Harrison’s Principles of Internal Medicine is regarded as one of the premier textbooks for physicians through to medical students.

Primarily aimed at internists, it is accessible to medical professionals at all levels with its fundamental clinical medicine coupled with an explanation of underlying pathophysiology. Now in its 18th edition, it is without doubt one of the most recognizable and useful resources to practicing physicians today.

iMedicalApps has previously reviewed Harrison’s Manual of Internal Medicine for the iPhone here but today we take an in-depth look at the full Principles of Internal Medicine for iPad as it has now arrived via the Inkling platform. Inkling is renowned for taking classic textbooks and ‘reinventing’ them with a range of interactive features and media.

By their own admission, Harrison’s has been the most ambitious project to date and has taken over a year to complete the transformation to the iPad.

This review will not focus on the content of the book as most people will have experienced Harrison’s at some point during their medical career. Suffice to say Harrison’s Principles of Internal Medicine continues to set the standard as the pinnacle of current medical knowledge and practice, offering the definitive review of disease mechanisms and management.

As such, this review will focus on the overall Inkling platform and features which accompany this iPad version of Harrison’s Principles of Internal Medicine.

The first important thing to note about the Harrison’s textbook is its size. The paper version weighs in at 2,800 pages and this translates to approximately 2GB of space on your iPad. However all 397 Chapters and 57 eChapters are stored locally on your device removing the need for an internet connection.

Launching the textbook within Inkling brings the user to a familiar user interface.

All Inkling titles are designed and built upon the same platform and utilize the same structure as seen in other titles such as Essentials of Clinical Anatomy and Ganong’s Physiology.

Initially, the user is presented with a (very long) list of chapters. Each group of chapters is collected under a ‘Part’ but unfortunately there is no way to expand or hide these parts meaning that you have to scroll through every chapter until you find the one you want. I feel Inkling may have missed a trick here as the closest feature that has this function is the actual contents page (see screenshot) which breaks the book up into its various ‘parts’. This has more to do with the structure of the book which splits each section into chapters but it does mean finding the required chapter can be more challenging than it should be.

However, once a chapter has been selected, navigation throughout the text is simple and straightforward. The arrows in the bottom left of the toolbar quickly jump between sections.

Navigating within a section was sometimes more challenging than desired. While there was some inertial scrolling, I found that this was not always enough to quickly scroll through the sections in each chapter. This was only really apparent on the larger chapters which contained vast amounts of information. In general, though, I did not have any problems interacting with the book. I was pleasantly surprised by the speed at which different sections and images were loaded.

One aspect of this title which the Inkling platform does not cope particularly well with is the sheer size and detail of many sections. Although there are options to change the text size, I felt that sometimes the text was too big (even on the smallest setting) and as a result actually became harder to read.

An example is shown in the screenshot below where one paragraph takes up the entire page which is difficult to read. Page fidelity with the paper version is maintained and marked off at the start of each chapter.

Integrating media into textbooks has always been an Inkling strong point and they do not disappoint with Harrison’s. There is a wealth of images, tables, slideshows, videos and more, all fully integrated and linked to within the text.

Tapping on a table or image will cause it to slide in on a new page so that you can purely concentrate on the information while a quick flick will cause it to slide away. I found I often used the search function to navigate as it was often quicker and easier than scrolling through numerous detailed chapters. I liked the fact that all information related to treatment and management had been highlighted which made finding this essential information quick and easy.

One of the nice things about using the Inkling platform is that thought that has gone into the little details. For example, including an inbuilt dictionary to define words or including the option to search by content type. One feature I hadn’t noticed before was the inclusion of a ‘back’ button when a hyperlink takes you between chapters.

The inbuilt search function is highly effective and useful tools such as bookmarks, highlighting, and basic annotation make customizing the textbook easy. While the annotation tools are not as comprehensive as those seen in PDF management apps, they are generally suitable for most uses.

Having used this book for a number of weeks now, I think it is an excellent title and believe that Inkling have done a fantastic job transferring this title to the iPad. The rich text and media go a long way to making Harrison’s more accessible to medical professionals and students alike. Time will tell if the inbuilt social features allowing users to share notes takes off.

Price:

• $199 although there is currently a 20% discount code posted in the forum

Likes

• All content stored locally
• Treatment information clearly highlighted including algorithms
• The range of interactive features that have become an integral part of Inkling titles
• Having each chapter split into sections making it easier to find information

Dislikes/Future updates I’d like to see

• More inertial scrolling
• Expandable sections and chapters to make navigating 350+ chapters easier
• I would like to see the option of a smaller text size whilst reading the main sections
• Constantly having to scroll whilst reading which can become cumbersome

Overall Rating

• Harrison’s Principle of Internal Medicine is another excellent title from Inkling
• One or two navigation issues do not take away from the fact this is the only iPad optimized version of this essential clinical reference text
• Medical professionals who purchase this text will know they carry one of the most extensive medical resources in a highly accessible format on a device no larger than a notepad.

iTunes link:
Inkling Store:

Over the past couple of weeks, iMedicalApps has taken a close look at Inkling, a company that is trying to revolutionize learning through next generation medical textbooks.

Each article first, second, and third has focused on a different aspect of Inkling and it seems only fair that they should have the opportunity to further explain what they do.

I was fortunate enough to be invited to one of Inklings webinars for industry professionals during which they demonstrated their vision for the future of medical education. Inkling were kind enough to let us publish these webinars for those who may be interested. In this fourth and final article, iMedicalApps brings you Inklings future of medical education.

