After reviewing the less-than-impressive Pretest Psychiatry app, I decided to give the Pretest series another try.

I used the entire Pretest Medicine app while studying for my internal medicine rotation, and found it to be a helpful review for the exam.

This app, compatible with iPhone, iPod Touch, and iPad, costs $29.99 and is based on its corresponding text (which, incidentally, was written by physicians at my institution).

It is published by Modality Inc., the same publishers of the previously reviewed First Aid for the USMLE Step 1.

From the opening screen, users can create a new quiz, view saved quizzes, go to the question browser, or view their cumulative statistics. I enjoyed the question browser mode, a tutor-type, untimed mode where you can answer questions and read explanations with just a few taps of the screen. In this mode, users can view a list of all questions, filter questions by section, and review bookmarked questions.

Within the question browser, you may also select reference mode, which will automatically display correct answers. There are 15 different question sections, including:

• Infectious Disease
• Hospital-Based Medicine
• Rheumatology
• Pulmonary Disease
• Cardiology
• Endocrinology and Metabolic Disease
• Gastroenterology
• Nephrology
• Hematology and Oncology
• Neurology
• Dermatology
• General Medicine and Prevention
• Allergy and Immunology
• Geriatrics
• Women’s Health

As in the other Pretest apps, correct and incorrect answers are not saved in the question browser mode.

Creating a quiz allows you to track your performance. Quiz questions can be drawn from any section, and each quiz can contain up to 50 questions. Quizzes are timed at an average rate of one minute per question. You can review your cumulative statistics later from the app’s home screen.

Since the majority of people using this app are preparing for either their internal medicine shelf or USMLE Step 2 CK, an important question is: How do these questions compare to those on the board exam? I took the shelf exam recently, and found the questions on the app to be much shorter and overall less difficult than the actual exam questions.

That being said, the app does a good job of covering essential concepts tested on the NBME, and most of the answer explanations were adequate. They thoroughly explained the rationale for the correct answer, and in most cases, discussed the reasons that other answer choices were not appropriate. Reading them provided a useful review for me and helped to clarify high-yield information.

I do wish that the app contained more questions. Like most books and apps in the Pretest series, this app contains around 500 questions (496 to be exact, while the text version contains 500). However, since internal medicine is such a broad field, providing more questions would allow even more comprehensive coverage of material.

While I would not use Pretest Medicine as my only resource for exam preparation, it covers a vast amount of material and serves well to test understanding of concepts and augment your knowledge base.

Price:

• Currently $29.99

Likes:

• Good coverage of high-yield information
• Helpful and thorough answer explanations
• Interface is intuitive and identical to those of other Pretest apps
• Ability to track performance on questions
• Convenience of answering questions and reviewing explanations instantly

Dislikes:

• Questions not representative of the length or difficulty of those on the actual exam
• Could use more questions for even more extensive coverage of material
• Price—the text version can be found cheaper used or on online retailers such as Amazon.com

Overall:

• Though not recommended as a sole resource, Pretest Medicine is a valuable supplement to other materials for board preparation.

iTunes Link

by: Brittany Chan, MBA, MS3

The Pretest series has long been a popular resource for medical students, especially third-years studying for clerkship boards and the USMLE Step 2 CK.

Many of the Pretest books have now gone digital; I had the chance to review the Pretest Psychiatry app during my psychiatry clerkship.

The app costs $29.99 and is based on its corresponding text. It is published by Modality Inc., the same publishers of the previously reviewed First Aid for the USMLE Step 1 app. Thus, their interfaces are almost identical. The app is compatible with iPhone, iPod touch, and iPad.

From the opening screen, users can create a new quiz, view saved quizzes, go to the question browser, or view their cumulative stats.

In question browser mode, users can go to a list of all questions, view questions by section, view bookmarked questions, or select reference mode, which will automatically display correct answers.

There are 13 different question sections, including:

• Evaluation, Assessment, and Diagnosis
• Human Behavior: Theories of Personality and Development
• Human Behavior: Biologic and Related Sciences
• Disorders of Childhood and Adolescence
• Cognitive Disorders and Consultation-Liaison Psychiatry
• Schizophrenia and Other Psychotic Disorders
• Psychotherapies
• Mood Disorders
• Anxiety, Somatoform, and Dissociative Disorders
• Personality Disorders, Human Sexuality, and Miscellaneous Syndromes
• Substance-Related Disorders
• Psychopharmacology and Other Somatic Therapies
• Law and Ethics in Psychiatry

It is important to note that correct and incorrect answers are not saved in question browser mode.

To track your performance on questions, you will need to create a quiz. Quiz questions can be drawn from any or all of the 13 aforementioned question sections, and each quiz can contain up to 50 questions.

Quizzes are timed at a rate of an average of one minute per question. Cumulative statistics from completed quizzes can be accessed later from the app’s home screen.

Unfortunately, Pretest Psychiatry falls short of being a helpful resource for the National Board of Medical Examiners psychiatry shelf exam. From my experience with the shelf exam, the Pretest questions were too short and simple and did not accurately represent the difficulty of the actual test.

Also, the Pretest app has many questions more pertinent to a psychology grad student than a medical student, including questions about founders of theories and names of developmental stages. For instance, one set of six questions in the section titled, Human Behavior: Theories of Personality and Development, asks you to match a statement with its corresponding psychoanalyst.

Meanwhile, the NBME focuses more on diagnosis and management of disorders than psychological theory.

In my opinion, questions in this Pretest app were much simpler than those on the actual exam. Furthermore, I found a few instances of inaccurate or conflicting information in this app. For example, body dysmorphic disorder was described in one answer explanation to be more common in adolescent women, and in another explanation was said to occur most often between ages 20-40, with an equal distribution among men and women.

