As a medical student, there were a few must-haves when it came to surviving the wards. On pediatrics, the Harriet Lane Handbook was a godsend. On surgery, Surgery Recall was key to surviving the all too common tradition of pimping on obscure eponyms and surgical approaches. And when it comes to any topic relating to internal medicine, Pocket Medicine – produced by the good folks at Massachusetts General Hospital and Lippincott, Williams, & Wilkins (LWW) – was my best friend.
Anyone who has ever set foot in a teaching hospital is surely familiar with Pocket Medicine, perhaps one of the best quick reference texts for medical students, residents, and other medical professionals. It is a concise yet comprehensive, conveniently sized, and evidence-based tool that certainly helped me get through a lot of call nights. Skyscape has now brought this venerated reference text as an iPhone and iPad medical app.
As you can see in the screenshot of the home screen (left), this resource is part of a much broader suite of iPhone and iPad medical apps including other previously printed resources like the Washington Manual. As we pointed out in that review, one of the particularly interesting features of an app like Skyscape – essentially a portal to hundreds of reference medical titles – is the ability to cross-link topics across different texts. I’ll delve into that feature more a bit later. For now, lets start from the top and see how this app performs.
There are four ways to navigate the wealth of information presented in Skyscape’s Pocket Medicine – through an index, a table of contents, a drug reference, and (my favorite) an algorithm list. The searchable index is very comprehensive, but would benefit from a keyword search rather than the alphabetical search (i.e. searching “GI bleed” returns “gastrointestinal bleeding” rather than the topic closest to “GI” alphabetically).
At the bottom of the screen is a static navigation bar that allows you to return to the home screen of the Skyscape app, the index screen (shown above), inter-app links (which I discuss below), and a history of recently accessed topics. When within a particular topic there is a “See Also” button which links to relevant topics – for the above algorithm, it pulls up the full entry of “Diarrhea.”
One point of improvement with this app, which is particularly apparent in the algorithms, is that pages often do not fit on the screen and thus require a lot of scrolling around (see above). I did notice that some screens had an icon for an “interactive” algorithm (a function that is not yet active in the app) which may get around some of this. In the meantime, having all the content fit the screen at least in one dimension (horizontally or vertically) and allowing the user to zoom as needed would make the content a little less cumbersome to navigate.
Within most of the topics accessible through the table of contents or index, there are two ways to navigate the information – either scroll the full topic entry or use the outline (below). The ability to conveniently go back and forth between these two views via the button on the right side of screen is quite nice as the full entry can be overwhelming at times, especially when it requires a lot of vertical and horizontal navigation.
As you can see, the information presented is quite comprehensive and sticks to the highly abbreviated style of the print version of Pocket Medicine – quite clearly an app designed for an on-the-fly refresher and not a full lesson on any topic. And consistent with the print version, the authors/developers have in many instances included the relevant references to their recommendations.
As part of the Skyscape suite, one of the other interesting features is that it is interlinked with the other apps available through Skyscape. By clicking on the “Link” button, you are given the option to browse your other Skyscape apps for topics related to your primary search. Below, I used the Link feature on the GI Bleed topic and have shown below the results in 5-Minute Clinical Consult. Obviously, this kind of feature creates opportunity for great synergy between different apps. However, many of the apps in the Skyscape suite have overlapping information. So while being able to review the same information in different sources can be positive, it also creates some obvious inefficiencies if the different apps have too much overlap. So the strength of this feature really depends on putting together a suite of complementary Skyscape apps.
What I like about this app:
- A number of ways to navigate content – I’m a huge fan of the “Algorithm” index!
- A very comprehensive yet concise resource that definitely follows the standard set by the print version of Pocket Medicine
- The “Link” feature has a lot of potential and could be quite useful in when linked to the appropriate resources (in this case, something like RxDrugs rather than the Washington Manual)
- The app was a little cumbersome to navigate at times, having to scroll vertically and horizontally. It would benefit from the ability to fit all content onto the screen in at least one dimension with the user then zooming in/out as needed.
- While the Link feature for a topic can be useful, I actually find the Medscape approach to this kind of linkage better where all the information is in the same topic – drugs, tests, etc. The cross-referencing draws a lot more information from a rich app suite, but also pulls up a lot of potentially distracting information.
Price: After downloading the free Skyscape portal app (which includes some free resources), there are two purchasing options for Pocket Medicine – either a subscription or standard purchase. The subscription, up to 1 year, gets you free edition updates during the term at a cost of $41.95 but requires renewal at the end of the term for continued use. The standard purchase, $48.95, gets you free content (not edition) updates for 1 year but you get to use the app after that term ends.
Conclusion: Pocket Medicine has long been a mainstay of the white coat pockets of medical students, residents, and others. Skyscape brings this resource to the iPhone in its full glory, maintaining the comprehensive nature of Pocket Medicine in this mobile form. Some of the particularly nice features – multiple content browsing options (especially the algorithm index), convenient ways to browse individual topics – really enrich the resources. There are several areas for improvement that could help this app take full advantage of the iPhone as a platform, especially more manageable layout that reduces the amount of vertical/horizontal scrolling. The Link feature is sort of a mixed bag and balancing efficiency with comprehensiveness is definitely a challenge here.
- In the end though, Pocket Medicine is a great resource and was a must have on the wards. The print version is $49.95 on Amazon, so when it comes to choosing between the two, I’d definitely go with Skyscape Pocket Medicine (probably the standard version as I have trouble seeing the utility of a limited-use subscription). And I definitely look forward to seeing how Skyscape further enriches this app and improves on the user interface in future versions.