The webinar by Matt Macinnis, CEO and Founder of Inkling, shows his vision for the future of medical education through medical textbooks. The webinar agenda is shown below:

• Introduction to Inkling
• A Brief History of Textbooks
• Demo of Inkling for Medical
• Guest Speakers
• Nadine Dexter, MLS
• Warren Wiechmann, M.D., MBA
• Conclusion

Inkling Medical Webinar from Inkling

The webinar is a really informative, inspiring vision for the future of medical education through mobile technology. I would advise all those involved in medical education to take some time out of their day to watch this. Please note it is 38 minutes long but well worth the time for the in-depth discussion of Inkling as a medical education resource.

Inkling Website

Apple’s education media event on Thursday suggests Apple are primed and ready to enter the world of digital publishing. As we pointed out in our last article, evidence suggests that Apple is likely to bring important changes to the iBook platform with a particular focus on academia and furthermore push into the education industry. Previously, thoughts have focused on Apple improving the iTunes U platform and trying to use this as a gateway into educational institutions. Others believe that Apple are planning on upgrading the iBooks platform and distribution method to remove the intermediates of the publishing industry.

A number of key players in this industry have made some interesting observations; Matt MacInnis, CEO of Inkling pointed out one of the main issues facing Apple is that they,

“do not have a history of building software specific to any particular vertical market, and so we believe they’ll continue to allow their developers to work in this area.

Cult Of Mac believe that Apple:

“intends to slowly take control of the book publishing industry… by providing the leading tools and cloud infrastructure for authors to create and then market their books directly to readers starting with the education segment of the publishing market.”

Interestingly, MacInnis had similar thoughts to this noting,

“We think Apple could devalue traditional textbooks, but not necessarily by replacing them with something data-driven, interactive and pedagogically sophisticated. Instead, we think Apple could make it easy for others to create baseline content that serves ostensibly the same purpose as a print book, pushing the market dollars in search of more effective learning tools.”

If Apple do introduce a system that connects textbook authors to readers and removes the intermediate publishers, we are likely to see an interesting future in medical textbooks. Apple may be trying to reinvent the iPad as a learning platform and content distribution service in much the same way as companies like Inkling and the Khan Academy are. Using Apple as a source of medical textbooks means that distribution costs may go down enabling easier access. Furthermore Apple is poised to bring a range of interactive features to iBooks as illustrated by their free release of the Yellow Submarine book which demonstrated a range of media, annotation and other creative features. If Apple do offer publishing tools and remove the intermediates in the publishing industry then we are likely to see a very exciting time as MacInnis says,

“Apple will encourage others to produce content for that ecosystem, and if they can reach a critical mass of content, they might very well make the traditional textbook obsolete for iPad users.”

whilst Cult Of Mac believes that,

“Apple will begin the long process of reinventing the textbook industry as a stepping stone to eventually reinventing the entire publishing industry.”

Apple taking control of publishing would have interesting ramifications in what has been a relatively inactive market. Imagine the possibilities of updates to textbooks being pushed to your iPad in the same simple fashion as updating an app. What is clear is that the future of publishing is not page-bound as the educational market has not responded well to textbooks that are essentially PDF copies.

Thanks to Matt MacInnis, CEO of Inkling for offering his unique insight into the issues facing companies such as Inkling in advance of Apple’s media announcement.

Source: Cult Of Mac

Apple has planned a media event at the end of January in New York City with current speculation suggesting that Apple is preparing to revolutionize digital textbooks.

Isaacson first suggested in Steve Jobs biography that Apple were looking to hire textbook writers in order to create original digital textbooks on the iPad.

“His idea was to hire great textbook writers to create digital versions, and make them a feature of the iPad. In addition, he held meetings with major publishers, such as Pearson Education, about partnering with Apple.”

A source close to Apple released the following details:

• This event will focus on iTunes University and Apple in education
• I learned of the event back in September when it was originally scheduled for late Fall in New York but it was eventually postponed.
• The event will be in New York rather than in the Silicon Valley because New York is more centrally located for textbook and publishing.
• This initiative has been in the making for years.
• The announcement will be small in size but large in scope–a big announcement in a demure space.
• I expect at least two large project announcements as they relate to Apple in education.
• Steve Jobs was intinimately [sic] involved with this project before his passing. He gave a hat tip to the textbook side of this project in the Isaacson biography.
• This will not be a hardware-related announcement.

There are also further suggestions indicating the announcement could likely involve support for the EPUB 3 standard, which enables a wider variety of multimedia and interaction features.

All the evidence suggests that Apple is likely to bring important changes to the iBook platform with a particular focus on academia. We have already seen the successful creation of engaging interactive textbooks courtesy of Inkling whilst companies such as CourseSmart offer a wealth of titles to students.

Perhaps Apple is considering launching its own platform to compete with these eTextbook developers using its considerable resources. ArsTechnica notes “Digital textbooks represent another nascent market that Apple could potentially upend as it did with music and mobile apps”. If Apple does push into the education industry then we can expect to see more mobile technology integration into the classroom.

Source:MacRumours

In 2011 we did a review of the first interactive medical textbook, reported on major investments by mainstream publishers in digital platforms, and wrote extensively on the the distribution of iPads and other tablets to medical students, residents, and physicians.

Here at iMedicalApps we are always interested in ways to utilize mobile technology for a positive purpose — changing the way that healthcare professionals are trained certainly falls into that category.

