An AcrobatTM‐based program for gross anatomy revision

contact and teaching resources were severely limited. An urgent need arose to re-invent teaching methods. Technological advances in sound digitisation provided the avenue for change in the form of electronic stethoscopes. What was done Electronic stethoscopes (Littmann model 4000) were used to record the heart sounds of patients with echocardiographically proven heart disease. Heart sounds were recorded at 6 areas in each patient, corresponding to the 6 classically taught precordial positions for cardiac examination. This allowed identification of radiating sounds. Clinicians in full personal protective equipment performed the recordings. Cardiologists validated the sounds, which were then used to teach 234 students in simulated bedside sessions. Students took turns to act as patient and auscultator . While the auscultator simulated the clinical examination routine on his ⁄her patient , the soundtrack corresponding to each area of auscultation was played through the stethoscope earpieces. Students thus learned to examine real people while picking up real auscultatory signs, not unlike actual patient encounters. Peer-to-peer teaching helped to overcome the shortage of teaching staff. Soundtracks could be downloaded, stored, beamed from 1 stethoscope to another and re-used to teach large groups of students, thus maximising the limited clinical material available. Evaluation of results Outcome measures included accuracy of auscultatory diagnoses by students in relation to amount of learning exposure and subjective appreciation of sounds by tutors and students. At baseline, students correctly identified sounds in a mean of 2.74 of 5 cases (95% CI: 2.53–2.96). Mean scores improved to 3.62 (95% CI: 3.31–3.94) with greater learning exposure (P < 0.01). Mean appreciation scores for sound quality were high for both tutors (3.40 out of 5 on Likert scales; 95% CI: 2.72– 4.08) and students (3.43; 95% CI: 3.32–5.54). This is the first time that the Littmann electronic stethoscope has been used in this fashion. The implementation of this new method was driven by the need for bedside teaching without patient contact and the need for more efficient use of limited resources during the SARS outbreak. Bedside teaching in many developed countries faces similar constraints. Patients are less tolerant of multiple examinations and florid signs are rare with earlier treatment of diseases. This method may thus have applications beyond the SARS outbreak. Modern medical educationalists can embrace technological advances to complement, but never completely replace, teaching at a patient’s bedside. Correspondence: Professor Khek Yu Ho, Department of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. Tel: 00 65 6779 5555; E-mail: mdchoky@nus.edu.sg.