Development of education program on cardiac auscultation built in time-axis variable function of digital stethoscope

1. 数字式听诊器时轴可变功能在心脏听诊教育中的应用评价数字式听诊器时轴可变功能在心脏听诊教育中的应用。结果表明，时间轴变函数对提高听诊能力有一定的帮助，特别是对不同分量的连续心音或杂音的时间关系的识别和把握尤为有效。全科内科门诊患者心脏听诊事件的临床特点评价全科内科门诊患者心脏听诊事件的临床特点，并试图对基层医疗心脏听诊技能教育提出教学建议。我们建议以下心脏听诊事件应在初级保健中给予优先教育；1)第四个心音作为额外的心音。2)无源性杂音：无源性杂音的特点及与器质性心脏病所致收缩期杂音的区别。3)主动脉瓣狭窄或二尖瓣返流引起的收缩期杂音。4)主动脉反流引起的舒张期高音杂音。利用模拟器进行心脏听诊教育虽然真实再现真实情况的模拟（高保真模拟）很重要，但通过对物理现象的处理，如数字听诊器的时轴变函数等进行综合显示的方法，在医学教育中也很有用。

1. Usefulness of time-axis variable function of digital stethoscope in education on cardiac auscultationWe assessed the application of the time-axis variable function of the digital stethoscope to education on cardiac auscultation. It was suggested that the time-axis variable function could be useful for improving auscultatory ability, and it could be particularly effective in the identification and grasp of the time relation of several sequential heart sounds or murmurs with different components.2. Clinical features of cardiac auscultatory events in outpatients in general internal medicineWe assessed the clinical features of cardiac auscultatory events in outpatients in general internal medicine, and tried to make teaching suggestions for education on cardiac auscultatory skills in primary care medicine. We suggest that the following cardiac ausculatory events should be given educational priority in primary care ; 1) Fourth heart sounds as an extra heart sound. 2) Innocent murmurs : characteristics of innocent murmurs and discrimination from systolic murmurs caused by organic heart disease. 3) Systolic murmurs caused by aortic stenosis or mitral regurgitation. 4) Diastolic high-pitched murmurs caused by aortic regurgitation.3. Education on cardiac auscultation using simulatorAlthough simulation which faithfully reproduces the actuality(high-fidelity simulation) is important, method for comprehensibly displaying by processing a physical phenomenon, such as time-axis variable function of digital stethoscope, could be useful for medical education.