CourseSmart offers a huge range of online digital textbooks which are easily accessible on a range of devices. We have previously introduced CourseSmart and recently reviewed the platform, concluding with some mixed impressions. We also had a chance to talk to CourseSmart’s Chief Marketing Officer, Jill Ambrose and ask her a few questions about CourseSmart and get some insight into the transformation of medical education.

Please tell us a little bit about the background and initial founding of CourseSmart

CourseSmart was founded in 2007 when a group of six higher education publishers partnered together to offer faculty a textbook evaluation service and students a new choice for buying and accessing their required textbooks online. The publishers included Pearson, Cengage Learning, McGraw-Hill Education, John Wiley & Sons, Houghton Mifflin and Bedford, Freeman and Worth Publishing Group (Macmillan).
Today, the company is recognized as the world’s largest provider of eTextbooks and digital course materials with more than 30 higher education publisher partners and over 20,000 eTextbooks and eResources available to our 2.5 million users.

What is the vision for CourseSmart as a company?

Our vision has always been to expand access to higher education and improve learning outcomes by connecting content producers with content users in the higher education space and offer:

• significant savings
• device agnostic access both online and offline
• superior reading experience
• advanced app technology
• unmatched campus integration.

The way in which students and faculty are consuming course materials is changing rapidly and we pride ourselves in staying ahead of these trends. We have a long list of industry firsts that include the first iPhone app in August of 2009, the first iPad app in April of 2010 and the first Android app in April of 2011, and the first mobile web app last month among others. We are continually enhancing our offering across all platforms and devices that connect users with our content.

CourseSmart has an enormous range of titles available-could you elaborate on the process by which titles are selected and transferred to electronic form?

We believe content is critical and a main differentiator between us and many of our competitors. How important is your offering to students if they can’t get the titles necessary to pass the class?

We rely on our publisher partners to provide the most current course materials in use today to ensure students are able to find their required course materials in digital form and can take advantage of all of the digital efficiencies that accompany our eTextbooks, including guaranteed, upfront savings of up to 60% when compared to print textbooks, anytime, anywhere access via any computer or web-enabled device, as well as the ability to “cache” their eTextbooks for usage offline. Our expertise in this end to end workflow allows us to obtain the content in a PDF file along with various metadata associated with the title. Our proprietary system manages the content ingestion and publishing processes so that students and faculty alike can find what they need quickly.

The reviews on iTunes of your CourseSmart iPad app seem largely negative with criticism directed toward a lack of multitasking, the repeated sign-in and a number of other issues. Do you feel that these reviews are justified?

Being the first to market with apps for the iPhone, iPad and Android, we have blazed the trail for many followers in the industry. Being first often means you have to anticipate the best features before the device is even in the market such as the iPad app. We get many of them right and listen carefully to our customers.

We take all feedback into account as we develop the next iterations of our mobile offerings to ensure we have the best offering on the market. The rating on each version of the iPad app is higher than the former version demonstrating our commitment to continuous improvement. As we develop features to satisfy our customers’ needs, new feature needs arise. The requests that you are seeing in the reviews today are currently being evaluated for future development. We continuously strive to enhance our offerings to remain the top destination for accessing digital learning materials.

Has CourseSmart linked up with any medical schools to integrate technology and learning?

CourseSmart has partnered with hundreds of institutions to offer a comprehensive solution across a broad range of disciplines, and we have worked with several medical schools that now offer digital course materials specifically for their medical programs. As background, CourseSmart’s eTextbook platform can integrate with an institution’s learning management system, student information system or campus portal, enabling faculty and students to integrate their digital course materials directly into their workflow.

Where do you see the future of medical education?

Like the rest of the higher education industry, I believe many courses taught outside the lab or hospital will move online, offering flexibility to students. In addition, simulations and interactive learning will provide additional practical learning environments for students. Real time mobility of information will be a source for learning while in medical school with applications that will extend into future examination and operating rooms.

What does the future hold for CourseSmart?

We at CourseSmart will continue to innovate and provide a robust offering for the devices and platforms that are most in demand. The continued proliferation of Web-enabled mobile devices and campus WiFi will drive eTextbook and other digital materials growth. We will also see the growth of course materials with integrated assessment and automatic feedback for students (eResources) as they are utilized to improve learning outcomes.

Is there anything else you feel our readers should know about CourseSmart?

CourseSmart’s primary goal has always been to connect content providers with content users at the lowest cost possible in an effort to increase access to course materials and improve learning outcomes.

While eTextbook adoption is growing rapidly, many students still prefer print textbooks and this makes page fidelity crucial. CourseSmart enables all students, whether they are using a digital or print edition, to literally be on the same page. Further, CourseSmart’s eResources provide students with engaging experiences that result in higher learning outcomes. It’s not just about what’s “fun and interesting” in their eTextbooks but rather, what truly helps them to engage and ultimately, the comprehension of that learning experience.

Coursesmart Website

by: Alexander Chamessian, MS2

Recently, I had the pleasure of reviewing one of my favorite anatomy books on the Inkling app for iPad.

I was curious to see how the peculiarities of studying anatomy would pan out on Inkling. I’m now undertaking the same task on another popular e-reader app for iPad, Coursesmart.

The book I’ll be reviewing is my favorite neuronanatomy textbook, Neuroanatomy Through Clinical Cases by Hal Blumenfeld, 2nd ed (NTCC). The quality of this title is undisputed, so like my last review, I’m not going to focus on the content as much as the delivery.

