This was an open-label randomized controlled pilot study. This research was designed to evaluate the utility of the phonocardiogram in remote cardiac auscultation. Remote auscultation using an internet connection was used as a control. For standardization and reliability, a cardiology patient simulator for cardiac auscultation was used.6 (link) All sessions in this research were conducted at the skills lab and the research room in the Department of Diagnostic and Generalist Medicine, Dokkyo Medical University. The direct distance between the two places is approximately 200 m. Attending physicians and senior residents in the Department of Diagnostic and Generalist Medicine and junior residents in the university hospital were recruited as the participants. Attending physicians, senior residents, and junior residents were classified according to the years since obtaining a degree in Medicine (attending physicians: ≧6 years, senior residents: 3–5 years, junior residents: ≦2 years). The attending physicians and senior residents were internist. Junior residents did not have any specialization and rotated through several departments at the hospital. Participants who refused to participate in this study or had hearing loss were excluded. The research was conducted in accordance with the Declaration of Helsinki. The study was approved by the institutional review board of Dokkyo Medical University Hospital, Tochigi, Japan (R-49-18J). Written informed consent was obtained from each participant after the explanation of this study's protocols before participation.