In addition, answer explanations were often inadequate and did not explain why each answer choice was right or wrong, even in some cases where more than one choice seemed plausible.

The Pretest Psychiatry app would not be my first choice to prepare for the NBME psychiatry shelf exam. Though I did learn some useful nuggets of information from it, and it helped to reinforce some of the concepts I already knew, in retrospect I found the psychological theory questions a huge waste of time and the questions overall unrepresentative of the type of questions on the actual NBME.

Price:

• $29.99

Likes:

• User-friendly, familiar interface
• Ability to track performance on questions
• Convenience of answering questions and reviewing explanations instantly
• Ability to bookmark questions that you wish to return to at a later time

Dislikes:

• Price—the text version can be found cheaper used or on online retailers such as Amazon.com
• Questions not representative of the difficulty of the actual exam
• Factual mistakes
• Incomplete/inadequate answer explanations

Overall:

• A decent resource to test general knowledge base
• Not recommended as a primary resource for preparation for the NBME Psychiatry shelf exam

iTunes: Psychiatry Pre-Test App

by: Brittany Chan, MBA, MS3

Mastering human anatomy is one of the most difficult challenges in medical school and throughout a physician’s career. From Modality Inc. comes the Thieme Atlas of Anatomy app to help medical students learn and physicians review human anatomy.

This app is based on the paperback atlas of the same name. It is not a standalone app; it must be purchased within the ModalityBODY app for $74.99.

The ModalityBODY app is a free app that contains other anatomy and imaging apps available for purchase, compatible with iPad only.

Upon entering the app, the user is greeted by a menu of different anatomical areas to explore, including back, thorax, abdomen and pelvis, upper limb, lower limb, head and neck, and neuroanatomy. From there, the user can select either Images or Pages in the upper right hand corner. Selecting Pages will allow you to peruse the app as if you were reading the book, while Images allow you to study one image at a time and test your knowledge.

For the purposes of this app review, I will focus on the abdomen and pelvis section. I studied this area first in Page mode. After selecting Abdomen & Pelvis from the welcome screen, you will see several thumbnails of pages you may choose from. You may scroll through the pages to jump to a specific structure. The table of contents also lists all of your options.

The pages are typical of any anatomy atlas, including labeled structures, tables, and information about clinical correlations. Occasional radiographs are also shown.

From the bottom of any page, you may scroll to the next or previous page using the arrow buttons, or jump to another page using the thumbnails. The thumbnail images are difficult to see; they will enlarge when you tap and hold them, but I found it difficult and often frustrating to select exactly the page I wanted. You may also select the index to search for a particular structure.

After studying the Pages, you may quiz yourself over each image in Image mode. By default, structures are tagged with pins. Tapping a pin tells you the name of the structure. You may also pin and label your own structures, or view the image without pins. One extremely neat feature is the ability to acquire more information about a structure via Google, Wikipedia, or PubMed right within the app. However, I found this mode to be slightly buggy; parts of other random images would show up behind the image I was trying to view (as seen in the screenshots). This was slightly distracting and annoying, though fairly easy to ignore. Perhaps Modality will fix this with a future update.

While studying an image, you can easily refer to its corresponding page in the atlas by tapping “Page” in the upper right hand corner. Also in the corner is a gold button labeled “Practice,” which will prompt you to find structures on that image at random. Tapping the pins will then give you feedback on whether you selected the correct or incorrect structure.

Though not perfect, this app is a fun and interactive way to learn and review human anatomy.

Likes:

• Decent images
• Interactive
• Ability to study the book pages of the atlas, then quiz yourself with images only
• Features Google, Wikipedia, and PubMed searches within the app

Dislikes:

• Very expensive, especially for a medical student
• A few bugs in Image mode with overlapping images
• User interface needs some improvement
• Not compatible with iPhone and iPod touch
• Must be purchased within the ModalityBODY app

Conclusion:

• The Thieme Atlas of Anatomy app makes good use of the iPad’s large screen size and rich color imaging.
• The app is fun and fairly user friendly, though parts of the user interface could use improvement (such as the thumbnails at the bottom of each page).
• I especially liked the ability to quiz myself using the pins in Image mode and using the Practice mode to quiz myself at random.
• This app is useful for medical students and physicians alike, though I imagine its main appeal would be to medical students.
• However, at the steep price of $74.99, many people, especially students, would likely hesitate to purchase it, particularly with the paperback version available for $54 on Amazon

iTunes Link

by: Brittany Chan, MS3

Medical training is dotted with a series of milestones that we dread until the moment they arrive and look back on with some degree of bittersweet nostalgia. I am now happily in my third year of medical school and done with the dreaded USMLE Step 1. One of the apps that helped me get here was First Aid Q&A for the USMLE Step 1, by Modality, Inc.

The First Aid series is one of the most trusted resources among medical students. Published by McGraw-Hill and written/edited by a group of physicians and medical students, it is a great resource. As an app, it costs $44.99, almost exactly the same price as the book of the same name. Here, we look to see if it is just as valuable.

This app features almost 1,000 practice questions to help students ace Step 1. Seventeen subject areas are covered, including:

• Behavioral Science
• Biochemistry
• Embryology
• Microbiology
• Immunology
• Pathology
• Pharmacology
• Cardiovascular
• Endocrine
• Gastrointestinal
• Hematology-Oncology
• Musculoskeletal and Connective Tissue
• Neurology
• Psychiatry
• Renal
• Reproductive
• Respiratory

Upon entering the app, users are greeted with the welcome screen (above). From here, you can create a new quiz, view saved quizzes, use the question browser, or view your cumulative stats.