With neuroanatomy, it’s all about the images. You need to visualize the parts of the brain and nervous system to truly understand what’s going on. One of the reasons NTCC is a favorite amongst medical students is because of its numerous excellent illustrations and figures.

Unfortunately, the Coursesmart platform does little to enhance those gems. There is no ability to open a figure within a new window and study it in isolation. This means that the figures are restricted to the size that they appear embedded within the text. Using the finger-pinch-zoom is not much recourse because this just causes the images to get granular.

Another feature that is lacking is the ability to turn off labels. Removing the labels and quizzing oneself is one of the most effective ways to study anatomy. There would be so much added value to the Coursesmart presentation of NTCC if I could have removed the labels, but sadly I could not.

Moreover, on the whole, the brilliance and quality of the figures was rather low. Both the text and the figures in Coursesmart are dull and on every page there is an annoying faded identifier barcode that can interfere with text and figures.

NTCC has a fantastic chapter on the Neurological Exam that is accompanied by a series of videos demonstrating the parts of the exam. Those videos are normally found on a free companion website. I was hoping that in the digital version of NTCC on Coursesmart, these videos would be integrated into the text such that a seamless and dynamic experience could be achieved.

However, that was not the case. In this omission, Coursesmart missed the opportunity to demonstrate the added power and value of digital textbooks.

Although it’s missing some important things I’ve come to expect from an e-textbook, Coursesmart does have some good features that make their offerings better than just reading a paper book. There is an annotation function that allows readers to take notes on each page. Navigation is intuitive with a collapsible page bar at the bottom of the page as well as a dropdown bar at the top. There is also a powerful search function and ‘jump to’ capability. Also, unlike Inkling, Coursesmart works on multiple devices, including my desktop computer, which is something I value since I have several devices on which I regularly work.

Price

• $47.95 for 540 days (rental)

Likes

• Large number of medical titles
• Can be viewed on multiple devices
• Offline and online reading
• Annotation and search functions

Dislikes

• Poor image and text quality
• Cannot ‘turn off’ labels on figures
• No jump links in the text to figures or other parts of the book
• No integrated media (videos) into the text
• Book is rented, not owned
• Not much different from reading a PDF

Conclusion

• Overall, I was not very impressed with my experience with NTCC on Coursesmart.  All told, reading NTCC on Coursesmart was comparable to reading a PDF, which isn’t to say the experience was bad, but it wasn’t great either. Coursesmart gets the job done. That much is sure. What was missing most for me was an appreciation for the individual quirks of this title. There was no effort to customize Coursesmart for NTCC, which is what I was hoping for.

• But truth be told, I could not get this title digitally on my iPad through any other means. And I couldn’t view it on so many devices either. And therein lies the best thing I can say about Coursesmart: it’s got a lot of titles, more than most any other digital reader. With future iterations, I hope Coursesmart makes an effort to adapt to the special needs of the textbooks it publishes and makes the experience as dynamic and social as Inkling is doing with its textbooks.

Coursesmart Neuroanatomy through Clinical Cases, Second Edition

Many university providers and educators around the world have embraced digital course materials in order to supplement existing course materials. Many now aim to go beyond merely distributing PDF notes or making lectures available online and use platforms like the iPad to teach medicine in new ways.

CourseSmart, a venture founded in 2007 and supported by many leading publishers, aims to provide eTextbooks and digital learning tools to students across America. CourseSmart is one of the largest provider of digital course materials and their catalog includes over 90% of the core textbooks in use today by North American Universities.

CourseSmart’s business model is based around providing easy, instant access to a vast range of texts. They have signed up an impressive number of publishers including Pearson, McGraw-Hill, Elsevier, John Wiley & Sons, Macmillan, Lippincott, Wilkins & Williams amongst many others. A quick search of their medical section revealed over 190 texts purely in the medicine category.

It is straightforward to search for and add a text to your ‘cart’ which subsequently becomes your ‘bookshelf’ once you have paid for your book. Interestingly, CourseSmart works on an annual rental basis so the user is essentially paying for one years worth of access to a specific title.

The additional eResources provide a variety of digital content and tools created for the end user and include:

• Links to other websites for content associated with a particular course
• Online quizzes or exercises
• Simulations and online videos

CourseSmart also partners with institutions to try and integrate their digital materials into the specific course, “thereby improving productivity and performance for students and instructors alike.” Students can access the eTextbooks via the web or on a range of mobile devices such as the iPad, iPhone and Android. The web reader boasts an impressive interface including the ability to annotate, highlight, search, copy, share and print.

The actual eTextbooks are high quality scans of the original books and easy to navigate. One aspect which is useful is the fact that CourseSmart eTextbooks maintain the valuable aspects of the print textbook including page numbers and page layout thus enabling students to quickly and easily switch between physical and electronic versions. Student are also likely to be pleased with the monetary savings available due to the fact that CourseSmart tests cost on average, 60% less than a printed textbook (source).

CourseSmart has certainly put their stamp on the particularly exciting development of online textbooks and resources. The wide range of medical textbooks available and ease of accessibility are sure to help ensure CourseSmart become a popular resource for both students and educators. CourseSmart enables instructors to be more productive and facilitates instant access to essential learning materials for students.

Stay tuned for a review of the CourseSmart system in action, an interview and a comparison between CourseSmart and their competitors.

