RealWorld Orthopaedics and RealWorld Radiology

App: RealWord Orthopaedics and RealWorld Radiology
Cost: $9.99 / $2.99
Function: Enhancement

The RealWorld Orthopedics app provides the user with a library of radiographic images for common orthopedic concerns. Each series of case images is paired with a clinical scenario in a quiz format. The    answer grid outlines both visually and through a text description the precise abnormalities seen in the image.

Real World Radiology is a valuable tool to support the art and science of reading flat plate images for common primary care complaints. As with its counterpart above, case scenarios outline background clinical information to help the user determine the mechanism of injury or clinical signs and symptoms that accompany the images presented. The information is presented in quiz format and the answers highlight the specific radiological signs that lead to diagnosis.

These apps are useful when reviewing cases with learners and patients. They also provide a very helpful library of visual resources for simulation exercises and exam review purposes.



Heart Murmur Pro

App: Heart Murmur Pro – The Heart Sound Database
Cost: $2.99
Function: Enhancement

Heart Murmur Pro is an app that allows learners to hear a variety of pathological heart sounds, some of which they are unlikely to encounter on a regular basis in primary care. Aside from the pathological sound, there are two key features of this application that make it particularly valuable. The first is that there is a visual representation of the abnormal sound. The representation contains both location as compared to the S1 and S2, as well as characteristics of the sound such as crescendo or decrescendo. Providing both the visual and auditory data at the same time will simplify knowledge acquisition by the learner. The other key feature of this program is that it allows the user to move rapidly between an abnormal heart sound and entirely normal heart sounds. The ability to contrast the two types of sounds allows the learner to appreciate the differences between them. By functioning in this fashion, the application exploits the technological capability of the iPad to provide an educational experience that previously required a PC in order to accomplish.


MSK Injections

App: MSK Injections by Elsevier, Inc.
Cost: $29.99
Function: Enhancement

MSK Injections by Elsevier is a textbook application that has been enhanced to include a variety of video clips that provide detailed instructions on how to give injections (and aspirations). Each detailed video illustrates how to carry out the procedure that is described in the text. The text is enriched with further information related to indications for the procedure, possible complications, necessary equipment for procedure set up and handy instructions for follow up care for patients..

Where the video information used to be available on a collection of DVDs, now the physician has access to the information in one application. This is particularly useful as it does not require internet connectivity which  can often be an issue when care is provided in a rural setting or in the patient’s home.

As a teaching tool, residents can read about a procedure, and then watch the video before they perform the procedure. When used by faculty, it helps to standardize the foundational teaching around a specific procedure provided in the clinical setting.


McGraw-Hill Color Atlas of Family Medicine

App: McGraw-Hill Color Atlas of Family Medicine
Cost: $124.99
Function: Replaces existing resource

The McGraw-Hill Color Atlas of Family Medicine is an app that functions as a replacement for the physical textbook by the same name. While this type of replacement may at first appear to be a very limited exploitation of the technology, its format is superior to its hard cover counterpart as it permits rapid search options and is easily portable in and out of various clinical environments for in the moment bedside teaching.

This type of reference app is particularly useful because of the high quality colour images it has compiled for both common and less prevalent clinical conditions seen in Family Medicine. It is a wonderful supplement to learning when clinical opportunities are limited. For example, the following demonstration shows how the app may be used to highlight the diagnosis of Koplik spots when concerns over a potential measles outbreak was looming.


Importance of Titles

I noticed the other day when I posted video clips to Vimeo, if I used more descriptive (longer) titles, then more people re-tweeted my videos. This behaviour has encouraged me to be more descriptive in my titles.

For example, rather than “Enabling Lock Rotation”, I am now using “Preventing your iPad screen from rotating”. The old title was very “feature” specific – in that it was labelled based upon the name of the feature. The new title is more behaviour or user specific – in that it describes how the feature is actually used.


In educational design research, improved design is achieved through multiple iterations of the design. Iterations occur at both the macro and the micro level. In this study macro iterations occurred at the program design level. With each new data point, the overall iFPD program design was adjusted to account for the new information. In addition, iteration occurred at the workshop level and the artifact level. Individual workshop design was conceptualized and re-conceptionalized to address the changing context in which the research was taking place. Finally, the artifacts themselves (website, eBook, and workshop handouts) went through multiple iterations of design to ensure the information they presented flowed appropriately and worked for the environment in which it was to be delivered.

In design, iteration is necessary and is constant, however, this poses an interesting conflict with research practices. It would be completely not practical to have to re-submit research ethics requests with each iteration. However, there does come a time in the project when enough things change, that the reapplication to ethics becomes necessary. I’ve now reached that point. I can no longer work within the constraints of my current data collection tools. In addition, the nature of participation in my project has changed.

