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Clin Cardiol. 2008 Jul;31(7):334-9. doi: 10.1002/clc.20213.

Using virtual patients to improve cardiac examination competency in medical students.

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David L Geffen School of Medicine at UCLA, St. Mary's Medical Center, Long Beach, CA 90813, USA.



Cardiac examination (CE) skills are in decline. Most prior studies employed audio recordings, evaluating only one aspect of CE (i.e., auscultation) that precluded correlation with visible observations. To address these deficiencies, we developed a curriculum using virtual patient examinations (VPEs); bedside recordings of patients with visible and audible cardiovascular findings presented as interactive multimedia.


The purpose of this study was to evaluate whether VPEs improve CE skills, and whether any improvements are retained. We assessed CE competency overall and in 4 categories: inspection, auscultation, knowledge, and integration of audio and visual skills.


Students (n = 24) undergoing the 8-wk Internal Medicine (IM) clerkship rotation and receiving supervised instruction with VPEs (intervention group) were compared with students (n = 58) undergoing IM clerkship rotation without supplemental CE instruction (control group). The groups were tested at the beginning and the end of their rotations.


The Intervention group improved significantly in overall mean scores: from 58.7 to 73.5 (p = 0.0001). The Control group did not improve: from 60.1 to 59.5 (p = 0.788). The Intervention group improved inspection, auscultation, and knowledge (all p <or=0.02); control group showed no improvement. Fourteen months after the study, 8 students from the intervention group were re-tested and mean scores improved further to 83.6 without additional intervention (p = 0.004); controls showed improvement on re-testing, but it was not significant: 65.0 (p = 0.464).


Cardiac examination inspection, auscultation, and knowledge improved by using VPEs to the level of cardiology fellows. These skills were retained 1 y later. The teaching and testing tools emphasizing the bedside use of both sight and sound, identify which CE skills needed improvement and additional training.

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