Abstract:
An auscultation training system is disclosed comprising a half-body mannequin with speakers providing heart, lung, bowel and bruit sounds in the correct anatomical positions for student training of auscultation with a standard stethoscope. An integrated computer system provides the tools for training and assessing students. Synchronized phonocardiograms and a palpable carotid pulse accompany heart sounds. Sounds can be played and auscultated simultaneously to simulate a live patient, or played and auscultated separately for teaching purposes. The system may be accessed online using a virtual mannequin and stethoscope for viewing and listening to heart, lung, bowel and bruit sounds.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    Not Applicable. 
       STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH AND DEVELOPMENT 
       [0002]    Not Applicable. 
       FIELD OF THE INVENTION 
       [0003]    This invention relates to educational training systems, and more particularly to an auscultation training system utilizing a software application to playback pre-recorded sounds for different categories of auscultation sounds at various listening sites in a half-body mannequin. 
       DISCUSSION OF RELATED ART 
       [0004]    Portable training systems that facilitate learning of auscultation have been widely developed for assisting teachers and medical practitioners. Various devices like mannequins, electronic stethoscopes, computer programs and sound simulators have been devised to digitally record, store, modify and play different sounds and murmurs characteristic to various human organs. Most of these systems require the use of a special stethoscope integrated into the training system. Such systems include a sound generator and converter for converting the sound signals to an audible sound for humans. Most of the conventional systems do not integrate a broad variety of instruments commonly used in the reproduction of sounds and do not provide any platform to incorporate different kinds of training scenarios in a cost efficient manner. 
         [0005]    An electronic auscultation system and method for simulating sounds arising from human organs has been described in U.S. Pat. No. 6,220,866 issued to Amend on Apr. 24, 2001. The system includes a patient simulating mannequin torso, a plurality of electro-magnetic transmitters having antenna coils positioned in predetermined locations beneath the torso surface. Each transmitter is connected to one or more computer sound cards which, upon activation, generate signals from prerecorded sound data which produces the appropriate sounds of human organs based on the transmitter locations. The system utilizes a simulated stethoscope that includes a receiver and/or sensing triggering devices so that the stethoscope can determine particular areas on the torso to define the appropriate sound generated. Such a system does not allow training with a normal stethoscope nor does such a system expose the students to a larger number of sounds and murmurs with descriptions, lectures/lessons, phonocardiograms, drawings, and questionnaires controlled by a computer program. 
         [0006]    U.S. Pat. No. 6,527,559 issued to Yoshii on Mar. 4, 2003, provides a human sized mannequin for the training of auscultation. The mannequin comprises a core body formed of resin foam that has speakers coupled to a sound reproducing apparatus and is covered by an imitation skin on the outside of the core body. The core body includes recesses corresponding to auscultation sites and a sound reflector with a concaved surface attached to the outside of each speaker. Such a system does not include a provision to integrate a variety of instruments used in the reproduction of sounds. In addition, such a system makes it very difficult to distinguish the variations of sound which can be detected by moving a stethoscope to the various auscultation sites on the mannequin. 
         [0007]    U.S. Pat. No. 7,209,796 issued to McKinney on Apr. 24, 2007 discloses an auscultation training apparatus which includes a database of pre-recorded physiological sounds stored on a computer that can be heard utilizing a playback system. A graphical user interface software program is stored on the computer for use with a conventional computer mouse. The program allows a user to select one of the pre-recorded sounds for playback. In addition, the program is operable to generate an inverse model of the playback system in the form of a digital filter. If employed by the user, the inverse model processes the selected sound to cancel the distortions of the playback system so that the sound is accurately reproduced in the playback system. The program also permits the extraction of a specific sound component from a pre-recorded sound so that only the extracted sound component is audible during playback. The program displays a spectrogram along with the selected specific pre-recorded sound. The spectrogram is a display not generally used in auscultation training. Such a system does it allow the user to control the apparatus, or provide different pre-recorded sounds, lessons, nor does it provide the capability to adjust the volume of the sound or trace size of the images. In addition, such a device does not produce real sounds, pulse, phonocardiograms/phonopneumograms, lectures, student assessments, heart/lung combinations or web-based software. 
