1330 responses out of a possible 1452 for all six course evaluation questions were achieved, for a response rate of 91.6%. The difference in response rates between the historical controls and the ARS was statistically significant (P < 0.00000001). Evaluation of results and impact The results show a statistically significant difference in the response rates achieved using the ARS compared with those of historical controls. Achieving a higher response rate would conceivably make the feedback more accurate and the evaluations more representative of the entire group, rather than of a motivated few. As honest evaluation is a hallmark of the academic process, mechanisms which allow more complete and timely evaluation of feedback should be encouraged. The ARS collects feedback in real time and allows for further analysis of the evaluations. This study demonstrates a method of capturing a high percentage of course evaluations in real time, using a modality that allows for further statistical evaluation. Use of the ARS should be pursued as an option for feedback on lectures. Correspondence: Joseph W. Turban, University of Hawaii, John A. Burns School of Medicine, 92-1373 Hoalii St., Kapolei, HI 96707. Tel: 00 808 672 9098; Fax: 00 808 672 9098; E-mail: jwturban@hawaii.edu doi: 10.1111/j.1365-2923.2009.03348.x Paediatric cardiac auscultation teaching based on digital phonocardiography Ioannis Germanakis & Maria Kalmanti Context and setting The clinical skills of medical students and junior doctors in cardiac auscultation have been described as rather suboptimal. Although echocardiographic evaluation can almost always effectively rule out the presence of congenital heart disease in children, the initial paediatric cardiac evaluation is still based on cardiac auscultation. The purpose of this pilot study was to evaluate the usefulness of a digital phonocardiography-based teaching course in improving the clinical skills of medical students in paediatric cardiac auscultation. Why the idea was necessary Bedside teaching of paediatric cardiac auscultation is a challenging task because of the increased heart rate, breathing and movement in children and the reduced tolerance and increased fear of young children to prolonged eval- uation by consecutive medical students. Furthermore, the rarity of academically active paediatric cardiolo- gists and the low prevalence of congenital heart disease among paediatric patients increase the need for alternative methods of paediatric cardiac auscul- tation teaching. What was done Twelve medical students participated in a 16-hour digital phonocardiography course dur- ing their last year of medical training. Following a brief introduction to the classification of heart mur- murs of childhood, students were able to listen to a large series (n = 125) of digitally stored phonocar- diograms, corresponding to a wide spectrum of congenital heart disease and innocent murmurs. Each phonocardiogram included four discrete recordings from standard auscultation sites, obtained from paediatric cardiology patients (neonates to adolescents) with the consent of their parents. Participants were able to listen to selected recording intervals (using high-quality earphones) and simulta- neously view the graphic display of the corresponding spectrum of sound frequencies over time (electro- cardiogram tracing). Sound frequency filters were used to enhance abnormal auscultatory findings. Questionnaires were completed by the students before and after the course. These required the students to listen to selected phonocardiograms (n = 29) and to interpret the murmurs’ timings and specific characteristics, for which they were marked on a scale of 0–100. Ethical approval for this study was granted by University Hospital Heraklion Ethics Committee. Evaluation of results and impact The average pre-test score was 43.6% (95% confidence interval [CI] 39.7–47.4). The corresponding post-test score was 73.7% (95% CI 62.2–78.1) (paired t-test, P < 0.001). That the students’ auscultatory skills in characterising innocent and abnormal paediatric heart murmurs were observed to improve by 69% following a digital phonocardiography course emphasises the need for new multimedia teaching approaches, especially in areas where student access to traditional bedside teaching is limited, such as in paediatric cardiac auscultation. Correspondence: Ioannis Germanakis, Paediatric Cardiology Unit, Department of Paediatrics, University Hospital Heraklion, Heraklion, Crete, Greece. Tel: 00 30 2810 392097; Fax: 00 30 2810 392778; E-mail: germjohn@med.uoc.gr doi: 10.1111/j.1365-2923.2009.03343.x Re-using e-learning objects Ann Jackson, Patricia Bluteau & Stephen Brydges Context and setting Two modules with different aims used one e-learning patient journey. Both modules involved Year 2 medical students, one with a unipro- really good stuff Ó Blackwell Publishing Ltd 2009. MEDICAL EDUCATION 2009; 43: 471–499 489