Doroshow Robin W, Aldrich Julie, Dorner Rebecca, Lyons Laurie, McCarter Robert
Department of Cardiology, Children's National Hospital and George Washington School of Medicine and Health Sciences, Washington, DC, United States.
Department of Pediatrics, Children's National Hospital and George Washington School of Medicine and Health Sciences, Washington, DC, United States.
Front Pediatr. 2024 Jan 16;11:1283306. doi: 10.3389/fped.2023.1283306. eCollection 2023.
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.
创建一种简短、可接受且创新的自主学习方法，以提高医学生对小儿心脏杂音的识别能力，并在随机对照试验中证明该方法的有效性。
设计了一个包含六个10分钟在线学习模块的课程，使用患者心脏杂音录音来进行小儿心脏听诊的刻意练习。应用成人教育学和多媒体学习原则来优化这项技能的习得。使用额外的录音创建了间隔4周的前测和后测，并在87名三年级医学生儿科实习期间进行测试。他们被随机分为在前测后或后测后可以使用这些模块，并被要求至少使用前两个模块。
47名受试者组成干预组，40名受试者组成对照组。在我们的主要结局指标上，即至少以中等信心区分生理性与病理性杂音，干预组的后测分数（60.5%）显著高于对照组（20.0%）。对于我们的次要结局指标，两组在区分生理性与病理性杂音的能力以及识别实际诊断方面也存在显著差异。在所有三个结局指标上，使用4 - 6个模块的干预组受试者得分高于使用0 - 3个模块的受试者，而后者得分又高于对照组。
应用当前成人学习原则，我们为医学生创建了一个学习识别常见小儿杂音的教学项目。其有效性在随机对照试验中得到了证明。该项目通过1小时的自主训练使这项技能有了显著提高，且学习者接受度很高。