My favorite feature was the question browser. Here you can answer questions by topic and receive feedback and explanations immediately. Answering questions is easy and simple – select your answer choice with one tap, then tap “Check Answer.” The app will instantaneously inform you if your answer is correct or incorrect. From there, you can view the rationale for the correct answer. Unfortunately, your answers are not saved in question browser mode, so the questions you do here are not recorded in your stats. The question browser also has an option for “reference mode,” in which correct answers are automatically displayed.

In quiz mode, you can create a custom timed quiz for yourself. This mode allows you to select topics you wish to be included in your quiz and set the number of questions in the quiz as well (up to 50 at a time). The timer, visible in the upper right-hand corner, gives you one minute per question, which is slightly less time than you will receive on the actual Step 1 exam. Your scores from these quizzes will be recorded in your cumulative stats.

You may also take one of seven pre-set timed quizzes in quiz mode. Each quiz contains 48 questions different from the ones available by topic, providing you with an additional 336 practice questions.

Finally, you can easily monitor your performance right within the app. Performance statistics can be viewed by subject section, completed quizzes, or all questions answered, allowing you to assess your strengths and weaknesses with just a few taps.

Overall, this app makes USMLE Step 1 preparation faster and easier for busy students.

Pricing:

• $44.99

Likes:

• No need to carry around another book!
• Friendly user interface and easy navigation within the app.
• Instant feedback and explanations –no need to keep flipping to the back of a book or calculating your own percentages.
• Ability to bookmark questions that you wish to return to at a later time.
• Automatically records your performance statistics.

Dislikes:

• Recent update requires an Epocrates login to use the app.
• Impossible to annotate questions, explanations, or cross out answer choices.
• Though the price of the app is approximately the same as the list price of the book, the text may be purchased at a significantly lower price online.

Conclusion:

• This app allows students to answer questions and receive feedback quickly, without the inconvenience of having to flip back and forth in a book.
• It is also a great choice for students on the go, who can answer questions on their iPhones whenever they have a few spare minutes.
• If you’re a student that needs to highlight, underline, and mark out answer choices while answering questions, this may not be ideal for you, as annotations are not currently possible.
• However, its ease of use made it one of my favorite study tools, and I found it highly useful.

Many of the best selling medical applications in the App Store are well known textbooks or reference guides which have been ported to the iOS system. These books are often interactive, searchable and generally easier to transport around than a thick pocket book in a white coat. However, as we’ve seen many times before, the jump to mobile has not been easy for some publishers.

The PreTest series is the latest to get the iOS treatment with a number of books in the series released by Modality over the past few months. The most recent, PreTest Pharmacology is designed for students preparing for the USMLE Step 1 and general pharmacology exams. It contains over 500 questions covering twelve essential content areas. And while this mobile incarnation is one that could be even better than the print version, it faces the same pitfall as many of its peers.

Upon launching this application, users are presented with four options: New Quiz, Saved Quizzes, Question Browser, and Cumulative Stats. Selecting a new quiz allows users to create a quiz testing specific content areas; alternatively, it allows users to create a quiz based on their bookmarks. This is particularly helpful as it allows user to test themselves on questions they may find challenging. Other user-defined options include setting a question timer, adjusting the number of questions and selecting whether or not to include previously answered questions.

The content in each question is based on the book and there are a number of multiple choice options. Each question has an option to be saved as a bookmark for review in the future. Once a quiz has been submitted, the correct answers are highlighted for each question and the rationale behind each answer is displayed.

The content and detail of the rationale is ideal for improving understanding and it is set at a level appropriate for users. There are also references to pharmacology texts for those looking for further information; it should be noted that the level of detail in the application is fine for all but the most challenging of questions. It is also possible to view statistics for each particular question in addition to statistics for the quiz overall.

The question browser mode allows users to browse through questions in either sections or bookmarks. Helpfully, the application displays your statistics for answering questions allowing you to identify areas and questions which may be the user’s weakness. It is possible to check your answer for each question immediately and the rationale is easily accessible. The abundant use of statistics throughout the application is a very useful feature and one which helps separate PreTest Pharmacology from other multiple choice applications.

The only question mark lies over its price. A cursory glance at Amazon shows that it is possible to buy the book (which contains the same content) for $17.28 which is cheaper than the $29.99 for the application. This is a common issue amongst textbook applications which have been transferred into the App Store and it remains to be seen whether the availability of the content elsewhere will dent sales.

Price

• $29.99

Likes

• Well written content pitched at an ideal level for target audience
• Statistics everywhere helps identify weaknesses early

Dislikes

• Question marks over price

Overall Rating

• Overall, this application has made a very successful transition to the iPhone interface.
• It carries out its function in a highly effective manner and is a sound purchase for anyone looking for a solid in-depth self-test resource.

iTunes link

Epocrates, the venerable medical reference company, has bought Modality – a prolific iOS app making company.  With the launch of the App Store by Apple, Modality bet big early by focusing on apps and were the first large company in the medical educational app space – boasting titles such as Netters and Procedures Consult and bringing them to life in a mobile and aesthetically pleasing form.  We have reviewed quite a few of their apps and more often than not come away impressed [click on links for full reviews by iMedicalApps].

Although Modality does boast a wide variety of medical apps, they have worked on non-medical apps as well.  It will be interesting to see if this partnership will cause Modality to focus more on the medical and health care aspect of app making or if they will maintain their non-medical educational component.

This is clearly a move that makes sense for Epocrates. From the press release, it appears they are eager to use Modality’s mobile app development expertise for medical app making – possibly for an iPad customized Epocrates app?  Remember, Epocrates still does not have an iPad customized app. To those who might be unaware, Skyscape came out an iPad customized version of their medical reference app many months ago – currently I defer to Skyscape instead of Epocrates when using my iPad to look up medical reference information.

