second test as compared with the first test in all three S2s, S3, and S3 + S4 (p < 0.0001). Conclusions: Medical students may be less likely to correctly identify S2/S3/S4 as compared with heart murmurs in a situation close to clinical setting even immediately after training. We may have to consider such a characteristic of students when we provide them with cardiac auscultation training. (C) 2016 The Author(s). Published by Elsevier Ltd on behalf of Japanese College of Cardiology.
