Here we review the Prognosis: Your Diagnosis app from Medical Joyworks, available for the iPhone/iPad/iPod Touch and marketed as a clinical case simulation game for physicians, medical students, nurses, and paramedics. Within 10 days of its release on November 15, Prognosis rocketed onto the Top 10 most-downloaded list of free medical apps in the app store.

Founded in 2010, Medical Joyworks is run out of Sri Lanka and strives to “make medicine fun.” Prognosis represents Medical Joyworks’ first and, thus far, only foray into the app world.

The app opens with a Main Menu from which cases can be accessed. Of note, individual cases (those with the arrow icon) need to be downloaded separately in order to be accessed.

Regardless of your 3G or WiFi connection, each case downloads very quickly (<5 seconds)– I took 1-2 minutes when I first opened the app to download all 16 cases. Once downloaded, the cases do not require any 3G or WiFi connection to be accessed.

Here, we explore the cardiology “Jaw Pain” case (the diagnosis will be unstable angina). The 5 panels of each case (History, Examine, Investigate, Manage, and Finish) are quickly accessible from the bottom of each panel for quick navigation between the various panels. The case opens with the first panel– History. In the app’s cases, the History typically contains only several sentences, all of which contain very pertinent data– there is very little extraneous or irrelevant material here.

The next panel (“Examine”) features a cartoon figure with incomplete vital signs and various physical exam descriptors (“no oral ulcers,” “JVP not elevated,” etc.) with arrows to the general body part (and occasional illustrations, if applicable).

The third panel for each case is the “Investigate” function, allowing the user to perform various diagnostic studies. Appropriately, the info disclaimer does note that in certain situations, some diagnostic investigations may be unnecessary and even harmful to the patient. In this cardiology case, our available diagnostics include a chest x-ray, EKG, troponin assay, and an echocardiogram.

Performing the EKG brings up a description of what the EKG showed and a snapshot of an unidentified lead, thus not requiring (or even allowing for) EKG interpretation. Performing the chest x-ray shows a cartoon illustration of the heart and lungs with a read (here, “the x-ray appears normal”), also not requiring or allowing for any CXR interpretation.

The fourth –and most satisfying– panel is the “Manage” panel, affording users the opportunity to help manage the patient in the case with a series of binary yes-no options. These panels often omit several therapies that should be administered (here, therapies such as aspirin and nitrates were omitted, likely due to space concerns), and the panel thus does not contain a comprehensive management strategy.

After submitting your choices, the app provides a “Your Performance” reflection, based on a three-tiered scoring system of “very well,” “satisfactorily,” or “poorly.” Of note, the user’s performance appears to be based on both which diagnostic tests are ordered as well as which management therapies are chosen.