COMPARING CARDIAC AUSCULTATORY SKILLS USING REAL PATIENTS AND CD-ROM HEART SOUNDS. J. Solomonides 1 , D.S. Hatem 1 , M. Belanger 2 ; 1 University of Massachusetts Memorial Medical Center, Worcester, MA; 2 University of Massachusetts Medical School PURPOSE: Recognition of cardiac auscultatory events has been shown to be deficient. Whether the assessment method influences documented skills acquisition has not been determined. Our purpose was to compare second year medical students' abilities to recognize cardiac physical examination findings in patients with known murmurs with recognition of abnormal heart sounds produced by a CD-ROM. METHODS: Ninety-one second year medical students were evaluated on cardiac auscultation skills at the end of a Physical Diagnosis course. Students examined 1 Real Patient (RP) with a known murmur and listened to a CD-ROM (CD), to 2 murmurs and 2 extra sounds, then recorded their findings. Findings assessed included Heart Sounds (HS;5 items for RP and CD)and Murmur (M;5 items for RP, 4 items for CD) scores. RP murmurs included a systolic ejection murmur (SEM; n=44 students) and aortic stenosis with aortic insufficiency (AS/AI; n=47). Gold standard for the RPs was a recent exam by their cardiologist. The Criley CD-ROM was used to assess HS with abnormalities including S3 and S4 sounds (5 items; n=91), and murmurs with abnormalities including mitral regurgitation (4items; n=91) and aortic stenosis (4 items; n=91). Mean scores were compared using paired sample T-tests. RESULTS: Students' recognition of cardiac findings differed significantly with the two methods of evaluation. Overall mean scores for the CD-ROM cardiac findings (HS and M scores)were 77.5 while those for the RPs were 59.3 (p < .001). Mean HS scores were similar between groups (CD 81.7,RP 78.7; p=0.1) while M scores accounted for the differences in student performance for the two evaluation methods (CD 72.0, RP 37.7; p < .001). These mean score differences were similar when comparing single murmurs on CD-ROM to the RP with a single murmur (CD 68.5, RP 37.7; p < .001)and to the RP with two murmurs (CD 68.5, RP 38.1; p < .001). CONCLUSION: Medical students scored significantly higher when cardiac auscultation skills were assessed using a commercially produced CD-ROM compared to their skills in examining real patients. Differences may be due to examination technique, patient factors (body habitus), competing sounds (breath sounds), or patient complexity (2 murmurs v 1 murmur). The lack of difference in HS scores may be due to the small numbers of abnormal findings resulting in lack of discriminatory capacity as opposed to a true skills difference. The use of a CD-ROM alone to assess cardiac findings may overestimate student skills. This reinforces the need to focus our cardiac auscultatory skills teaching to enhance student examination skills acquisition. (3) increase the number of independent patient contacts by students in community teaching sites. Our current study looks at the impact of this mission based program. METHODS: We developed a survey evaluating six key components of an Active Learning Environment (ALE) (table 1) .Third year students rated their preceptors on each ALE component at the end of the 4-week internal medicine ambulatory clerkship using Likert-type scales to generate an ALE score (min.=6, max.=30). Faculty development programs were designed to improve preceptors' ALE teaching skills. Follow-up letters were sent to each participant reviewing program highlights and providing them with the ALE ratings they received from students for 6 months prior to their workshop. These were compared to preceptors' ratings received for 6 months after their faculty development participation. Student's t-test was used to compare differences in pre-and post-workshop mean survey results. RESULTS: To date 14 community preceptors have participated in three faculty development programs. Table 2 results show a trend towards higher post-workshop ALE scores. Their was a significant increase in the post-workshop independent patient contacts reported by students. CONCLUSION: A mission-based faculty development program can have a significant impact on the learning environment of community teaching sites in an ambulatory clerkship.