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.
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.
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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.
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!