Modality Brings Procedures Consult to the iPhone, We're Blown Away
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 is a 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.
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 Internet 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.
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....).
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 interent. 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.