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.

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.

The challenge of identifying and absorbing relevant medical literature will not abate anytime soon and the proliferation of services that purport to simplify or eliminate this problem for physicians is itself now becoming a distraction. The rapid adoption of web-enabled smart phones by physicians, such as the iPhone, is driving this dilemma from the theoretical realm directly to the bedside. The hope is that if relevant medical literature is immediately available at the point of care, physicians would be more inclined to use it.

At the same time, the mantra of practicing medicine that is evidence-based is ringing ever louder. Thus far, it seems to this reviewer that most physicians apply it most strenuously when criticizing other physicians’ decisions rather than applying it to their own practice. Nevertheless, large well-respected compilations like the Cochrane Abstracts are available and widely used.  They offer well constructed summaries of evidence-based diagnostic and treatment guidelines for thousands of pathologies.  It is into this nexus that the “Evidence Central” app enters.  This review will cover the features of this recently released medical application, which is technically “free” in the App Store, but requires a paid subscription of $79.95 in order to actually use.

Wiley-Blackwell, the venerable scientific publisher (“knowledge for generations” is their tagline) offers subscription web based access to the Cochrane database as well as other partially overlapping databases of clinical literature such as Evidence Based Medical Guidelines and Essential Evidence Plus. Unbound Medicine is a multi-platform mobile medical application developer. The two have partnered to port these databases into the Evidence Central App, available on the iPhone and Android devices.

Unbound Medicine has a long list of prominent electronic offerings including the Merck Manual (reviewed previously), the Oxford Handbook, and Harrison’s Manual.  The Evidence Central application is a mirror of a web portal to the three Wiley web databases mentioned above as well as partial web access to four well known journals, American Family Physician, Annals of Internal Medicine, JAMA and NEJM.

While the depth and breadth of information available through these databases is truly impressive, the application unfortunately also propagates the corresponding dilemma. Namely, it does not attempt to solve the problem of parallel entryways into the separate databases nor the multiplicity of similar sounding titles and topics.  It does not explain to the user how each database is different and, unlike the corresponding website, does not offer a global search across the databases.

What I liked about this app:

• The quality and breadth of the the abstracted information available in the three database families is impressive. Having it quickly available on your mobile device is a fundamental improvement from having one’s medical library taking up shelf space.
• The application is quite responsive as most of the content is apparently locally stored

What I didn’t like as much:

• There is no guidance available to the user as to where to search for information nor any ready description of the qualities of each database (to be fair, this information is hard to glean from the actual web databases themselves)
• There are some rough spots in the application’s user interface with the bottom navigation bar appearing and disappearing unpredictably, as well as the text search box

What I would like to see in future versions:

• A global search across the databases, akin to the website (perhaps this was omitted due to technical limitations of the platform)
• A more refined search experience, with more explicit guidance as to where to ask a particular question

(below picture is a screen clipping when using evidence central via your computer browser)

Conclusion:

The dilemma of the practicing physician basing complex decisions on incomplete information will undoubtedly remain inseparable in the future from the practice of medicine. However, closing the gap between available evidence based literature and the clinical question at hand is at least partially addressable with improving technology. In this case, Unbound Medicine’s “Evidence Central” assembles a highly potent collection of clinical evidence aimed directly at the practicing physician. Access to the Cochrane Abstracts alone might well justify the price of subscription.

However, what we are also seeing thus far with the first wave of clinically based applications is that more targeted products, e.g. Procedures Consult: Musculoskeletal, are more finely tuned to access via a hand held device.  This appears logical since it is significantly more difficult to synthesize thousands of pages of text and literature and have it instantly reborn on a mobile device, which is partially the huge task Evidence Central tries to accomplish.

In the future, it is inevitable that medical authors and publishers will start to primarily design for smaller form factors and this task will not be left solely to software developers. When this occurs, we should see a better translation of medical literature to mobile applications. Until then, we can certainly enjoy the wealth of knowledge that rich applications such as “Evidence Central” allow us to carry in our pockets.

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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 the 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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1)PalmDoc.net has a great review on an app to help you train for performing lumbar punctures. The last app we reviewed, Procedures Consult-Internal Medicine, also has an excellent example of how to perform lumbar punctures. But the beauty of the Lumbar Puncture app is it’s only $1.99, as compared to the $40 for Procedures Consult. Procedures Consult consult packs 25 different procedures, so if you just need something for Lumbar Punctures, check out the LP Procedures app instead.

2) Merck Manual just released another iPhone app called Home Edition & Procedures, and it’s been getting some buzz on the internet. The app is supposed to provide quick and easy medical knowledge for patients. A CNET author goes far enough to say it will help save on co-pays and "countless" visits to the doctor, we’re not sure if we’d go that far. We’re gonna try to get a copy of the app for a review. Here is the CNET article. Melodika.net has a writeup on this app as well.

Everyone in the medical field has heard the phrase, “See one, Do one, Teach one”. When you’re a budding medical student and intern, you’re taught to watch a procedure being done at least once, then to perform the procedure under supervision, and then after performing the procedure successfully, teach one.

The Procedures Consult:Internal Medicine App aims to help improve the success of this learning process. This $40 app packs 25 Internal Medicine procedures explained in detail through text, pictures, and videos. The app itself takes up a staggering 462 megabytes of space on your iPhone or iPod Touch. For that much space allocation one would think the app better be good. After using this app over the past week and seeing the responses from other medical students, interns, and residents, I can assure you, it’s better than good.  This app is going to be making our soon to be released Top 10 list of Medical Apps for Residents.  This is an extensive review of an app that is well deserving of the attention.

