Related Experiment Video
Updated: Jun 29, 2026
Ultrasonographic Assessment During Cardiopulmonary Resuscitation
Published on: October 24, 2020
When Listening Is Better Than Reading: Performance Gains on Cardiac Auscultation Test Questions
Kathleen Short1, S Deniz Bucak, Francine Rosenthal
1K. Short is program officer, National Board of Medical Examiners, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-9602-3124. S.D. Bucak is manager, National Board of Medical Examiners, Philadelphia, Pennsylvania; http://orcid.org/0000-0002-4370-8266. F. Rosenthal is senior editor, National Board of Medical Examiners, Philadelphia, Pennsylvania. M.R. Raymond is research director and principal assessment scientist, National Board of Medical Examiners, Philadelphia, Pennsylvania.
Purpose:
In 2007, the United States Medical Licensing Examination embedded multimedia simulations of heart sounds into multiple-choice questions. This study investigated changes in item difficulty as determined by examinee performance over time. The data reflect outcomes obtained following initial use of multimedia items from 2007 through 2012, after which an interface change occurred.
Method:
A total of 233,157 examinees responded to 1,306 cardiology test items over the six-year period; 138 items included multimedia simulations of heart sounds, while 1,168 text-based items without multimedia served as controls. The authors compared changes in difficulty of multimedia items over time with changes in difficulty of text-based cardiology items over time. Further, they compared changes in item difficulty for both groups of items between graduates of Liaison Committee on Medical Education (LCME)-accredited and non-LCME-accredited (i.e., international) medical schools.
Results:
Examinee performance on cardiology test items with multimedia heart sounds improved by 12.4% over the six-year period, while performance on text-based cardiology items improved by approximately 1.4%. These results were similar for graduates of LCME-accredited and non-LCME-accredited medical schools.
Conclusions:
Examinees' ability to interpret auscultation findings in test items that include multimedia presentations increased from 2007 to 2012.
Related Concept Videos
01:17Assessment of apical pulse
Assessing the apical pulse is a critical nursing procedure, particularly indicated for:
01:15Heart Sounds
Auscultation is the process of listening to these internal body sounds using a stethoscope. The heart produces four types of sounds, but only two—S1 and S2—can usually be heard with a stethoscope.
S1, also known as the "lub" sound, is caused by the closure of atrioventricular (A-V) valves at the...
01:28Physical Assessment of the Respiratory Tract IV: Auscultation
Breath Sounds
Breath sounds are categorized into vesicular, bronchovesicular, and bronchial.
01:25Assessment of the Cardiovascular System IV: Auscultation
Normal Heart Sounds
S1 (First Heart Sound)-
S1 is made by the closure of the mitral and tricuspid valves (atrioventricular valves), marking the beginning of systole.
S2 (Second Heart Sound)-
S2 is made by the closure of the aortic and pulmonic valves (semilunar valves), marking the end of the systole.
01:25Cardiovascular System Abnormal Findings II: Auscultation
Abnormal Heart Sounds
Gallops:
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion, evaluates...