Category Archives: Case Vignettes

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.

 

OtoSim Companion

App: OtoSim Companion
Cost: Free App ($4.99 to unlock)
Function: Enhances


Teaching ear examination in the clinical setting can be very challenging. The first problem is that it may be difficult to provide the learner with the opportunity to see all of the pathological entities that they might encounter in practice. The second problem is that most books present a complete picture of the tympanic membrane rather than the small segments that are often seen with the otoscope. There are stimulators that can be purchased to offer trainees a wide range of clinical content. However, the OtoSim Companion app for the iPad provides a cost effective alternative. By selecting an image and then having the learner examined the image through an ear speculum from approximately 10-15 cm away from the iPad screen, it is possible to simulate what they would actually see through an otoscope.

The OtoSim Companion app contains a series of images with descriptions that include both common presentations and conditions that occur rarely and as such are unlikely to be encountered by a trainee. The simulation allows learners to observe a much wider breadth of clinical material than they would be likely to see during their regular rotations.

The app itself is free, but the free version only contains a few sample chapters. The remaining chapters can be unlocked through an in-app purchase for $4.99.

Challenge Activity

In groups of two, one person open the OtoSim app and choose an image. The second person, using an ear spec, examine the image and determine what they are seeing.

SimulusDM

App: Simulus DM by Simation Medical Ltd.
Cost: free
Function: Provides something new


The SimulusDM App provides simulation around various diabetes treatment options for patients . It allows the user to select a patient from several patient profiles with diverse variable (type of DM, age, weight, past treatment and lab results etc.). Once a patient profile has been determined, the app user can modify the patient’s glycemic physiology through modifications in lifestyle choices and medications. The app will then provide a visual representation of the effects of the modification on blood sugar over the course of three months. . The app supplies information in both metric and US units.

Note that this app requires that you be connected to the Internet. It is memory intensive, so you may wish to close any apps you do not need before using this.

From a teaching point of view, one of the biggest benefits to this type of simulation app is that you can allow residents to make treatment decisions that you would not be feasible or appropriate in real time clinical settings. It allows residents to see the consequences of various management decisions and learn from their mistakes without risk to patients.

Tone Generator Ultra

App: Tone Generator Ultra
Cost: Free
Function: Replaces


Tone Generator Ultra is a replacement app with a difference. It does not replace medical resource information clinical academic content such as a textbook but instead uses technology to replace clinical tools (in this case a tuning fork) to provide more flexibility and effectiveness to the clinician. Strictly speaking this is not a recommendation for a specific app, rather it is an example of a type of app that can provide a replacement for an existing tool in your office. In addition, as it is easier to use with a smaller device, you may wish to use your iPhone rather than your iPad.

Many hearing conduction apps exist, however, for this example, we will demonstrate the free app Tone Generator Ultra which can be used to replace the tuning forks in your office. As it is easier to use with a smaller device, you may wish to use your iPhone rather than your iPad. Tone Generator Ultra is particularly useful when providing clinical care outside the office setting where specific diagnostic tools may be limited.

From a teaching perspective, it is easy to demonstrate the principles of air conduction to trainees, easy to perform and interpret the test and gives a foundation on which to discuss the limitations of testing in the office and in the field. Specifically, the increased frequencies tested with this app will provide better assessment of the patient’s deficits: the diagnosis of hearing loss will not just be limited to the voice recognition frequencies but will also pick up gaps in higher and lower frequencies that could put patients at risk if not heard (e.g., a bus that may be barreling in behind them).

If you search the App Store for Tone Generator, you will soon discover a plethora of free apps that serve this hearing assessment purpose. We recommend that you play with a few of them and choose the one that works best for you.

Teaching Residents Clinical Anatomy

App: Visible Body’s Human Anatomy Atlas (Argosy Publishing)
Cost: $24.99
Function: New Technology
More information: http://www.visiblebody.com/atlas_overview/


Visible Body’s Human Anatomy Atlas is a 3D reference tool that gives a visual representation of the human body. The app presents both male and female models with thousands of gross and microanatomy structures. The 3D structures may be rotated in all spheres to show the various body regions and systems components and their relationships to each other. There is a “zoom” in option to further convey location and relationships between structures. The app provides preset views of certain systems or regions that are easily browsed. It also permits the user to build custom views with the aid of various  ‘hide” options. All visual images may be sent electronically  which can be very helpful for patients and learners alike. The app has embedded in the tool definitions, pronunciation aids, quizzes, study cards and static images for presentations.

This app is incredibly useful as it provides the clinician with a readily available atlas for verification of differential diagnosis,  in the moment teaching for patients and learners alike. For example, a learner may have difficulty identifying the source of traumatic pain to a shoulder on physical exam however the patient has point tenderness in one location. With the use of the app options that permit drilling  down to the exact pain location, the learner is better equipped to provide a solid differential diagnosis and more appropriate main diagnosis. The preceptor and learner can examine the detailed anatomy of the shoulder usingVisible Body’s Human Anatomy Atlas for iPad/iPhone (Argosy Publishing, 2013). This app allows the preceptor or resident to manipulate three-dimensional images of any muscle system, fading or hiding muscles, until the learner is able to identify the correct source of the patient’s injury. The app and the ability to manipulate the 3-dimensional images within the app using touch screen gestures provides a tool that was previously not available to the clinician. In addition, the portability of the tablet allows the preceptor to take advantage of the teachable moments anywhere, including offices and treatment rooms within the clinic.

Dr. Jay Mercer demonstrates how to use Visible Body’s Human Anatomy Atlas for iPad/iPhone to teach shoulder anatomy.