         [0008]    U.S. Pat. Application No. 20100279262 entitled to Lecat on Nov. 4, 2010 discloses an auscultation training device that utilizes a medical training mannequin, a controller, and a database of auscultation training sound data to simulate and communicate the sounds of the human body to users. The invention is able to initiate the playback of prerecorded sounds via a variety of trigger mechanisms, and transmit live sounds, or combinations of sounds, to remote examiners. Such a device does not produce real sounds, heart/lung combinations, pulse, phonocardiograms, phonopneumograms, lectures, student assessments, or web-based software. 
         [0009]    Therefore, there is a need for an auscultation training system utilizing a software application to playback pre-recorded sounds and pulses for different categories of auscultation sounds and pulses at various listening sites in a half-body mannequin. Such a needed system would allow students and trainers to utilize standard stethoscopes for the auscultation training. Such a system would expose the students to a larger number of sounds, including heart/lung combinations, pulses and murmurs with descriptions and lessons, lectures, phonocardiograms, drawings, questionnaires, short videos and student assessments. Such a system would allow the user to control the system to provide different pre-recorded sounds, lectures/lessons and questionnaires, and control the volume of the sound at each anatomical location and trace size of the images on the graphical user interface (GUI) of the software application. Such a system would also allow the user to compare two or more pre-recorded sounds and provide a means to enable more than one user to listen to the sounds. The system would also include a graphical user interface (GUI) that provides a mannequin display area and a corresponding sound display area for phonocariograms or phonopneumograms, allowing the user to self-study auscultation techniques and learn the location of events such as murmurs and clicks. 
       SUMMARY OF THE INVENTION 
       [0010]    An embodiment of the present invention is an auscultation training system utilizing a software application to playback pre-recorded, simulated and real physiological sounds for different categories of heart, bruit, breath and bowel sounds and arterial pulses at various anatomically correct listening and palpation sites in a half-body mannequin. The auscultation training system enables a user to listen to and experience various auscultation sounds using a standard stethoscope. The system comprises the half-body mannequin, a computer system and an interface module to connect the computer system with the mannequin. The half-body mannequin comprises a plurality of speakers installed at anatomically correct sound listening sites and relays installed at anatomically correct palpation sites for the transmission of a palpable pulse. The interface module converts the digital signals from the computer system into the analog signals necessary for the speakers and relays. The computer system is electronically connected to the interface module with one or more digital connections and the interface module is electronically connected to the speakers and relays in the mannequin with multiple analog connections. The computer system comprises one or more software applications with a graphical user interface for the selection of a plurality of pre-stored heart, breath, bowel and bruit sounds and pulses for transmission to the interface module. The user interface also provides for the simultaneous graphical display of phonocardiogram and phonopneumogram waveforms for every sound, so students may view the sounds as they are heard which aids in training for detection of location of murmurs or other events that are systolic or diastolic. 
         [0011]    The plurality of category of physiological sounds may include heart sounds, breath/lung sounds, bowel sounds, bruit sounds, heart and breath combination sounds and heart and bruit combination sounds. Sounds also include Valsalva maneuvers, egophony, bronchophony and pectoriloquy. Sounds can be played and heard simultaneously to simulate a live patient, or played and heard separately for teaching purposes. 
         [0012]    To aid in training, pulse and respiration rate may be varied. Heart sounds may be heard at 60, 75, 90 and 110 beats per minute and respiration rate may vary from 12 to 30 breathes per minute. Transmission of the carotid pulse is timed with the first heart sound to aid the student identification of systole. Breath sounds may be heard on both the upper and lower anterior and posterior lung. Lungs may be separated with different volume settings. Sounds in the database include all generally recognized pediatric sounds to include ASD, PDA, VSD, primary Pulmonary Hypertension, Pulmonary Stenosis, third heart sounds, Eisenmenger&#39;s Syndrome, summation sounds and Tetralogy of Fallot. Users may palpate certain murmurs known as physiologic thrills and certain breath sounds may be palpated, known as tactile fremitus. 
         [0013]    The mannequin is a full size replica of a human torso, neck and head, without arms. It is portable, weighing approximately 23 pounds and can be used in the upright or left lateral position. The mannequin is latex free. 
