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J Paediatr Child Health. 2015 Aug;51(8):815-9. doi: 10.1111/jpc.12839. Epub 2015 Feb 3.

International trial of online auditory training programme for distinguishing innocent and pathological murmurs.

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Children's Heart Centre, Izaak Walton Killam (IWK) Health Centre, Halifax, Nova Scotia, Canada.
Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
School of Human Communication Disorders, Dalhousie University, Halifax, Nova Scotia, Canada.
School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.
Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada.



Recognition of normal and abnormal heart sounds and murmurs is an important but declining clinical skill among practitioners. Current teaching methods are often ineffective. This may result from inadequate repetition and normal-abnormal comparisons needed for auditory recognition. This paper describes a rapid new method of teaching murmur recognition using principles of auditory training.


Participants were 120 Australian and 42 Canadian medical students. The medical students were randomised to intervention and control (no intervention) groups. The 1-h online programme structured like a computer game used auditory training methodology to teach students to distinguish between innocent and pathological murmurs. Participants underwent pre- and post-testing on 20 paediatric murmurs. Post-testing occurred immediately following training and after 2 months. Twenty-two Canadian medical students were retested 1 year later with a brief mastery-style reinforcement programme.


Median pre- and post-test scores improved in about 1 h from 75-95% (P < 0.001) for Australian students and 85-95% (P = 0.004) for Canadian students. Two-month post-test scores declined for Australian students to 85% (P = 0.001), and for Canadian students to 85% (P = 0.02). Australian controls had no significant change during the study period, whereas Canadian controls improved slightly. The group receiving reinforcement after 1 year had a median final score of 90%.


This auditory training programme rapidly teaches students to distinguish innocent and pathological murmurs with at least 90% accuracy. The skill declines within 2 months but can be restored with brief mastery reinforcement 1 year later.


auditory training; clinical skill; heart murmur; online teaching; paediatrics

[Indexed for MEDLINE]

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