I am a physical therapy student. This steth and cuff have served me well and are more than adequate for school. I hear much better with this steth than with the ones the school has. The earpieces are more comfortable too! The BP cuff is fine but the way you hold the bulb can be a bit finicky. Also the way the valve for the bulb on the cuff locks down makes for some resistance to be overcome so you have to be careful not to let out too much air as you open the valve. This is learnable and not a big deal but something to consider in your purchase.. I am still able to take accurate manual BP and HR measures while walking with a patient in a hallway, so it works just fine.