When Listening Is Better Than Reading: Performance Gains on Cardiac Auscultation Test Questions.

Area of Science:

• Medical Education
• Cardiology Assessment

Background:

• The United States Medical Licensing Examination (USMLE) incorporated multimedia heart sound simulations into multiple-choice questions in 2007.
• This innovation aimed to assess the impact of multimedia on the difficulty and examinee performance of cardiology test items.

Purpose of the Study:

• To investigate changes in item difficulty and examinee performance over time following the introduction of multimedia heart sound simulations.
• To compare the performance trends of multimedia-enhanced items with traditional text-based items.

Main Methods:

• A total of 233,157 examinees responded to 1,306 cardiology items from 2007 to 2012.
• 138 multimedia heart sound items were compared against 1,168 text-based control items.
• Item difficulty changes were analyzed over time and stratified by medical school accreditation (LCME vs. non-LCME).

Main Results:

• Examinee performance on multimedia cardiology items improved by 12.4% over the six-year period.
• Performance on text-based cardiology items improved by only 1.4%.
• Similar performance improvements were noted for graduates of both LCME-accredited and international medical schools.

Conclusions:

• Examinees demonstrated a significant increase in their ability to interpret auscultation findings using multimedia presentations.
• Multimedia simulations appear to enhance the learning and assessment of cardiac auscultation skills.