         [0014]    In addition to allowing the user to select sounds and pulses to be transmitted to the interface module, the user may select preset lessons related to each of the plurality of pre-recorded sounds or choose from a selection of editable lectures that includes a collection of physiological sounds. The system also allows the user to create and save lectures and tests/assessments related to each of the plurality of pre-recorded sounds. Tests/assessments consist of a collection of sounds, much like for a lecture, but without the written explanation of the sounds. Thus allowing the student to listen, palpate and optionally view the phonocardiograms or phonopneumograms of each sound in the collection before identifying the sound presented. 
         [0015]    The software application provides a comparison selection function to select two or more pre-recorded sounds for performing a comparative study. Students can quickly compare any two sounds to learn how to distinguish between similar sounds. For instance, a pleural rub of the lung has a similar sound to a pericardial friction rub of the heart. The application allows for a quick, back and forth comparison of the two sounds. 
         [0016]    The software application may be a web-enabled application. In this mode, there is no connection to the interface module or mannequin. The computer system or external speakers are used to listen to the heart, lung, bruit and bowel sounds. The graphical user interface includes a virtual mannequin display area which displays the half-body mannequin with a plurality of listening sites corresponding to each of the plurality of pre-recorded sounds. The virtual mannequin display area further displays a virtual stethoscope that allows the at least one user to click on the plurality of listening sites and listen to the plurality of pre-recorded sounds. The graphical user interface displays a simultaneous corresponding phonocardiogram for each of the plurality of prerecorded sounds on the graphical user interface when placing the virtual stethoscope on each of the plurality of listening sites. 
         [0017]    The sound repository means is organized as a disk folder having the plurality of sub-folders for digitally storing the database of the plurality of pre-recorded sounds for the plurality of category of auscultation sounds. Each of the plurality of pre-recorded sounds is arranged as a .wav file format. Each .wav file format for each of the plurality of pre-recorded sounds includes the plurality of interleaved sound signal which is presented as a is standard audio 7.1 formatted container. The sound repository means is stored in an encrypted file format into a hidden folder. When at least one of the plurality of pre-recorded sounds is selected by the at least one user for playback, the encrypted file is decrypted to a particular .wav file format corresponding to the selected pre-recorded sound and copied from the hidden folder to a virtual disk. The sound repository means is then encrypted and the particular decrypted .wav file format in the virtual disk is submitted to a windows media player for playback. If the user selects another one of the plurality of pre-recorded sounds for playback, the previously existing particular .wav file format in the virtual disk is replaced. Thus the process is repeated for selection of each of the plurality of pre-recorded sounds. The virtual disk is highly volatile in nature and it empties the contents when the software application terminates. Finally, the particular .wav file is submitted to the interface module or, when functioning without the interface module and mannequin, the file is submitted to a sound codec of the sound engine module from the windows media player to generate the plurality of interleaved sound signals for each of the plurality of pre-recorded sounds at each of the plurality of sound listening sites. The database of the plurality of pre-recorded sounds for the plurality of category of physiological sounds includes a plurality of attributes for each of the plurality of pre-recorded sounds. The plurality of attributes may include saved and default sound attenuation levels for each of the plurality of interleaved sound signals, channel trace defaults, trace scaling defaults, sound multiplexing target assignments and lecture/lesson assignments. Instructors may determine how often students access this program. 