Link: Coursemart

Inkling is in the process of trying to revolutionize modern medical education. In the first and second parts of our series, we examined some of the features that are helping drive the success of Inkling.

In the third part of our series on Inkling, the company developing a range of interactive textbooks for iPad, iMedicalApps brings you an exclusive interview with Matt MacInnis, Founder and CEO, where we explore the initial motivations for this idea and get the ultimate insider perspective on bringing mobile to medical training.

Please tell us a little bit about your background and the initial founding of Inkling

After growing up in Nova Scotia, Canada, I graduated from Harvard with a degree in Electrical and Computer Engineering. I spent about eight years at Apple working in product marketing, primarily in education. I was tapped a few times by execs to build new initiatives and teams from the ground up. After more than two years in Beijing building Apple’s first Asian education group, I returned to Cupertino to establish an international education market development group under the VP of Education. I had a great run at Apple, and I learned a ton before I left to start Inkling.

What is your vision for Inkling as a company?

We’re building the world’s most powerful digital publishing platform. We’re starting with iPad, the world’s most popular tablet device, and producing textbooks, the most difficult type of content you can tackle. And by starting there, we’re covering a huge spectrum of publishing challenges. As we broaden our library of learning content, we see ourselves as a household name among college students, as the preferred source of intelligent, dynamic and interactive smart books for learning. And that’s just where we’re starting.

What first inspired you to attempt redefine the standard textbook?

During my time at Apple, I sat in the back of hundreds of classrooms where we’d deployed shiny new laptops. But no matter how compelling the resources on the laptop, teachers would still ask students to open their textbooks. I always saw it as such a lost opportunity! We’d have spent all this time and energy getting technology into their hands, but the textbook would win out with the teacher. It broke my heart. After talking to a lot of teachers and colleagues, I realized that there was a huge opportunity to help people reimagine the textbook and learning content itself. So I left to start Inkling.

Could you give approximate download numbers for the Inkling iPad App?

We do not release specific information about downloads, but we can share that Inkling textbooks have been recommended or required by faculty at over 60 institutions in the US, and are used at hundreds of schools around the world.

Which medical schools are you partnered with and how are they implementing Inkling textbooks into their curriculum?

Inkling has been adopted by a broad range of medical schools around the country, with varying approaches to implementation. Some schools using Inkling actively include Cornell, Brown’s Alpert Medical School, UC Irvine, the University of Miami, and the University of Central Florida, among others.

Institutional adoption models vary by school. For instance, students at Brown paid for their own iPad and then purchased their own Inkling titles. UC Irvine and Cornell provided both the iPads and the Inkling titles to their students. Inkling works with publishers to provide institutional discounts to schools, and we’re happy to work at whatever level suits the needs of the program. No two schools are alike, and there are models from soft recommendations to requirements to outright school-wide licensing on behalf of the students.

To date, we’ve seen a remarkable uptake in the platform at these schools. We see how many students follow through on recommended purchases, and how much time they spend with their content, and it’s an impressive number. Over 80% of the users we surveyed earlier this year said that they felt Inkling helped them improve their grades, and over 80% have recommended Inkling to their friends. Those numbers are unheard of for digital textbook solutions, so we’re pretty darn happy.

by: Joshua James Harding BSc Hons (MS2)

Historically, anatomy has always been a cornerstone in medical education. Until recently, dissection and didactic lectures have predominated.

The publication of the General Medical Council’s guidelines for UK medical schools, set out in the document Tomorrow’s Doctor’s, recommends that undue emphasis on detail is not required and calls for a reduction in the burden of factual information in the medical curriculum.

Since then, many medical schools in the UK have changed their course structures and one noticeable change has been a decline in the use of cadaveric dissection. Whether this is due to legislation issues brought about with the introduction of the Human Tissue Act or by the shortage in donated cadavers, this trend certainly raises a number of important questions around how best to train the future physician.

Cadaveric dissection is widely valued by professional anatomists as the most suitable method to fulfill learning objectives when teaching anatomy, whether they are of a traditional or more modern viewpoint. The best method to teach anatomy continues to be widely discussed, but the importance and significance of cadaveric dissection remains overwhelmingly valuable.

Anatomy underpins all of clinical practice – physicians call on anatomical knowledge to perform examinations, formulate differential diagnoses, undertake investigations and communicate findings to patients and colleagues.

As Friedrich Tiedemann once said,

“Doctors without anatomy are like moles. They work in the dark and the work of their hands are mounds.”

In some reports, the knowledge base of junior physicians in applied clinical anatomy has been reported as being below what many would consider to be safe. This coupled with an increase in litigation claims due to “anatomical ignorance,” should raise concerns.

So how can we teach anatomy? There are a number of available modilities including dissection, prosection, computer-assisted learning, radiologic imaging, procedural/clincal anatomy, and didactic lectures. Most medical schools opt for a multi-modal approach to teaching anatomy, but many neglect the necessity of clinical anatomy.

Technology has advanced significantly and its impact in medicine and anatomy are widely known. Many consultant radiologists have been forced to relearn their anatomy, as more advanced tools that detect anatomy were simply was not viewable when they were trained.

I believe that advancement in technology has the potential to unite traditional and modern approaches to teaching and learning anatomy. We have seen a boom in anatomy learning tools in the last decade, ranging from tablet apps to online resources such as Anatomy.Tv from Primal. This growth is not expected to slow. So if dissection is in decline, despite the support of its use by both medical students and expert anatomists, what teaching modality will medical schools of the future be delivering?

