It starts with a heartbeat. The first question asks students to distinguish what they hear: Is it normal or abnormal? MurmurQuiz, an online training system, challenges medical students and practitioners to improve the skill of auscultation, or diagnosing heart disease with a stethoscope.

Created by cardiologist Reid Thompson, pediatric cardiology fellow Gary Beasley and the Johns Hopkins Technology Innovation Center, MurmurQuiz presents a picture of a patient’s chest and asks the user to decide where to listen, how to use the stethoscope, and whether to listen to the patient sitting, standing or lying down.

After listening, the student answers multiple-choice questions to pinpoint any abnormalities in the heart sounds and link them to the most likely diagnosis. “You interact as you would in the clinic to formulate a diagnosis,” says Beasley.

Thompson began recording heart sounds in 1997 following a period when the use of a stethoscope declined significantly, when ultrasound became the gold-standard method for diagnosing heart conditions. Today, just 20 percent of clinicians are proficient at auscultation.

To help students and clinicians hone their skills, Thompson created a free online virtual cardiac clinic in 1999—MurmurLab—where users could listen to more than 5,000 sounds from over 1,000 patients. MurmurQuiz is the new iteration of this project, offering an interactive, gamelike experience that saves students’ results and tracks their progress.

Eventually, Thompson hopes these efforts will help devise a way to accurately test proficiency of auscultation for board exams. In the meantime, MurmurQuiz is being used by medical students and residents at The Johns Hopkins Hospital and will be available to users outside of the organization later this year.