     
    
     
       DESCRIPTION OF THE DRAWINGS 
         [0018]      FIG. 1  is a schematic view of an auscultation training system in accordance with an embodiment of the present invention; 
           [0019]      FIG. 2  is a front view of an interface module associated with a half-body mannequin in accordance with an embodiment of the present invention; 
           [0020]      FIG. 3  is an exemplary screen illustration of an embodiment of the present invention, illustrating a main window displayed on a graphical user interface of the computer system installed with a software application; 
           [0021]      FIG. 4  is an exemplary screen illustration of an embodiment of the present invention, illustrating a sound select page showing the list of a plurality of pre-recorded sounds for each of a plurality of category of auscultation sounds; 
           [0022]      FIG. 5  is a block diagram illustrating the functionality of a sound repository means associated with a computer system; 
           [0023]      FIG. 6  is a block diagram illustrating the functionality of a sound engine module embedded within the half-body mannequin; 
           [0024]      FIG. 7  is an exemplary screen illustration of an embodiment of the present invention, illustrating a lecture page showing the details of preset lectures/lessons related to each of the plurality of prerecorded sounds; 
           [0025]      FIG. 8  is an exemplary screen illustration of an embodiment of the present invention, illustrating a create lecture page that allows the user to create and save the lectures/lessons related to each of the plurality of prerecorded sounds; 
           [0026]      FIG. 9  is a block diagram illustrating the functionality of a lecture sequence link in the main window; 
           [0027]      FIG. 10  is a front elevational view of the half-body mannequin showing a plurality of listening sites for heart and bruit sounds; 
           [0028]      FIG. 11  is an elevational view of the half-body mannequin showing the plurality of listening sites on both anterior and posterior portions for breath/lung sounds; and 
           [0029]      FIG. 12  is a front elevational view of the half-body mannequin showing the plurality of listening sites for bowel sounds. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
       [0030]      FIG. 1  is a schematic view of an auscultation training system  10  that enables the at least one user  12  to listen to and experience various physiological sounds. The system  10  comprises a half-body mannequin  14 , a computer system  16  installed with a software application and an interface module (not shown). The half-body mannequin  14  comprises a plurality of sound listening sites  20 . The computer system  16  comprises a database of a plurality of pre-recorded sounds for a plurality of category of physiological sounds in the form of a sound repository means that includes a plurality of sub-folders. The software application facilitates the at least one user  12  to access a tabbed graphical user interface  22  defined in the form of a main window. 
         [0031]    The interface module which is in electronic communication with the sound repository means is embedded in the half-body mannequin  14 . The interface module is configured to receive pre-recorded sounds for the plurality of category of physiological sounds and to generate a plurality of interleaved sound signals for each of the plurality of pre-recorded sounds at each of the plurality of sound listening sites  20 . A standard stethoscope  24  is used to hear the audible sounds transmitted to the speakers in the mannequin. 
         [0032]    The system  10  allows the at least one user  12  to select at least one of the plurality of pre-recorded sounds for at least one of the plurality of category of physiological sounds in the graphical user interface  22  and to playback the plurality of interleaved sound signals corresponding to the selected pre-recorded sounds at respective sound listening sites  20 . 
         [0033]      FIG. 2  is an external front view of an interface module  30  associated with the half-body mannequin  14 . The interface module  30  includes a pair of universal serial bus ports  32 , a headphone connection port  34 , an on/off switch  36  and a power supply port  38 . The computer system  16  is operatively connected to the pair of universal serial bus ports  32  and optional external speakers or an optional electronic stethoscope which may be connected to the headphone connection port  34 . The power supply port  38  is connected to the DC to power the electronic components within the half-body mannequin  14 . The half-body mannequin  14  should be operated in an environment cooler than 80° F. or 27° C. The plurality of interleaved sound signals can be listened to using at least one speaker (not shown) connected to the headphone connection port  34 . 
         [0034]      FIG. 3  is an exemplary screen illustration of an embodiment of the present invention, illustrating a main window  40  displayed in the graphical user interface  22  of the computer system  16  which is installed with the software application. The software application may be a web enabled application which will allow simultaneous use of the system by multiple users. In this mode, sounds are transmitted to the user&#39;s computer or external speaker rather than to the interface module. The main window  40  includes a link to sound select  42 , which allows the at least user  12  to access a sound select page giving the details of each of the plurality of category of auscultation sounds with the plurality of pre-recorded sounds. The main window  40  further includes a link to lecture sequence  44 , which allows the at least one user  12  to access a lecture page giving the details of the preset lectures/lessons related to each of the plurality of pre-recorded sounds. 