From an educational component, this deal has huge ramifications for Epocrates.  If you look at the extremely popular MedScape app – it has a large educational component that has helped make it number one in our top 10 free medical apps list.  Modality knows how to develop great educational modules, and Epocrates would be shortsighted not to add educational functionality to it’s app in the future.

Android and other non-iOS smart phone users could be left out

One area of concern for Android and other non-iOS users – Modality is currently focused on making apps in the App Store – not Android. They have apps for the iPhone, iPod Touch, and the iPad, but have not ported these applications over to the Android platform.  Of note, Modality works with medical publishers to bring their content to a mobile platform – they do not create original medical content.

This might be why the apps they have made have not been ported over to the Android platform, but it’s also cause for concern to non-Apple device holders.  This is highlighted even more when you see that Epocrates still does not have a premium version of their popular medical reference app for the Android.

Hopefully this partnership will instead allow Epocrates to focus on the medical content, while Modality can focus on bringing the content to mobile form, not only for Apple devices, but other mobile devices as well.

-Prior Epocrates app review by iMedicalApps

Source: Press Release

Apple has made it clear that current iPhone apps will run on the iPad.  For many of the medical apps we’ve reviewed, its welcome news, but it won’t make the user experience of these apps any different.  However, there are a few medical apps currently on the iPhone whose user experience should be greatly enhanced by the iPad’s 9.7 inch 1024 x 768 pixel display.

The following are the top 5 medical apps we’re excited to see in action on the iPad.  This list is focused for health care professionals, and stay tuned for another list for medical students. Of note: These apps will only be great on the iPad if the developers port them over – basically, if the developers make a custom version of the app for the iPad.

(1) Blausen Human Atlas – When I think of the iPad in medicine, this app embodies one area in which the iPad could shine.  The Blausen Human Atlas includes 3D figures of human anatomy, an expansive medical glossary, over 1,000 still images, and a library of videos explaining common medical conditions like GERD and osteoarthritis.

Basically, everything in this app is designed with the goal of improving patient-physician communication. A provider who is trying to explain cholecystitis to a patient could access videos that explain the disease, still images to clarify any confusing points, and even 3D figures of GI anatomy to explain the corrective surgery.  The app performs admirably on the iPhone’s 3.5 inch display, but on a display more than twice this size – the iPad’s – it should shine.

Links: Blausen Human Atlas App Review
[iTunes Link]

By Dr. Jessica Otte

In early January, Elsevier and Modality released a new addition to their suite of popular iPhone medical apps. It is a true multimedia offering, combining text and video to explain the pre-procedure considerations, the technique and positioning to perform the procedure, and the complications and other advertisements for follow-up care. Overall, 27 different procedures are covered; these range from the basic (catheterization and wart treatment) to the more involved (lumbar puncture).

Being a resident physician, I am competent with some of these techniques to the extent that I can perform them by feel. Some, like circumcision, I’ve never seen, let alone performed. Fortunately, Procedures Consult provides a foundation for each. As I’ve mentioned in other reviews of procedure-teaching apps, there is no substitute for hands on experience under the guidance of an expert. However, applications like these may allow you to skip the ‘see one’ stage of the common ‘see one,’ ‘do one,’ ‘teach one’ approach to developing a skill.

Navigation is simple. A main menu allows you to view a list of all procedures or procedures by type. You can also search or use bookmarks for quicker access.

Once looking at a procedure’s entry, the pre-procdure text will walk you through indications, contraindications, equipment, and anatomy. Though some sections are written very thoroughly, the weakest consistently is the anatomy. Photos or graphics would really enhance a user’s understanding. For example, in female catheterization, it is not uncommon that a person new to the procedure will catheterize the vagina instead of the urethra; a simple illustration of the anatomy is a critical component to correctly performing this skill, and it is not clearly illustrated in the video.

The procedure section contains step-by-step instructions and each procedure may have numerous videos attached to it, which illustrate the steps. The videos are clear, well-paced, and generously narrated. However, the experience of watching them can be somewhat fragmented; the videos require you to rotate your phone to the horizontal and each section of the procedure is a separate video, which results in a 5 second pause. You can skip the pause by okay-ing a pop up. On the other hand, separation of the videos is a handy feature when only a certain section needs to be reviewed.

The inclusion of so many videos does take up quite a hefty amount of space on your iPhone, and in a magical world, a user would be able to select which procedures need to be on their phone. For me, some procedures – like catheterization – are so basic that I would never feel the need to refer to this software, while others are more difficult to the point of having separate software dedicated to their explanation.

Conclusion:

Overall, the application provides a fairly comprehensive list of procedures that might be undertaken in a GP’s office. I really liked that a variety of treatment options were presented for a few conditions, such as warts. Cryotherapy or cautery/curettage videos demonstrate technique while less invasive solutions are offered for patients who may not be amenable to the procedural approach. Despite a good general catalogue, a few things are missing; Inserting an IUD, dis-impacting cerumen, and performing a pap test are more likely in the Canadian GP’s realm than would be a shoulder reduction, however these more common procedures are not part of the software.

Taking a step back, this technology is quite exciting. It would have been beyond any one’s dreams 10 years ago, but these days, few young and technophillic doctors can live without this kind of resource in the palm of their hand. While useful and well-organized, there is still room for improvement with Procedures Consult: Family Medicine – General. As is though, this should find its way into the toolbox of brand new medical students and GPs who are a rusty on a few of the finer points of procedural skills.

Basic Connectivity:

No subscription or Internet required

Best for:

Family practice residents who missed learning a few basic techniques, rural GPs who do ‘the occasional’ of anything, and medical students who’ve never done a procedure before.