Virtual autopsy, admittedly in its infancy, has the potential to modernize and unify anatomical teaching, as well as its other applications in forensics and pathology. By combining data sets from CT and MRI scans of the body, it is possible to produce a full volumetric description of a human body, not just a 3D model.

One such company, Norrköping Visualization Centre, in collaboration with the Center for Medical Image Science and Visualization (CMIV), have developed the Virtual Autopsy Table shown below.

As you can see, the technology is visually stunning and allows multiple users to interact collaboratively and simultaneously to gain a deeper understanding and insight into the anatomy of the human body. With this technology in medical schools, an expert anatomist would be able to teach small groups dissecting on the fly, using virtual blades to dissect the specimen and view them in different anatomical planes. This allows for rapid display of key anatomy that could only be replicated (poorly) by multiple prosections.

Manipulating these data sets in full high-def 3D would allow students to obtain a proper appreciation of the human body, the kind of apperciation that previously could only be gained through dissection but devoid of the associated problems that are responsible for a decline in use of dissection in the UK.

With further development and the increased use of tablets among medical students, this learning experience could then potentially be personalized, as university’s could make the software and learning resources available to their students to use in their own time.

In conclusion, virtual autopsies are at the cutting edge of medical research and education and I for one look forward to seeing this modality of teaching take off in the future.

3D4Medical.com has recently released a number of their celebrated NOVA series apps in the Mac App Store. This is the first time, though, that we have seen a major iOS medical app developer port a successful iOS app onto the Mac platform.

We have talked before about the issues facing the Mac App store and its implications on physicians  and it is exciting and interesting to see the use of this new platform by an established developer.

The content of the app is identical to the iPad version reviewed here and contains useful anatomical information such as origin, insertion, innervation etc. This app also contains the same interactive features such as 360 degree rotation, pins and layers and quiz functionality.

Interestingly, the developers note:

“It is a completely new app, every detail has been re-designed from the photo-realistic 3D model to the quick navigation”

There are obviously a number of implications for physicians, medical educators and students everywhere who now have an additional tool which they can use to help teach/learn anatomy.

The ability to use a larger screen will certainly help develop understanding which in turn will make anatomy more productive and enjoyable. It will be interesting to see how this app copes making the transition from a touch based input to a mouse input.

The apps now available are:

1. Muscle System Pro II
2. Brain Pro
3. Heart Pro
4. Skeletal System Pro

A promotional video can be seen below.

We will keep you abreast of further additions to the Mac App Store.

by: Alexander Chamessian, MS2

For students, so much of the iPad’s utility stems from the ability to read textbooks.

Realizing this, publishers have teamed up with app develops to find the best way to transform paper books into e-books for the iPad.  Arguably, the most promising and advanced app in the arena is Inkling.

You can read more about Inkling in prior features we have done on the company.

I was curious to see how a popular anatomy textbook – Essential Clinical Anatomy (ECA) – would perform as an Inkling e-book. As an anatomy textbook, I think ECA is one of the best, but that’s not what I’ll review below. Rather, I was more interested in how peculiarities of an anatomy book would be represented and enhanced by the Inkling form.

Anatomy is a highly visual field. The images are as important – if not even more so – than the text, so that is the first thing I focused my attention on. As with other Inkling books, all figures are embedded in crisp, clear text. Selecting the figure brings up an isolated view that magnifies the image and provides a caption. Using the pinch maneuver, the image can be expanded with almost no grainy pixels. I was quite impressed with the brilliance and overall quality of the figures.

In fact, I find the images much superior to those in the actual paper text version of ECA. But what I found most useful is the ability to replace the image labels with question marks through the ‘test yourself’ function. For anatomy studying, this feature is a god-send. Most students have to buy a separate flashcard set (often for a hefty sum) in order to get the labels off of images, but not so with Inkling. There is great value here then, because you’re effectively getting two products for the price of one.

One of the most popular components of ECA are the “Clinical Blue Boxes”, which relate anatomy to clinical problems and practice. In the Inkling version, Clinical Blue Boxes are set apart from the text in the same way figures are, so that one can focus on the Blue Box contents by itself. Moreover, there are embedded links to relevant text figures so that one can quickly pull up a needed figure without having to do much digging.

Easy navigation, in fact, characterizes the whole Inkling experience. Several times I wanted to jump to a specific anatomical structure. The robust and rapid search function enabled me to go directly to the content I was interested in. Similarly, the ample use of headers and sub-headers in the navigation panel made it easy to go to specific sections in the book.

My one quibble is that Inkling doesn’t enable one to quickly jump to a subsection within a larger chapter section. Rather, you are taken to the beginning of the chapter section and then must scroll through to the specific spot. It can sometimes be annoying.

Inkling offers some markup abilities that I found very useful. Selecting text gives the user the option to add a note, highlight, search, copy or define. All of these features are very handy. Bookmarking is also easy and functional.

One novel feature that I think has much promise is the public commenting/annotating capability. At any section throughout the book, one can post a public note that any other Inkling user can see. I really like the idea of being able to see what other people are thinking when reading the same info as me.

But as it stands, the public annotation function is not very useful because there just aren’t very many users or notes yet. As Inkling becomes more widely adopted, I think learning anatomy and many other subjects will be made more enjoyable and productive by this function.

