Littmann cardiology 3

In the intervention group, participants performed real-time remote auscultation using an electronic stethoscope and an internet-connected online medical care program. In the control group, participants auscultated all sounds directly using a classical stethoscope (Littmann Cardiology III; 3M, St Paul, MN, USA), placing it on the lung simulator and the cardiac patient simulator by themselves. The participant listened to five different lung sounds and five different cardiac sounds in a previously determined order, with the correct classification provided for each sound. In the training session for lung auscultation, the following five sounds were played: normal lung sounds, wheezes, rhonchi, stridor, coarse crackles, and fine crackles. In the training session for cardiac auscultation, the following five sounds were played: normal cardiac sounds, third cardiac sound (S3 gallop enhanced), aortic stenosis, aortic regurgitation, and mitral regurgitation. Each participant was instructed to auscultate the simulators at standardized positions: two times each on the anterior (Figure 1a) and posterior sides (Figure 1b) of the lung simulator, and four times on the cardiology patient simulator (Figure 1c). Each sound was played for a maximum of one minute.