[itunes]

[website]

Dr. Otte is a Family Practice Resident on Vancouver Island. She completed her M.D. in 2009 at the University of British Columbia in Vancouver, Canada. She authors a popular blog – Dr. Ottermatic – which can be found at http://drottematic.wordpress.com/. Dr. Otte is also the newest guest contributor to iMedicalApps and we are thrilled to have her aboard!

Learning a new skill can be an intimidating task for budding health care professionals – especially when it comes to learning medical procedures.  There is a difference, any doctor will tell you, between reading about a procedure and actually doing it.  Educators are beginning to take full advantage of new technology – like the iPhone/iPod – to help bridge the gap between comprehending and performing medical procedures.

Procedures – Hospital Collection is a new app that uses bulleted text, clinical images, and audio/video instruction to familiarize the learner with the preparation, relevant anatomy, and individual steps of common procedures in the hospital setting.

This app is not the first we have reviewed that offers instruction on performing routine hospital-based procedures. In many ways, Procedures – Hospital Collection is like the more expensive Procedures Consult – Internal Medicine App in its content.

So… how does it stack up to Procedures consult?  In this post we’ll do a full review of Procedures – Hospital collection, and use the Procedure Consult series as comparison

For $19.99 MeisterMed’s Procedures: Hospital Collection uses hi-resolution video clips that look in many ways like the Procedures Consult family of apps or the New England Journal of Medicine Clinical Medicine videos that may be familiar to many medical students, residents and physicians.

As the name implies, the content is most applicable to those users in the inpatient hospital setting.  Modules included are:

1. Arterial Line Placement
2. BiPap & CPAP*
3. Bone Marrow Aspiration and Biopsy*
4. Femoral Line Placement
5. Glidescope Intubation*
6. Internal Jugular Line Placement
7. Internal Jugular Line Placement with Ultrasound Guidance*
8. Laryngeal Mask Airway*
9. Lumbar Puncture
10. Orotracheal Intubation*
11. Paracentesis
12. Pulmonary Artery Catheter Placement
13. Subclavian Line Placement
14. Thoracentesis
15. Tube Thoracostomy (Chest Tube) – (Procedures Consult has Needle Thoracostomy)

* Not one of the 30 procedures included in Procedures Consult – Internal Medicine

Navigating the App

The user can search, return to previously bookmarked pages, or simply browse one procedure at a time.  Each procedure page has three menu items: Procedure Details, Images, and Watch the Video.

Procedure Details:

Under the Procedure Details menu, the user will find indications, contraindications, complications, equipment, step-by-step instructions, lab analysis (if applicable), frequently asked questions, coding, and references.  This format differs from the “Pre-procedure, Procedure, Post-procedure” layout of Procedure Consult.  Navigation through the menus is not as fluid or intuitive as we would have hoped – transitions between pages have a lag of a second or two, and it is often difficult to distinguish linked-text from plain text – but the depth and quality of information in the Procedures Details menu is definitely on-par with competing apps.

Images:

Hi-res clinical images and corresponding captions are found under the Images menu.  Clinical images from the bedside are very large, generally high in quality, multi-touch capable, and convey the key steps of the procedure.

Important anatomy concepts are shown in figures (e.g. Mallampati Classification, landmarks for LP), but are lower in quality and fewer in number than similar figures in competing apps.  We would have liked to see more high-quality anatomy figures in color.

The Images menu lacks integration with corresponding items in the Procedure Details menu, and is clunky to use.  The user cannot view the image and its caption at the same time, which makes for the tedious process of opening the image, returning to the Image menu, opening the caption, returning to the Image menu, then moving on to the next image.

If we were designing this app, we would prefer to see the Images menu scrapped, or at least better integrated into the Procedures Details menu.

Video:

Ok, here’s the bread and butter of any procedures app or online teaching tool – the video.

Most videos are 3 to 5 minutes long, from preparation stage to completion.  Video footage for each of the procedures is generally well done.  Some procedures are staged in lighting that is less than ideal, but in general the video is clear and effective in showing key steps of the procedure, with “down-time” edited out.  Close-ups of appropriate steps are included.  The narrator guides the user through each step, sprinkling in the tips and tricks of an experienced clinician. Audio clarity is good.

Users may find the narrator’s unscripted approach distracting.  We did.  A well written script for each video — and some editing-out of messy sentences — would have undoubtedly cut down on “um, ah um” and probably ensured that more relevant narrative points be included.

Key point: a major strength of procedural videos is missing from this app. Videos on this app lack intentional pauses to emphasize the clinical pearls, anatomical relationships, safety reminders, and key techniques that are most important for the learner to remember.  Other effective procedure video apps and online videos use on-screen text or overlaid anatomical figures to make key teaching points. To maximize the learning experience to the user, we would have liked to see this integration of text-based key learning points within the video.

Likes:

• All the information is there… you just need to know how to get it.
• References included, and generally up-to-date.
• CPT Coding information included (missing from Procedures Consult)
• Entire content downloaded to the device (no Internet connection needed)
• Fully searchable and bookmarkable.
• HUGE clinical images with multi-touch zoom.

Dislikes:

• Key information in the text is not highlighted (bolded or different color)
• Text size not adjustable
• Clunky process of clicking back-and-forth between images and captions
• Narrator “ums,” run-on sentences, and abrupt stops.
• Navigation of the user interface is slowed
• Lacks integration of video, images, text, and audio into one coherent learning experience
• Only 15 procedures (compared to 25 on Procedures Consult – Internal Medicine)

Notably missing Procedures:

• Incision and Drainage of Cutaneous Abscess
• Pelvic Exam/Pap Smear
• Phlebotomy

Conclusion:

At $19.99 Procedures – Hospital Collection is a good buy for residents and students who are somewhat familiar with each of the procedures, but who need a quick brush-up on the needed equipment or step-by-step process just before seeing a patient.

