Introduction:
Cardiac auscultation (CA) provides important information about the patient’s health and has become a foundational skill in medical school training curriculum. The Center for Elaboration Competency and Innovation in Clinical Simulation – Pham Ngoc Thach University of Medicine (CECICS-PNTU) provides the opportunity for students to experience the modern and advanced simulation-based medical education (SBME) that meets the standard of the Society for Simulation in Healthcare. At CECICS-PNTU, second-year medical students of the Vietnam-Germany program (MS2VG) practiced CA skills with standardized patients using different device models, including high fidelity Cardiopulmonary Patient Simulator Harvey (Harvey), medium fidelity Student Auscultation Manikin 3G (SAM), and 3M Littmann Advance Electronic Stethoscope Model 3200 (Littmann). Our research effort focuses on the teaching and assessment of CA skills using Objective Structured Clinical Examination (OSCE) stations at CECICS-PNTU.

Background:
Many studies have shown that SBME is an effective strategy in teaching CA skills and diagnosing cardiovascular diseases. Device models used in clinical simulation with different levels of sophistication have been utilized and implemented in teaching and assessing CA. Most manikins with medium to high fidelity allow learners to listen to pre-recorded heart sounds. The test-retest reliability is used to measure method reliability by calculating the correlation of results under the same condition over time to confirm values upon application.

Method:
After experiencing the CA training sessions, 28 MS2VG performed formative assessment of CA skills with SAM and ran the CA OSCE stations with Littmann recorded from SAM. Since CECICS-PTNU only has 1 SAM model, students were divided into five groups and took turn listening to different tracks of heart sounds. The Learning Space system consisted of three running circuits, with each circuit including five OSCE stations. Two out of those five stations were CA OSCEs. Spearman’s rank correlation was used to analyze the CA results between SAM and Littmann. The test-retest reliability was performed to verify the methods of running OSCE stations for CA skills that were conducted 9 days apart.

Results:
The Spearman correlation coefficient of the combination between SAM and OSCEs were positive and mostly strong, ranging from 0.608 to 0.670 and accounting for 83%. One Spearman correlation coefficient value of SAM and OSCE reached 0.510, corresponding to the moderate level and accounting for 17%.
The Test-retest reliability results conducted 9 days apart of CA skills from the OSCE stations with Littmann recorded from SAM were good ((ρ =0.815). Our Scatterplot Matrix showed that the results between two times of OSCE stations for CA skills tended linear and strongly correlated. These results indicated that the teaching method of running OSCE stations with Littmann recorded heart sounds from SAM carried significant reliability.

Conclusion:
The results showed that the study was feasible and reliable. Our research showed that it was possible to run the OSCE stations to teach and assess CA skills using Littmann heart sounds recorded from SAM. This method could provide the opportunity to optimize teaching resources for CA skills, creating a foundation for implementing simulation-based teaching of other auscultation skills to improve knowledge, clinical skills and the quality of teaching at CECICS-PNTU.

Keywords: Cardiac auscultation, OSCE, formative assessment, correlation coefficient, test-retest reliability, SAM 3G, Littmann 3200, medical education, clinical simulation.