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Multimedia presentation of lung sounds as a learning

aid for medical students

P. Sestini*, E. Renzoni*, M. Rossi**, V. Beltrami*, M. Vagliasindi*

Multimedia presentation of lung sounds as a learning aid for medical students. P. Sestini, E. Renzoni, M. Rossi, V. Beltrami, M. Vagliasindt. © ERS Journals Ltd 1995. ABSTRACT: New educational technologies might help to compensate for the decrease in time and emphasis dedicated to physical examination in medial training. This may, in particular, be applicable for improving the skills in auscultation of the chest. We investigated whether a multimedia presentation of acoustic and graphic characteristics of lung sounds could improve the learning of pulmonary auscultation by medical students, in comparison with conventional teaching methods.

We studied 48 medical students without clinical experience, who had received conventional formal teaching on chest examination. Chest auscultation skills were evaluated using an inaccuracy score for the student’s auscultation report on three patients, selected according to a standardized procedure. After a baseline evaluation, 27 students in groups of 5—10, participated in a multimedia seminar on lung sounds during which digitized lung sounds were played and the corresponding time-expanded waveform and frequency spectrum were commented on and displayed on a computer. The remaining 21 students received conventional bedside training, acting as control group. The following week, all the students underwent a second evaluation of chest auscultation skills.

*Institute of Respiratory Diseases, University of Siena and **Service of Respiratory Physiopathology, USL 30 Siena, Italy.

Correspondence: P. Sestini Institute of Respiratory Diseases Viale Bracci 3 53100 Siena Italy

Keywords: Computer-aided learning lung sounds multimedia

Received: August 26 1994 Accepted after revision February 19 1995

No differences in the inaccuracy score were observed between the two groups in the preliminary test. However, in the second post intervention assessment, the inaccuracy score of the students who had followed the seminar (11.2±1.3 points) was significantly lower than that of the controls (16.6±1.6 points). The answers to a feedback questionnaire confirmed that the great majority of the students found the association of the acoustic signals with their visual image to be useful for learning and understanding lung sounds.

We conclude that the exposure of inexperienced medical students to a multimedia presentation significantly boosts their learning of lung sounds compared to students receiving only conventional teaching. Eur Respir J., 1995, 8, 783—788.

The development of powerful methods of analogic and digital signal processing and the diffusion of computers in medical settings over the recent years has provided a valuable tool for the study of the acoustic characteristics of lung sounds . Although clinical applications of these studies are still limited , they have already had a forceful impact on the understanding of the origin of lung sounds, leading to the development of a standardized classification based on objective acoustic characteristics, and bringing order to a long-standing confusion of terms and adjectives

A further recent development of digital technology has been the popularization of sound and video boards, allowing microcomputers to record and play images and sounds with a reasonably high definition, an ability largely covered by the term “multimedia”. Multimedia technology lends itself particularly well to a teaching environment, and could be particularly useful in teaching clinically relevant sounds, such as heart and lung sounds, for which the utility of a method of acoustic reproduction, provided usually as an audio tape, has long been

recognized . A pioneer experience of multimedia, using an analogic apparatus, was reported as early as 1971 . The advantage of the use of computers as supporting devices for learning has been successfully experimented with in several medical disciplines , but only recently has it been applied to respiratory sounds .

The present study was devised to verify whether the simultaneous presentation of sounds together with their expanded waveforms (amplitude versus time plots on an expanded time scale) and spectrum analysis (amplitude versus frequency plots) can enhance the understanding and learning of medical students approaching the study of lung sounds for the first time.

Materials and methods


All of the 65 students attending the course of Respiratory Diseases in the 4th year of Medical School at the Università

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