Beyond the transformation of ECA into an Inkling book is some new content as well. Each chapter comes with high-yield quizzes that test one’s understanding of the anatomy information. The questions as well as the quiz interface, I thought, were very well done. There are also a number of case studies that accompany each chapter; these go more in depth and ask several probing questions related to each case. Overall, I thought the quizzes and case studies provided much added value.

Taken together, I think Essential Clinical Anatomy on Inkling is an incredible resource. The rich text and media, robust navigation and annotation capabilities, and the added content made my reading of ECA on Inkling even more enjoyable and beneficial than reading the paper text. I wish I had had this a year ago when I was learning anatomy.

Price:

• $64.99 ($9.99/chapter)

Likes:

• Rich text and images
• “Test yourself” feature that removes labels from images
• Robust navigation and annotation capabilities
• Public comments/annotation function
• Additional interactive quizzes and case studies
• Ability to buy single chapters rather than the whole book

Dislikes:

• Price. You get what you pay for with this app, but that doesn’t change the fact that $64.99 is still quite a bit of money to students on a budget.
• Public comment/annotation function is not useful at present time due to low number of uses
• Inability to navigate to specific subsections within book chapters

In the second part of our series on Inkling, the interactive textbook developer, iMedicalApps takes a closer look at some of the features that make Inkling unique.

The first part of our series focused on Inkling as a company with their aim to revolutionize learning by improving content delivery. By January 2012, they aim to offer over 30 interactive textbooks in a range of modalities for preclinical medical students. It is possible to broadly break down Inklings unique features into six major categories:

User Interface

The user interface of Inkling titles is highly refined, simple, easy to use and ensures that information can be found quickly. An interactive table of contents can be refined within each chapter to find the specific information quickly. Features that we expect from textbooks such as the use of bookmarks, notes and highlighting allow the user to annotate the textbook as they see fit. The use of hyperlinking between different sections mean that navigation throughout each textbook is simple and straightforward.

Price

Inkling allows students to purchase individual chapters within textbooks. This would obviously be impractical with physical textbooks but is relatively simple to achieve with a purely electronic distribution. This means that the average amount of money a student has to spend is less, unless they need the whole book in which case the price is still competitive compared to physical versions.
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Search Function

Any electronic textbook that wants to be taken seriously should have an effective search function. One of the many advantages of this is that it allows information to be rapidly found. The search function in Inkling is well implemented and particularly useful due to its ability to sort between the different media types available. Results can be ordered by Relevance, Content Order or Type.

Failing that, it is possible to search Wikipedia or Google from within the app using an in-app browser. This saves time switching between apps when looking for clarification on a particular term. The inbuilt notebook feature allows you to build up a complete set of notes based on the text within the textbook. These can be shared publicly or privately (more details below)
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Quiz Function

One of the first major successes Inkling had was integrating simple quiz functions into textbooks. This significantly improved the content delivery as it has been shown that repeat assessment is one of the best ways to learn information. Modalities such as Anatomy have been learned in a flashcard format long before the advent of the iPad and Inkling was one of the first to integrate this style of learning with a textbook. User scores can be tracked using the inbuilt scorecard while Inkling helpfully provide hints if you get a question wrong.
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Media Integration

The integration of media was again one of Inklings first major successes. Taking different forms of media such as audio, video and animations and combining them with detailed, well known textbooks has proved to be a great combination. Challenging concepts can be explained using videos narrated by experts. Interactive 3D models can be used to aid anatomical understanding. The quality of the images is high and standard touch gestures ensure that navigation is easy.
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Social Integration

The introduction of Inkling 2.0 in August this year brought about a new level of interaction. It is now possible to follow anyone using your book, see their notes and highlights in real time, create running discussions anywhere, and star the most helpful notes. If your course is supported by Inkling, then it is also possible to see the notes written by your professor (although I could not test this feature). I found the social feature difficult to use and integrate with my workflow due to the fact that I did not have an immediate social network of people using Inkling around me.

Personally, I would only want to see comments from trusted sources such as classmates or professors rather than connect to random people. However, there is no doubt that some students will find this new level of interaction a useful resource.

It is as if Inkling is creating a personal learning space focused around whichever textbook you happen to be using. This has the potential to be a very interesting feature if enough people use Inkling.
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The combination of all these features means electronic textbooks from Inkling barely resemble the actual texts they are based on. These features are all designed to facilitate and improve learning and, in my experience, are quite successful. In the next part of this series, we look at how Inkling is trying to integrate with a range of medical schools and how successful this has been. We will also take a look at what the future holds for Inkling and how this can be applicable to medical education. Stay tuned.

What are your thoughts on the interactive features offered by Inkling?

In a little seen nugget published in an article of the Chronicle, the Ivy League medical school, Warren Alpert Medical School of Brown University, will be requiring their incoming medical students to use the Inkling e-book app for key medical textbooks in their first year of medical school.

They will be requiring their incoming first year class to purchase iPads as well.

We have been the first to report how and why Inkling is a game changer in the arena of medical e-books when we reviewed Ganong’s Review of Medical Physiology:

Ganong’s Review of Medical Physiology for the iPad allows you to highlight, write notes, view innovative multimedia modules, and easily search for content — taking what you can do on a paper based textbook to a higher level — and taking e-learning to a completely different stratosphere.

The three key Inkling textbooks that will be required by Brown University’s medical school: Essential Clinical Anatomy, Grant’s Atlas of Anatomy, and Bates’ Guide to Physical Examination and History Taking.

