This American paper is based on a reasonable premise that paramedics are required to be adept at auscultation practices as they are first on scene at emergencies, and also that the skill of auscultation is often poorly taught. Although the article refers to the inadequacies of auscultation competence in physicians and extrapolates this point to paramedics, similar concerns have already been raised about student paramedic practice (Williams et al, 2009).
The article critiques the amount of discrete, auscultation-specific education that student paramedics receive and the limited approaches that are used—albeit in just one educational programme. It does seem reasonable to assume that these issues are transferable to other paramedic education courses, including those in this country, although the length of time for the programme in question—42 weeks (i.e. one academic year)—is limited compared to most contemporary UK courses.
The paper reports on the introduction of a modified stethoscope—the ‘Ventriloscope’—which contains a remote-controllable library of pre-recorded MP3 formatted sounds (heart, lung, abdominal and vascular) which clinicians might expect to find in patient examinations. A variety of abnormal auscultatory findings can be sent wirelessly to the device from an FM transmitter held by a faculty member for the student to hear and interpret while examining otherwise healthy patients/volunteers. As such, it is a device to enhance simulation-based learning.
Similar approaches are already in use for rhythm strip interpretation, which readers may be familiar with, and the article claims similar advantages for the ‘Ventriloscope’, such as safety and simulation validity. The authors propose it as a low-cost item at circa $8 000 for the stethoscope and sound card.
The study design has employed mixed-methodologies; both quantitative statistical analysis and qualitative questionnaire findings are reported. Students self-selected into one of two approximately equally sized groups: a ‘standard teaching’ group and the ‘intervention’ group using the ‘Ventriloscope’. Participants underwent pre-test, post-test and a ‘follow-up’ assessment one month later to identify ability to recognise key auscultatory findings. The article reports results from two groups.
Analysis of these test results uses appropriate statistical methods, although the authors do allow that the small sample size limits comparison of some of the results. Within the discussion it is noted that staging the investigation earlier on in the educational programme may have highlighted greater improvements between pre- and post-test scores due to students' more limited pre-test exposure to auscultation. Nonetheless, use of the ‘Ventriloscope’ did correlate with improved retention of auscultatory findings. Reporting of the students' narrated experience of the simulation stethoscope is very limited, and the paper might have explored this quantitative dimension more.
One issue worth highlighting is that of a potential conflict of interest. One of the authors (Lecat) declared a ‘financial interest’ in the ‘Ventriloscope’—the commercial product also bears his name (‘Lecat's SimplySim’)—which does raise a question about the degree to which this article serves as an advertisement for an interesting and novel item as much as critical and objective discussion.
The conclusion addresses the benefits of marrying face-to-face live patient contact with simulated, pathological findings; realistic yet safe physical assessment practice is facilitated within scenarios, which will appeal to readers engaging in and hoping to innovate clinical education.