         [0035]    Referring to  FIG. 3 , the main window  40  includes a volume adjust area  46 , a volume save button  50 , a recall button  52 , a reset button  54 , a select sound button  56 , a play sound button  58 , a compare sound button  60 , a select lesson button  62 , a basic select lecture button  64 , a phonocardiogram display area  66 , a virtual mannequin display area  68 , a freeze trace button  70  and a trace size button  72 . The volume adjust area  46  allows the at least one user  12  to change volume of each of the plurality of pre-recorded sounds at each of the plurality of listening sites  20 . This can be performed by moving one or more volume slide bars  48  in the volume adjust area  46 . The volume save button  50  arranged below the volume slide bars  48  allows the at least one user  12  to save the selected volume level. The recall button  52  arranged next to the volume save button  50  allows the at least one user  12  to recall the settings. The reset button  54  allows the at least one user  12  to return to the previously saved volume levels. The at least one user  12  can access the sound select page by clicking the sound select button  56 . The sound select page includes the details of each of the plurality of category of physiological sounds with the plurality of pre-recorded sounds. The play sound button  58  allows the at least one user  12  to play the plurality of pre-recorded sounds shown in the sound select page. 
         [0036]    The compare sound button  60  allows the at least one user  12  to select two or more pre-recorded sounds for performing a comparative study. The pre-recorded sounds can be toggled with the use of buttons such as play  1  indicated herein as  58  and play  2  indicated as  74  on the main window  40 . The mannequin display area  68  displays a virtual half-body mannequin  76  with a plurality of listening sites  78  corresponding to each of the plurality of pre-recorded sounds. The mannequin display area  68  further displays a virtual stethoscope  80  that allows the at least one user  12  to click on the plurality of listening sites  78  and listen to the plurality of pre-recorded sounds. The phonocardiogram display area  66  displays a graphical depiction of a selected pre-recorded sound when the at least one user  12  clicks on respective listening site. When the at least one user  12  compares two or more pre-recorded sounds, more phonocardiograms are displayed in different colors. Each color indicates the graphical depiction of each of the selected pre-recorded sound. The select lecture button  62  allows the at least one user  12  to view the lecture/lessons corresponding to the selected pre-recorded sound. Each lesson includes a description of the sound, a schematic of a chest, phonocardiograms, questions and answers and a basic lesson on cardiac auscultation. The basic select lecture button  64  allows the at least one user  12  to access default basic notes stored in the software application related to each of the plurality of pre-recorded sounds. The freeze trace button  70  allows the at least one user  12  to freeze the phonocardiogram and simultaneously listen to the selected pre-recorded sound. The trace size button  72  allows the at least one user  12  to increase or decrease the amplitude of the signals in display areas  66 ,  68  for better viewing. 
         [0037]      FIG. 4  is an exemplary screen illustration of an embodiment of the present invention, illustrating a sound select page  90  showing the list of a plurality of pre-recorded sounds for each of a plurality of category of physiological sounds. The at least one user  12  can choose one or more pre-recorded sounds from the list and listen to the sounds at the plurality of listening sites  20  on the half-body mannequin  14  using a standard stethoscope  24 . The plurality of category of physiological sounds may include heart sounds, breath/lung sounds, bowel sounds, bruit sounds, aneurysms, heart and breath combination sounds and heart and bruit combination sounds. 
         [0038]      FIG. 5  is a block diagram illustrating the functionality of a sound repository means associated with a computer system  16 . The sound repository means is organized in the form of a disk folder that includes the plurality of sub-folders for storing the database of the plurality of pre-recorded sounds  100  for the plurality of category of physiological sounds. Each of the plurality of pre-recorded sounds is arranged as a .wav file format. Each .wav file format for each of the plurality of pre-recorded sounds includes the plurality of interleaved sound signals and presents as a standard audio 7.1 formatted container. The sound repository means is stored in an encrypted file format  102  into a hidden folder. When at least one of the plurality of pre-recorded sounds is selected by the at least one user  12  for playback, the encrypted file gets decrypted  104  to a particular .wav file format corresponding to the selected pre-recorded sound and copied from the hidden folder to a virtual disk  106 . The sound repository means is then encrypted and the particular decrypted .wav file format in the virtual disk is submitted to the windows media player  108  for playback. If the at least one user  12  selects another one of the plurality of pre-recorded sounds for playback, the previously existing particular .wav file format in the virtual disk is replaced. Thus the process is repeated for selection of each of the plurality of pre-recorded sounds. The virtual disk is highly volatile in nature and it disposes of the contents when the software application terminates. Finally, the particular .wav file format is submitted to sound codec hardware  110  in the interface module from the windows media player  108 . The database of the plurality of pre-recorded sounds for the plurality of category of physiological sounds  100  includes a plurality of attributes for each of the plurality of pre-recorded sounds. The plurality of attributes may include saved and default sound attenuation levels for each of the plurality of interleaved sound signals, channel trace defaults, trace scaling defaults, sound multiplexing target assignments and lectures/assessments. 