In comparison to the Procedure Consults – Internal Medicine app, users with no procedural experience – like many medical students – may miss out on many helpful “clinical pearls” and find the in-video learning experience to be lacking with Procedures – Hospital Collection.

But for half the price, this app provides more than sufficient information to learn the techniques and concepts behind the 15 included procedures, if only the user is willing to put up with a few more menu-clicks and less stream-lined audio and video quality.

This app succeeds in providing a comprehensive procedure learning tool, but fails to match the intuitive layout and high quality text-audio-video experience of the higher priced Procedure Consult App Series. And although Procedures Consult – Internal Medicine is twice the price, it also has almost twice the number of procedures.

Editor’s Addendum and comments

Our apologies, we needed to do a better job of distinguishing the procedures available in Procedures Consult – Internal medicine, and those in Procedures – Hospital Collection. We have updated the 15 modules we first listed for Procedures – Hospital Collection, labeling the procedures not included in Procedures Consult – Internal Medicine.

Also, the following procedures are available in Procedures Consult – Internal medicine, and are not available in Procedures – Hospital Collection: Atrial Blood Gas Sampling (In addition to Radial, Brachial and Femoral Approach included), Basic Airway Management, Cardioversion, Central Venous Catheterization: Femoral Approach, Cerumen Removal, Defibrillation, Epistaxis Management, I&D of Cutaneous Abscesses, Intravenous Cannulation, Local Anesthesia, Nasogastric Intubation, Pap Testing, Phlebotomy, Stapling Devices, Tick Removal, Transcutaneous Pacing, Transvenous Pacing.

I’d like to further stress the depth of the Procedures Consult – Internal Medicine app’s videos, text, and pictures. Although Procedures – Hospital Collection does show how to put in an a-line, Procedures Consult shows alternative approaches, with alternative in depth videos as well. The depth and breath of the video, text, and pictures in Procedures Consult – Internal Medicine are better than the Procedures – Hospital Collection app, as is the navigation and overall user interface.

But when making a decision on which app to purchase, look at the procedures offered by Procedures – Hospital edition that are not offered by Procedures Consult – Internal Medicine. If those extra procedures are key for you, and the extra procedures offered by the Procedures Consult app are not, than Procedures – Hospital edition would be a very good choice.

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Brett Einerson is one of our newest guest writers.  He is a fourth year MD/MPH student at Wake Forest University School of Medicine and the University of North Carolina Gillings School of Global Public Health.  He is a native of Minnesota and a graduate of Bethel University in St. Paul.

In the future he will be entering residency in Obstetrics and Gynecology. He is interested in evidence-based practice, comparative effectiveness research, physician decision-support systems, and practice guideline development.

The iPad has created a great deal of buzz in the tech community. The medical and healthcare community at large are set to benefit from some of its key features, mentioned in our prior posting.  One of these key features, the beautiful 1024 by 768 pixel, 9.7 inch screen, is set to change the overall user experience for medical apps that have a focus on imaging, such as anatomy applications.  Although this medical app review was done using an iPod Touch, we can only imagine how much more aesthetically pleasing the iPad’s experience will be. As will be discussed later in the post, these applications are a perfect example of how the upcoming iPad could be used in the clinic setting to improve patient education.

A key thing to remember is your iPhone medical apps will run just fine on the iPad.  This post will review a trio of Modality’s latest anatomy flash card apps and provide extensive pictures of the following: Clemente’s Anatomy, Rohen’s Photographic Anatomy, and Moore’s Clinical Anatomy.

Modality now has a variety of Anatomy Flashcard apps to choose from, depending on your preference. In addition to Netter’s Anatomy, an app we reviewed awhile back, Modality’s newest editions are Clemente’s, Moore’s and Rohen’s anatomy.  They are all priced at $24.99 (except for Netter’s, which is still $39.99).

Due to the similarities of these applications they will be reviewed in one post.  I’ve been using Modality’s Netter’s Anatomy Flashcards app for almost a year now and have a good reference to compare these new apps to.

Ultimately, your choice of anatomy app will come down to the anatomy book you like or the anatomy book your school uses.  I originally chose the Netter’s app for this reason.  These apps have generally the same user interface, and mainly differ on the type of anatomy images they provide.  However, individually, they each have some strengths and weaknesses.

Clemente’s

• Strengths: Great for the lymphatic system and also for schematics to simplify diagrams (e.g. brachial plexus, spinal nerve roots, dermatomes, etc.); Some X-ray images included; Excellent for bones and muscles.



• Weaknesses: Lacks “back of card” information that explains the anatomy in the illustration.

More Clemente’s Sample Pictures:

The momentum and enthusiasm in the mobile technology world is, these days, clearly with Google.  The question for many people is whether to go with the reigning champion of the mobile device world(arguably Apple) or to take a chance on the challenger. The Nexus One, the flagship of the Android family of mobile devices, was unveiled to much fanfare in advance of the Consumer Electronics Show (CES) in Las Vegas. The veritable King Midas of the online world had finally decided to take on its equally successful counterpart in the consumer electronics world. In the middle of this battle of the corporate titans, what’s the medical professional to do?

Previous commentary has often focused on the first few Android-based phones in comparison to the iPhone, such as our previous post addressing Verizon’s Droid vs. iPhone. But the choice is much broader – as integration of local and web-based resources improves, you’re really making a choice between a parallel suite of services. As Nick Bilton of the New York Times points out, the Nexus One is highly integrated with Google’s suite of online tools. So if you use Google Reader to keep up with the New England Journal, have your institutional emails centralized in your Gmail account, or otherwise live in the “Google world” then the Nexus One and Android-family of phones may have some clear functionality advantages.

