In this study, Vukanovic-Criley et al used a validated, 50-question, computer-based test to assess 4 aspects of cardiac examination competency: (1) cardiac physiology knowledge, (2) auditory skills, (3) visual skills, and (4) integration of auditory and visual skills, using computer graphic animations and virtual patient examinations. They tested 860 participants at all levels of training as well as practicing physicians. Mean scores improved from first- to third-year medical students (P = .003) but did not improve thereafter. Scores did not differ significantly among third- and fourth-year medical students, internal medicine and family medicine residents, full-time faculty, voluntary clinical faculty, and private practitioners. Only cardiology fellows tested significantly better (P<.001), with the highest scores in all 4 subcategories of competency. Cardiac examination skills do not improve after the third year of medical school and may decline after years in practice.