         [0039]    When the at least one user  12  selects the sound select button  112 , the plurality of attributes of the database  100  stored in a sound channel configurator  114  is activated. This facilitates the activation of virtual half-body mannequin display service  116 , audio channel sound level recall and reset service  118 , and waveform trace select service  120 . When the at least one user  12  selects a waveform display select  122  for lectures/lessons, the basic notes and the preset lectures/lessons  124  related to each of the plurality of pre-recorded sounds in the software application can be retrieved from the database  100  and a lecture sequence database  126 . The lectures/lessons are displayed in the graphical user interface  22  in a portable document format (PDF)  128 . The audio channel sound level recall and reset service  118  promotes the volume adjustments, and the waveform trace select service  120  promotes the display of phonocardiogram in the graphical user interface  22  for each of plurality of pre-recorded sounds. The at least one user  12  has the ability to select two pre-recorded sounds for comparison. The pre-recorded sounds can also include a toggle feature  130  to toggle the sounds with the use of buttons such as play  1  as indicated as  58  and play  2  indicated as  74  on the graphical user interface  22 . A channel control and a channel gain for the sound repository means in the computer system are connected with the pair of universal serial bus ports  32  on the interface module of the half-body mannequin  30 . 
         [0040]      FIG. 6  is a block diagram illustrating the functionality of an interface module embedded within the half-body mannequin  14 . Sounds from the computer system are sent to a commercial-off-the-shelf (COTS) eight channel USB audio adapter external sound card  142 . The analog signals from the sound card are simultaneously directed to a multiplexer  150  for the output to the speakers in the mannequin and to an A/D converter  144  in a COTS data acquisition module for transmission to the computer system for display as waveforms on the user interface  22 . The multiplexer  150  allows for routing the analog signals to the proper speakers and provides for the user to enable or disable speakers. The interface module  30  also provides a demodulation circuit and a pulse driver  154  to activate the pulse solenoid in sync with the heart sounds. The sound codec hardware may be a streaming codec hardware device and the multifunction board may be a universal serial bus (USB) multifunction board. The streaming codec hardware is installed separately with its own USB drivers. The streaming codec hardware may be a 7 channel USB Audio Adapter External Sound Card that can output 8 sounds such as front right and left, rear right and left, center, bass and surround right and left. The streaming codec hardware installation provides a virtual audio interface module where a one-time audio 7.1 user selection can be performed. The multifunction board is a data acquisition (DAQ) module that can input 8 analog and input/output 12 digital sounds. Each standard audio 7.1 formatted container  142  of each of the plurality of the pre-recorded sounds in the software application  140  is channeled to an analog to digital converter  144 , to a programmable channel gain amplifiers  146 , to a multifunctional control  148  and to a channel multiplex (MUX) distribution control  150  in the sound engine module. The graphical user interface  22  connects the sound repository means of the computer system to the interface module of the half-body mannequin  14 . 
         [0041]    The multifunction board can perform the multifunctional control  148  to the programmable channel gain amplifiers  146 , and to the channel multiplex (MUX) distribution control  150 . The multifunction board can perform a continuous 400 Hz sampling of each of the channel MUX distribution control  150  for achieving a tracing of waveform to a waveform graph. The programmable channel gain amplifiers  146  are actually utilizing a resistive attenuation method. The resistive range can be programmatically changed with 64 steps of equal resistive granularity. 
         [0042]    The streaming codec hardware receives the standard audio 7.1 formatted container  142  from the windows media player and generates the plurality of interleaved sound signals for each of the plurality of pre-recorded sounds at each of the plurality of sound listening sites. The plurality of interleaved sound signals may be in eight in number. The plurality of interleaved sound signals can be heard using a standard stethoscope through the speakers  152  integrated with the half-body mannequin  14 . The sound engine module includes pulse sync  154  that acts as a target for carotid pulse sound. 