Another advantage that Google brings is an army of software and hardware developers via the Open Handset Alliance who support the Android operating system, which is a Linux-based open source system. As such, Google does not charge mobile device manufacturers for Android, which Saul Hansell of the New York Times suggests may be because Google’s real ambition here is to prevent anyone, whether Apple or Microsoft, from controlling the mobile OS market. Some forecasts are suggesting that Android will control a larger percentage of the market than Apple by as early as 2012, with a forecast by Gartner Inc. estimating a 14.5% to 13.7% advantage. The plus here for medical professionals could be an operating system that evolves more rapidly and stimulates a even richer suite of applications produced by third party developers. We’ve already looked at some of these possible medical apps, such as dictation services for the Nexus One.

However, this same potential strength also exposes a potential weakness, namely fragmentation of the Android market leading to incompatibility across different handsets running the “same” Android operating system. Differences in phone features, screen sizes, and other characteristics could create some pains for developers, especially as new players like Lenovo and Dell join the traditional handset manufactures and create even more diversity in the Android market. In our commentary on whether the Droid will motivate developers, one developer commented that there is a substantial opportunity cost involved with learning a new platform. While a large Android community may raise the incentive to enter this market, fragmentation would essentially mean that developers will be weighing many small markets against the large cost of learning the relevant platforms.

Another recently exposed weakness is customer support. Google has traditionally relied on online forums, FAQ sites, and other similarly low-cost support mechanisms for its online suite of applications. With the release of the Nexus One, Google has started to learn a hard lesson that Apple has done pretty well with – keeping customers happy when things go wrong. Right now, early-adopters of the Nexus One have to call Google for software problems, HTC for hardware problems, and T-Mobile for service problems. As you can imagine, there are a fair number of people who are pretty unhappy with this. And if mobile technology is going to continue to expand among medical professionals, then reliability and robust support are a must.

All in all, the Nexus One and the Android family are well positioned and widely predicted to become a big time player in the mobile market. The iPhone has clearly transformed the mobile technology market and developers like Modality have used this platform to develop innovative and valuable tools for medical professionals. But many of the advantages the iPhone boasted when it first appeared, especially the rich developer community, are now being replicated and expanded upon by the Android family. And if Google is really not looking to turn the Android Operating System into a major revenue source, then it could be an even more dangerous challenger for the iPhone.

Originally Posted on MedPage Today ; Iltifat Husain contributed to this post.

Campbell’s Operative Orthopedics is a cornerstone of any orthopedic surgeon’s library. It’s one of the few volumes that every resident knows he or she will have to own – no point complaining about the price. If a junior resident shows up to do a case and has not at least read the requisite chapter in Campbell’s, then they should be prepared to go no further than a few hours of holding retractors for the attending and making idle chit-chat.

So, the arrival of an iPhone version of this four volume tome is certainly an important milestone. How did they do? This full review will explain.

This iPhone / iPod Touch medical application is another collaboration between the book’s publisher Elsevier and the mobile medical software publisher Modality.  As with other Modality titles, the user interface is clean and easy to navigate. The transition between text and images is easy to understand and the wealth of videos will please almost any user. A total of 242 techniques and nearly 25 videos have been ported to the mobile application.  Of course, the videos come with a storage price of  874 Mb on your iPhone or iPod Touch. While this will almost certainly be the largest app on your iPhone, a few minutes of use will have you wondering how you got by without it.

What I liked:

• gives you the opportunity to think about upcoming surgeries while on the go
• uncluttered and straightforward user interface
• text reduced to mobile screen-ready bullet points
• numerous embedded videos
• 1/4th the price of the printed version with DVD (currently more than $400 on Amazon.com)

What I didn’t like so much, and what could be improved upon:

• a “home” button to navigate to the root menu would be handy as it sometimes takes 3-4 steps to return
• the chapter authors are not always identified, important to know since surgical techniques are as much surgeon preference as science
• displaying the appropriate bullet point from the text beneath the operative drawings would make them even more valuable
• would like to have references from the text for additional reading (as an example, see the previously reviewed Clinical Orthopaedic Exam App)
• an option to enter your own notes for procedures would be a nice addition

Conclusion:

Disseminating text and visual information on surgical techniques would seem an obvious fit for technology and there are several very good resources already.The American Academy of Orthopedic Surgeons has “Orthopedic Knowledge Online”, a members-only website with surgical techniques and videos.  Other sources are the subscription-based Video Journal of Orthopedics, that is aligned with the important Journal of Bone and Joint Surgery and VuMedi is a commercial site with a wealth of videos and good social networking features. The missing link seems to be a mobile interface, so that the information is made available at the point of care. In that sense, the arrival of this application is timely.

Since surgical techniques are, to a large part, surgeon preference, there will likely never be a single definitive source of information. Nevertheless, within orthopedics, Campbell’s is as close as it gets to an authoritative resource. This pedigree immediately lifts this application, while the clean and easy to navigate interface makes it more attractive than the cluttered facade of all three of the above sites.

It is also striking that despite the wealth of information and careful editing that goes into a finely crafted tome such as Campbell’s Operative Orthopedics, textbooks still stand as isolated silos of information in an otherwise highly networked and rapidly-evolving internet era. Therefore, more innovations in medical education must necessarily be yet to arrive. For now though, just about every orthopedic resident and most attendings with an iPhone or iPod Touch would do well to save up the $99 to buy this application.

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-Dr. Wodajo is a senior writer for iMedical Apps and we feel privileged to have him on board.  He brings an extensive clinical background to his medical app reviews. His blog can be found at http://www.orthoonc.com.

