# A randomized, controlled trial of an innovative, multimedia instructional program for acquiring auditory skill in identifying pediatric heart murmurs

## TL;DR

A new online program helps medical students learn to identify pediatric heart murmurs, showing significant improvement in a controlled trial.

## Contribution

An innovative, multimedia instructional program for auditory skill acquisition in pediatric heart murmur identification.

## Key findings

- The intervention group showed significantly higher posttest scores in distinguishing innocent from pathological murmurs.
- Students who accessed more modules scored higher than those who accessed fewer modules or were in the control group.
- The program was effective with just 1 hour of self-paced training and was well accepted by learners.

## Abstract

To create a brief, acceptable, innovative method for self-paced learning to enhance recognition of pediatric heart murmurs by medical students, and to demonstrate this method's effectiveness in a randomized, controlled trial.

A curriculum of six 10-min online learning modules was designed to enable deliberate practice of pediatric cardiac auscultation, using recordings of patients' heart murmurs. Principles of andragogy and multimedia learning were applied to optimize acquisition of this skill. A pretest and posttest, given 4 weeks apart, were created using additional recordings and administered to 87 3rd-year medical students during their pediatric clerkship. They were randomized to have access to the modules after the pretest or after the posttest, and asked to use at least the first 2 of the modules.

47 subjects comprised the Intervention group, and 40 subjects the Control group. On our primary outcome, distinguishing innocent from pathological with at least moderate confidence, the posttest scores were significantly higher for the Intervention group (60.5%) than for the Control group (20.0%). For our secondary outcomes, the 2 groups also differed significantly in the ability to distinguish innocent from pathological murmurs, and in identifying the actual diagnosis. On all 3 outcomes, those Intervention group subjects who accessed 4–6 modules scored higher than those who accessed 0–3 modules, who in turn scored higher than the Control group.

Applying current principles of adult learning, we have created a teaching program for medical students to learn to recognize common pediatric murmurs. Its effectiveness was demonstrated in a randomized, controlled trial. The program results in a meaningful gain in this skill from 1 h of self-paced training with high acceptance to learners.