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So, now I need a new diagram that illustrates my data collection – because that will show the changes to the protocol. The review of the research questions looked good – the questions aren’t changing. I’m still trying to solve the same problem (statement of the problem is good), but the actual design of the program and the approach to solving the problem is fundamentally different. I think this is in part because the pre-curser information wasn’t available, so there is much more focus on that information, but also because the organizational context has shifted – the people involved in faculty development are different (new fac dev director) and the team of physicians that I’m working with is different. I had anticipated having more physicians volunteer to work as physician facilitator – that did not happen. Funding changed, which meant I had a reduced set of people to work with (Fac Dev budget doesn’t allow for compensating community physicians).  We have also moved further along in the adoption cycle. Rather than the tablets being new and interesting, we are shifting to the slope of disillusionment. The devices have been in people’s hands long enough that the newness effect isn’t enough to keep then interested in the program. With that, we are seeing a drop of in interest in attending workshops. That at least might explain it … I will need to ask the question on the survey at the retreat.

Research questions

Looking back at my proposal, my research questions are:

(1) How can iPads be used to support teaching and supervising residents in Family Medicine?

(2) What artifacts (e.g. facilitator guides, facilitator presentation material, participant resources) support the implementation of an iPad Faculty Development Program (iFDP)?

(3) What best practices relating to design, delivery, and evaluation can be derived from the implementation of an iFDP?

(4) Does iPad adoption increase in FMP who participated in the iFDP?

What is interesting, is that although there needs to be changes in the protocol and changes in the way in which the iFDP is created, the actual research questions don’t change (this is a good thing) .. this also helps me to ensure that I am not losing focus on this project, I am simply adapting to the needed changes.

I do, however, need to find more time to work on the project. I am finding myself running from one thing to the next, and rushing through things. I need to step back and try to ignore the time pressures .. and allow things to unfold in the time they need.


After the delivery the first workshop, the overwhelming comments were that the physicians wanted a resource to support the workshop. Seeing the information at the workshop was useful, but they wouldn’t retain that information.

After much thought and consideration, I began the development of a website – but that format didn’t see to work – so I began the development of an eBook.

The eBook is now evolving. I have two (or three) physician champions who are working on the eBook with me. Is it now looking like the eBook will be the star of the show – that is, it is will be focal point in the program, with the occasional workshop that uses the eBook. The eBook development really addresses the research question: How can iPads be used to support teaching and supervising residents in family medicine?

The latest outline of the iBook draws upon our experience with Essential Teaching Skills (another faculty development program delivered within the department of family medicine) – there are three sections: iPad essentials, cloud essentials, and clinical teaching essentials.

The website will be redesigned to align with these three concepts – largely because the current flow of the website it tied to workshops, which aren’t being attended.

Our current hypothesis is that people will only attend iPad workshops if they are adjunct to another event – such as the community retreat or annual retreat. In those events the workshops are well attended, but when we schedule workshops on their own, no one comes. We will try to schedule more workshops, and make them available at sites – but if we don’t get enough people they will be cancelled. The eBook is still valuable in and of itself, and so the study needs to show the value of the eBook as a resource to help improve the use of iPads in clinical teaching.

Now I need to go back to ethics and change my protocol and consent forms – the way this research project is playing out is very different than I anticipated. I had anticipated partnerships from peer facilitators, but really the partnership is one peer facilitator and a couple of other champions who are helping to support the project. Life is getting in the way … and of course that isn’t helping matters.

Program Evaluation

Reading through Guskey (2002), I am reminded that I need to be asking questions relating to the structure and organizational support in my end of session surveys.

Questions to ask on the survey:

Would you have attended this workshop if it were offered on its own (that is, not as part of the retreat)? Please elaborate on your willingness/ability to attend professional development workshops that relate to the use of technology such as the iPad.

eBook and Website design considerations

In another project, I’ve been producing iBooks. The eBooks have video, which had to be close captioned, and posed a problem. When I added the captions, the video file format meant that the files were huge. This, in turn, made the iBooks huge. One book was 1.5GB (actually, it got to 7GB, but the iBooks Store won’t publish anything over 2GB). One of the solution to this problem is to stream the videos from YouTube (or somewhere else) rather than to embed the videos. This requires a trade off – to view the video clips, the reader needs to be online. If you are using a data connect, this can get expensive (I will need to figure out how this works).

I polled the physicians in attendance at the Faculty of Medicine Fac Dev day – there were about 50 people there. Overwhelmingly they preferred the streaming option to the embedded option.

Why does this matter? Because as I add more and more videos to the eBook, the larger the eBook will get. I’m already finding the eBook to be bigger than I’d like.

So, I explored embed options. I began with, but found their widgets to involve too much advertising. I really disliked the look of it. I tried iAd, but I couldn’t get it to accept a video URL, only an embed video which defeats the purpose. I tried, which was free, but the quality of the videos streamed was horrible – the pictures were fuzzy. I tried Bookwidgets, which presented a nice widget – with good quality. I was ready to purchase a licence, but didn’t know which one I should buy. It is confusing because I’m the sole producer, but I am producing as a consultant, but all my clients are educational institutions. Their models didn’t line up with my use case, so I emailed them. They kindly gave me a free license since my primary use was for my PhD Thesis project – that was really kind of them.

So, I shall use BookWidgets (they also have a bunch of other cool widgets – I will be replacing the quiz widget with their widget, but I need to ask about accessibility needs in their widget.