Procedures Consult is actually a product from Elsevier, a publisher of medical and scientific literature. This app is derived from the site, Procedures Consult, where the same type of information you find there can be found in the app. On the website you can access more procedures than the procedures consult-internal medicine app. In order to access their website there is a fee. I called the company to ask them their rates since they are vague on their website and I’ll update this post when I get a call back. However, the price of the iPhone application is $40, and it’s a one time cost.

Now, back to the medical application itself. When you open up the application you can search, bookmark, or view all the different procedures at once or by type. There are 25 procedures available to view, ranging in varying levels of complexity. You can learn how to perform an arterial blood gas sampling procedure to more complex procedures such as performing an LP, thoracentesis, or abdominal paracentesis.

In this review I’m going to use the thoracentesis procedure as an example to show the functionality of this app. The thoracentesis procedure is found under the “aspiration” category. Once you select thoracentesis you are brought to a page with the Pre-Procedure information, along with many different options. On this page you have options to view the Procedure text/pictures, Post-Procedure text/pictures, make a bookmark, increase the size of the text, and most importantly, view a video of the procedure being done.

The Pre-Procedure page includes a great deal of information including indications, contraindications, equipment, and anatomy. Along with this great text information, you’re given excellent pictures to view as well. This type of format is repeated in the Procedure and Post-Procedure pages as well. The text and pictures on the Pre-Procedure, Procedure, and Post-Procedure pages are very handy when you’re not in a setting to view the videos or if you want to brush up on certain parts of the procedure quickly.

Video:

The video section is fantastically done(the last three pictures are of the video). Once you choose the video option, you are brought to a page with an option to view different parts of the procedure(refer to pictures). This is great because it takes out the need to fast-foward and rewind constantly. A moderator talks you through the whole procedure. Procedures Consult has done an excellent job in mixing graphic images with actual images. This useful when showing anatomy graphics so one is able to better understand the procedure. The videos also have moments where you are shown “clinical pearls” and given information about a key step in the procedure. Once you’re done with one section of the procedure, the application automatically goes on to the next video, but gives you five seconds to cancel this continuation.

Each section on the video page is about one to two minutes in length. The thoracentesis videos total to about eight minutes. The videos themselves are concise, informative, and have a nice pace. They even walk you through getting consent from the patient and the key risks to talk about. The post-procedural video clips are nice as well. The thoracentesis post-procedural video clip even tells you how to submit the pleural fluid to the lab.(i.e. EDTA tube is submitted for cell count and differential). In the wards, I’ve definitely been scrambling around with residents trying to make sure we have the correct tubes being sent off for the right information. The videos make this application absolutely shine.

Unlike other applications we have reviewed in the past, such as the Blausen Human Atlas and Clinical Orthopedic Exam, the Procedures Consult app has stand alone videos. I can’t stress this enough. The overall consensus among our group of reviewers is that stand alone videos are key because not everyone has Internet access available at all times. In the hospital my Internet access varies from good to bad. Since this could be considered a “study” application, having the videos available to you without the need of an internet connection is invaluable. You could even be sitting in a plane viewing videos of procedures, although the person sitting next to you might get a bit queasy. Having the videos built into the app takes up a massive amount of space, almost half a gig, but it’s well worth it.

What I liked about this app:

• Stand alone application, no Internet connection required.
• Procedures are explained in a concise and clear manner.
• Procedure pages do a great job of providing informative text mixed in with pictures.
• Videos are fantastic and replicate the feeling of actually watching a procedure, yet also provide great graphics to help explain the procedure.
• Starts with the page you last visited.
• Bookmarking
• Option to increase/decrease text size.

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

• An option to delete procedures not used in order to save space on your iPhone or iPod touch. Some of the procedures, such as ABGs or Phlebotomy won’t be accessed too much, and you could save some space by deleting them.
• Greater explanation of why the procedure is being done and the pathophysiology leading to the need of the procedure. (i.e. pathophysiology behind pleural fluid collection)
• When fast forwarding and rewinding the videos very quickly I found some lag time and had the application crash. Overall though, the application is stable and I rarely had any issues.

Who this app would be great for:

Residents, Interns, 4th year medical students, and others in the healthcare field who want an aid to help learn procedures quicker. It’s also for those who want to look like all-stars in front of their upper levels and attendings (paging all gunners….).

Conclusion:

As you can read from the above, the Procedures Consult-Internal Medicine app, developed by Modality, was a hit. When I showed this app to other medical students, interns, residents, and fellows they were stunned. The overall feeling was this app would help you learn procedures more quickly and decrease some of the anxiety that comes with doing the more complex procedures. The Procedures Consult app definitely does not replace the invaluable learning that occurs with the hands on practice of physically doing the procedure, but it definitely helps you learn the procedure quicker and become more efficient.

When I asked colleagues about the price of the app($40) they didn’t think it was cheap, but they didn’t think it was overpriced either. Some of the more experienced fellows didn’t think the app would be as useful for them, but all the 4th years, interns, and residents loved it.

It should also be noted this application can improve patient safety, for obvious reasons. Residency programs really need to take note of this application. Having the ability to view videos, pictures, and text of a particular procedure on your mobile device right before you need to perform the procedure is fantastic.

I urge those who are considering buying this app to check out the Procedures Consult website. The iPhone and iPod touch application version is basically like having the website in the palm of your hand, but without the need of an internet connection. The Procedures Consult website allows you to try the online version free of Procedures Consult for 30 days. The sample videos on the website correlate closely to the videos you’ll see in this application. They show samples of the text and pictures that correlate closely to the app as well. For $40 flat, you can have 25 internal medicine procedures, with text, pictures, and videos, in the palm of your hand to use at your viewing pleasure.

With this app you’ll be on your way to looking like an all-star in the wards and thats something we’d definitely recommend. For interns and residents, this is a must have application.

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The Procedures Consult website can be found here.

Note: This app was reviewed in consultation with interns, and residents.