The medical school’s director of preclinical curriculum, Luba Demenco, had the following thoughts to share with the Chronicle on the iPad implementation into the curriculum:

….she was on the fence about whether to require students to purchase Inkling versions until she read through them herself. The interactivity and portability sold her, and should be a great plus for students, she says. “Being able to have an educational tool made all the difference.”

The chapter option, she adds, was not an important part of her decision. Indeed, Brown students will still be expected to purchase entire texts and retain them as a reference. Dr. Dumenco does think the chapter option could be useful for students looking to brush up on concepts—cell biology, say—that they were expected to have learned before medical school.

The chapter version that Dr. Dumenco is referencing is the ability to buy single chapters, a feature we spoke highly of in our original review:

The ability to buy individual chapters for $1.99 cannot be overstated. One of the worst feelings as a medical student is when you purchase an expensive book at full price, only to find you used only one quarter of the chapters or fewer.

Schools that have largely PDF based curriculums, such as Stanford, have had an easier time transitioning medical content to the iPad. Schools that have implemented an iPad curriculum that requires referencing textbooks have expressed their frustration with textbook publishers to iMedicalApps.  They have found “textbook silos” — the inflexibility of e-book medical publishers to share content and add functionality to electronic medical books — to be a hindrance of implementing mobile curriculums.

Although Inkling’s model could be pegged as creating another textbook silo — at least it creates a value added by its interactive nature and innovative pricing scheme.

At the end of the day, we’re definitely excited to see how Inkling continues to morph, and still feel it’s a game changer for medical education.  We’re happy that we’re not the only ones in the medical ecosystem that feel the same way…

Source: The Chronicle

iTunes: Inkling iPad app

We’re giving out promo codes for a popular medical app in the comments section of this post

The medical textbook has long been a ripe target for digital enhancement. In the 1990s the paragon of digital publishing was the CD ROM. At that time, publishers produced premium versions of their leading texts which included a CD ROM with additional images, search capability and even videos.

As the internet became a viable distribution model, publishers moved the supplementary content to the web and started offering paid subscriptions. Of course, the internet also encourages free distribution, and thus arose comprehensive medical ad-supported websites aimed at consumers and physicians, e.g. WebMD and Medscape, respectively.

One national society, the American Academy of Orthopedic Surgeons, launched a large, curated site of surgical and non-surgical treatment techniques for its members (“orthopedic knowledge online”) which includes videos of surgical procedures and offers continuing medical education (CME) credits.

With the advent of powerful mobile devices, a new shift in electronic publishing is underway. These devices have the ability to easily display imbedded graphics and videos and maintain a full-time internet connection. Thus, there is now the opportunity for a complete re-imagining of the concept of a textbook. Some ideas were explored on this site in a post titled “Social Textbooks and the iPad – How the Medical Community Could Benefit from Dynamic E-books”.

Any good idea, of course, occurs simultaneously and in many forms. In fact, this year’s annual Consumer Electronics Show (CES) was apparently rife with multiple vendors’ versions of electronic book readers. For example, while the Amazon Kindle clearly has an early lead among e-book readers, new electronic ink technologies stand to rapidly overcome the Kindle’s two biggest failings – the inability to display color and the sluggish response of its display. Qualcomm (yes, the cell phone chip company) is bringing out a very interesting color e-reader based on a novel oil-based display technology that can go weeks without recharging, as seen in Alex Pham’s LA Times blog.

According to ZD Net, however, possibly the “most exciting announcement at CES” might be the Blio Reader. In contrast to the many devices demonstrated, Blio Reader is purely software. The site claims Blio will run on Windows, Mac, Linux, iPhone & Android, although it is not clear whether it will be native to Mac and Linux or simply run inside Microsoft SIlverlight (a Flash analog).

Blio reader accepts as input a PDF or ePub version of a text and allows the addition of interactive multi-media elements, including video, quizzes and live internet content. It adds an attractive simulation of a page being turned (reminiscent of the iPad iBook application) while allowing annotations and note taking. An interview with its creator and demonstration of the Blio reader is available at CNET.

That medical textbooks would benefit from additional interactive features was obviously anticipated by the developers of Blio Reader. This is evident on their home page where an anatomy text is prominently displayed. In a keynote presentation at CES that included Steve Ballmer, CEO of Microsoft, an automated anatomy quiz using Blio Reader was demonstrated to the CES audience.

The Blio Reader also has an interesting provenance, being developed by Ray Kurzweil, the famous technologist and futurist.  Kurzweil is a gifted inventor who has started multiple companies and whose contributions span optical character and speech recognition technologies. He has long had an interest in education as well as assistive technologies.

In fact  K-NFB, the company producing Blio, is a joint venture between Kurzweil Technologies and the National Federation of the Blind. Not surprisingly, the Blio Reader will have included a built in text-speech synthesizer to read books. It will also allow synchronization of a professionally recorded audiobook with the text, highlighting the word or phrase being spoken. This could  potentially be a great teaching tool for beginning readers.

Blio Reader software will be offered for free and was supposed to be available in early 2010, although it seems the date has slipped some. The company has partnered with Baker & Taylor, a large book distributor as well as several publishers and claims will launch with 1.2 million books in their e-bookstore, a number that exceeds any other electronic book store, with 1 million predicted to be free. Given the combination of widespread distribution, free content and software, we can imagine rapid adoption. If this is the case, a new era of medical textbooks may be around the corner.