If one wanted to get an idea of the potential of the iPhone as a tool for bedside medical and surgical education, this application by Modality and Elsevier would be a good starting place to get inspired. While it seems obvious that a portable device with a great user interface, a sophisticated operating system and great multimedia features should be a shoe-in for portable medical education, what is equally true is that the critical ingredient remains great instructional content.

“Procedures Consult: Internal Medicine – Musculoskeletal” brings together a highly detailed review of orthopedic bedside procedures, such as aspiration of small and large joints, splint application and reduction of joint dislocations, with a well crafted user interface to create an application that will genuinely be useful for emergency room physicians and junior orthopedic residents.  This review will cover how this medical application for the iPhone and iPod Touch goes about teaching these procedures.

The content is derived from Elsevier’s Procedures Consult website, which is a curated video site describing over 270 procedures spanning several disciplines. (Please see the recent review of the companion application “Procedures Consult: Internal Medicine – General” on this website. The content for this application is derived mostly from the emergency medicine/musculoskeletal section. The information for each procedure consists of pre-procedure and post-procedure check lists as well as step-by-step instructions of the procedure itself, accompanied by references. In addition, one or more videos for each procedure is embedded into the app, available for immediate viewing. Surface landmarks are shown graphically as is a simplified 3 cut-away dimensional graphic of the relevant deep anatomy. Some procedures, such as shoulder reductions, are also accompanied by a representative radiographs of the problem.

What I liked about this app:

• the attention to the relevant surface and deep anatomy, as well as the indications for each procedure is very helpful
• videos are of high quality and are embedded directly in the application. (refer to other Procedures consult review for more details)
• the techniques themselves are well-described and, I believe, few practitioners will find much cause to quibble with the instructions

What I did not like about the app:

• not much really, perhaps the post procedure care is unrealistically detailed for the typical bedside interaction

What I’d like to see in future versions:

• the content for this application is aimed mostly at ED procedures, which is surely a good market, however a future application with a more orthopedic focus, including closed fracture management and even surgical procedures would certainly be appreciated

Conclusion:

While there has been a proliferation of medical instructional websites over the last five years, bringing that information to the bedside is more than just a convenience, it is a critical next step. Websites and mobile applications will not replace peer-reviewed scientific literature nor the principle of apprenticeship in medical training. However, I can easily imagine when all post-graduate trainees are routinely expected to refer to mobile applications such as this one before undertaking unfamiliar procedures. This will undoubtedly reduce errors and enhance the care of our patients.

Title of app: Procedures Consult: Internal Medicine – Muscloskeletal

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Dr. Wodajo is a guest contributor to the medical app review team and we feel privileged to have him on board. He brings an extensive clinical background to the reviews. His blog can be found at http://www.orthoonc.com.

Procedure apps appear to be all the rage lately in the mobile medical world, and rightfully so. These instructional apps are a valuable resource to those learning how to do procedures in the health care world. We reviewed another Procedures app recently, Procedures Consult-Internal Medicine, that covers a wide variety of procedures. However, this app focuses on one specific procedure, and is a fraction of the cost.

Procedures – Subclavian Line, is a $2.99 app produced by MeisterMed. You might remember one of our previous reviews on a MeisterMed app, PediDoser. We weren’t huge fans of that app (although to their credit, PediDoser has a 3.5 star rating in the App Store). Nonetheless, once I tried out this current app for this review I was definitely impressed.

I’ve had the opportunity to do a few subclavian lines as a medical student, and the experience is exciting and frightening at the same time. The best way to learn at first is to see, but unfortunately you don’t always have a good view, or the resident might not be the best teacher. Thats where this app comes in.

The navigation is pretty simple. When the app opens you have the option to view the procedure details or watch the full video. In the procedure details section you have a few different options, from step-by-step instructions to complications and coding numbers. There is also a toolbar at the bottom of the screen. It contains navigation tools, bookmarking, and an option to write custom notes. The bookmarking feature was not useful, but the custom note feature was a nice touch.

Video:

The video is approximately 10 minutes long and included within the app. You don’t need internet access to view the video. It shows the full procedure being done from start to finish. The audio component of the video is instructional. I found the audio to be layered nicely with the video. The instructions were concise, high yield, and the explanation of the procedure was excellent.

What I liked:

• Simple, easy to use
• Great Price
• Ability to take custom notes
• Video is standalone, no Internet access required
• The verbal explanation during the video is done well
• There is a separate text section step by step instructions.

What I didn’t like and Improvements that could be made:

• Overall video is great, but at 10 minutes in length, it would be nice to see the video broken into separate sections that are easy to access.
• It would be nice to see text inter-laid with the video on the crucial steps of the procedure, so you can view the video without always needing the audio
• The step by step text instructions only contain one picture. More pictures would be nice additions to this section.

Conclusion:

This is a great medical application for those learning how to do subclavian line procedures. It’s simple, easy to use, and easily accomplishes its goal of teaching how to put in a subclavian line. Like I’ve mentioned with past procedure applications, there is no substitute for getting lots of supervised practice before actually doing this procedure on your own. However, this app definitely reduces the apprehension felt when attempting this procedure for the first time under supervision. I could also see it helping speed up the learning time needed for this procedure.

The previous procedures app we reviewed, Procedures Consult-Internal Medicine, had 25 procedures explained(including subclavian line), but costs $39.99. We really liked that app, but if you don’t need access to all those procedures or don’t want to spend that much right now, then this app is a great buy at $2.99.

I’d definitely recommend this medical application as a must have for 3rd/4th year medical students, interns, residents, and other healthcare professionals who are learning to do subclavian lines.

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