The learning program CliniSurf, developed by the Institute for Medical Education (IML), is so popular that lecturers at the University of Tübingen in Germany recommend it to their students. One German student has now developed an app based on it. “I’m very pleased that our website gave Manuel Sigle the impetus to spontaneously develop an app”, says Ulrich Woermann, Head of Group E-learning at the IML.

Cardiac auscultation app

The app contains the 65 heart sounds and heart murmurs from CliniSurf. The ear can only be trained if sounds and murmurs – be they normal or pathological – can be repeatedly listened to and compared. From a learning-didactical perspective, the concern in this regard is with developing pattern recognition. This also applies to images such as x-ray images, blood smears or ECGs. With the app, the learner is able to practice what can and needs to be detected. Moreover, the program provides further explanations. This is where the value in electronic learning programs can be seen: They complement text-based learning materials such as textbooks by offering acoustic and visual examples.

A self-test (quiz) helps users to monitor their success and learning progress, enabling them to check their progress in recognizing heart sounds and murmurs. In this way, future physicians can further develop precision in their findings.

Students are being given less and less opportunity to practice on real patients. The CliniSurf program and the app act as a bridge in this regard: Students can practice with real heart sounds countless times until their accuracy is sufficiently differentiated that heart sounds and heart murmurs can be correctly detected in real patients.

Example: Graphics /finding third heart sound

“For young people nowadays, learning with digital media is a matter of course. Therefore, we are increasingly being contacted by medical students who want to develop new learning media”, explains Woermann. “We are happy to support such ideas. Additionally, students in Bern have the possibility to implement the production of learning media as a Master’s thesis and dissertation”.

Anchoring in practice

The app pursues the same didactical goals as the CliniSurf website and reinforces the E-learning concept of the institute. Most of the learning modules of CliniSurf have a central focus on detecting visually or acoustically discernible changes. As such, the emphasis is on the image and/or the sound. To consolidate theoretical knowledge, books and lectures continue to be paramount. The CliniSurf program is freely available and has existed for 15 years. Currently, its design is being reworked.

The cardiac auscultation app is offered on Google Play as a lite version with limited functionality or as a full version (for a fee). The fact that the student Manuel Sigle implemented the app for mobile learning of his own volition demonstrates the status of CliniSurf. Therefore, after careful quality control, the IML has acquired the app. Its further development will be undertaken by Manuel Sigle.

Questions to the developer Manuel Sigle

CliniSurf was recommended to us students in our first clinical semester by the internal medicine lecturers. In addition, we had an oral-practical exam, for which cardiac auscultation findings had to be correctly interpreted. CliniSurf offered the ideal learning and preparation platform for that.

A thing I find practical about CliniSurf is that it contains all information about cardiac auscultation in compact form in one place – from physiology and origin of the heart sounds to the more profound clinical knowledge. The didactic preparation is also a success: As learning a sound amounts to a kind of aural training, graphical illustrations were developed which enable the learner to store auscultation findings in memory even in the long term.

Nowadays, a lot of online contents are accessed via smartphones. Unfortunately, CliniSurf isn’t adapted for mobile end devices, meaning that the display on the cell phone screen corresponds exactly to that on the large computer monitor, and lots of zooming is therefore required for readability.

For this reason, I decided to pack all the contents from CliniSurf Cardiology into an app and supplement them with useful additional functions. So now, in the full version, the quiz can be listened to in a loop, and after each finding a voice announces the correct finding. Because everyone always has their smartphone to hand anyway these days, it’s therefore possible to learn and practice any time and place.

There are already some other apps on cardiac auscultation, but none of them come close to the extent of 65 auscultation findings. The didactic preparation of other apps also leaves something to be desired. In addition, in contrast to the “competition”, the IML app has useful additional functions, like the auscultation quiz described above, and the function of comparing findings. Another advantage of the app is the comfort of use and the fact that it works completely offline.