         [0043]      FIG. 7  is an exemplary screen illustration of an embodiment of the present invention, illustrating a lecture page  160  showing the details of the preset lectures/lessons related to each of the plurality of prerecorded sounds. The lecture page  160  includes a create lecture button  162 , an edit lecture button  164  and a delete lecture button  166 . The at least one user  12  can preprogram the lectures/lessons related to each of the pre-recorded sounds using the editing tool provided by the user interface. Each user may have multiple lectures/lessons each with a different title. The lecture page  160  also allows the at least one user  12  to save student assessments related to each of the lectures/lessons. 
         [0044]      FIG. 8  is an exemplary screen illustration of an embodiment of the present invention, illustrating the create lecture button  162  that allows the at least one user  12  to create and save the lectures related to each of the plurality of prerecorded sounds. When the at least one user  12  clicks on the create lecture button  162 , it navigates to a create lecture page  170 . The at least one user  12  can fill a lecture panel  172  with his/her name  174  and lecture name  176 . Then the user  12  can select and list the plurality of pre-recorded sounds  178  which are pertaining to the filled lecture name  176 . 
         [0045]      FIG. 9  is a block diagram illustrating the functionality of a lecture sequence link  44  displaying in the main window  40 . The at least one user  12  can create a lecture sequence  180 , view or edit lecture a sequence  182  to build a sequence of the plurality of prerecorded sounds into lecture steps  184  for facilitating student lectures, student self-teaching and student testing. 
         [0046]    The at least one user  12  can assign the build sequence  184  to a unique name into the lecture sequence database  186 . The at least one user  12  can build a sequence of up to 20 different pre-recorded sounds. Within the lecture sequence database  186  an unlimited number of sequences can be saved. The functionality of lecture sequence may be protected by password/account lecture manipulation privileges. Such privileges allow the user  12  to create  180 , edit  182  and delete  188  the lecture sequences. With user selection of one of the lecture sequences  190  from the lecture sequence database  186 , a lecture sequence processor  192  initiates the lecture sequence and executes it step-by-step. At each step a selected pre-recorded sound will in playback through the sound engine module  194  using next step  196 , previous step  198 , and quit sequence  200  virtual buttons. 
         [0047]    The lecture sequence database can be assigned to a test assignment list  202  for test mode operation and to execute the lecture sequences either in test mode or non-test mode. According to the user&#39;s selection of one of the test from the lecture sequence database  186 , a lecture sequence processor  192  initiates the test  204  and executes it step-by-step in the test mode. In the test mode, the lecture sequence includes a list of tests, names, descriptions, and functionality which are hidden. The lecture sequence database  186  includes the test assignment privileges such as assign number of test  206  and view/print the test assignment list  208 . 
         [0048]      FIG. 10  is a front elevational view of the half-body mannequin  14  showing the plurality of listening sites for heart and bruit sounds. The heart sounds include five listening sites such as aortic  210 , pulmonic  212 , tricuspid  214 , mitral  216  and carotid pulse  218 . The bruit sounds include one listening site such as carotid bruit  220 . 
         [0049]      FIG. 11  is elevational views of the half-body mannequin  14  showing the plurality of listening sites on both anterior and posterior portions for breath/lung sounds. The breath/lung sounds include four listening sites such as upper right lung  222 , lower right lung  224 , upper left lung  226  and lower left lung  228  on the anterior portion of the half-body mannequin  14 . The breath/lung sounds further include four listening sites such as upper right lung  222 , lower right lung  224 , upper left lung  226  and lower left lung  228  on the posterior portion of the half-body mannequin  14 . 
         [0050]      FIG. 12  is a front elevational view of the half-body mannequin  14  showing the plurality of listening sites  20  for bowel sounds. The bowel sounds include two listening sites such as upper right quadrant  230  and upper left quadrant  232 . 
         [0051]    While particular embodiments of the invention have been illustrated and described, it will be apparent that various modifications can be made without departing from the spirit and scope of the invention. For example, the software application may include additional functionality such as videos and metrics related to the pre-recorded sounds. Accordingly, it is not intended that the invention be limited, except as by the appended claims.