Auscultation knowledge and skills were assessed by a computerized validated 40-item test administered before and after the rotation. Ten of these items tested the recognition and interpretation of heart sounds (skills component), and 30 tested facts about auscultation (knowledge component). Baseline and post-intervention scores were compared within groups using paired t-tests, and between groups with independent t-tests. When possible, residents who dropped out (n=10) were analyzed with their last outcome carried forward. RESULTS: Pretest and posttest scores are shown in Table 1 . At baseline, the two groups did not differ in demographic characteristics, pretest knowledge or total scores. The intervention arm had a lower mean pretest skills score than the control group. While both groups had improved scores after the rotation, residents in the intervention group had significantly higher improvements in skills, knowledge, and total scores than those not exposed to the CD-ROM based tool (* all p < 0.001). CONCLUSION: Protected time for internal medicine residents to pursue self-directed study with a multimedia auscultation tool during a primary care rotation enhanced both cardiac auscultation knowledge and skills. (1) self-reported use of information resources, (2) self-reported comfort with EBM skills, and (3) PURPOSE: Although thyroid examination is the least invasive and inexpensive method to detect thyroid pathology, most physicians lack the ability to detect thyroid abnormalities by examination. We developed a single and brief multimodality session to improve the thyroid examination skills of physicians-in-training and evaluated its efficacy in a controlled trial. METHODS: Thirty-nine first-year internal medicine residents were randomly allocated to participate in a multimodality learning session on thyroid physical examination or to receive no intervention (control group). The 50-minute learning session consisted of a slide presentation, a computer graphics animation, videotaped and hands-on demonstrations of the appropriate technique, participant examination of a patient with thyroid abnormalities and a normal volunteer under preceptor observation, and an evidence-based handout. All the participants were assessed in two stations of an objective structured clinical examination (OSCE) for appropriate thyroid examination technique (through a 2-way mirror) and identification of thyroid abnormalities (using a scored participant report of findings). The OSCE preceptors and results analysts were blinded to participant allocation. RESULTS: Of the 19 residents in the intervention group and 20 residents in the control group: 6 and 3 observed the neck for thyroid abnormalities (32% vs 15%; p = 0.3); 17 and 16 residents used proper hand position (90% vs 80%; p=0.7); 13 and 15 residents had the patient swallow while palpating the neck (68% vs 75%, p=0.7), respectively. There was a significant difference between the mean scores on thyroid physical findings between the intervention and control groups (100 vs 52.5, p=0.047) CONCLUSION: A single and brief multimodality learning session did not statistically improve the thyroid examination skills of first year Internal Medicine residents, but did positively affect their ability to detect abnormalities. Future research (with larger sample sizes) should test the effectiveness of iterative sessions or of increased emphasis on hands-on thyroid abnormality detection rather than appropriate technique. 