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

 
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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.

 
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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.

 
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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.

 
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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.

 
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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.