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.

Which iPad should I buy?

The best model of iPad for you is the one with the features that you need. What you need will depend upon how you intend to use the iPad. For example: if your primary purpose for using the iPad is academic reading, you will likely not need the same model of iPad if your primary purpose is for storing medical database apps. However, I recommend that you buy the iPad with slightly more features / memory than you think you will need, as once you get your iPad you are likely to find new and exciting ways to use it.

There are four questions you need to answer in order to determine which iPad is best for you:

  1. How do you expect to use your iPad?
  2. Where are you most likely to use your iPad?
  3. Does size matter?
  4. Will you use the iPad to present?

In the following sections, I explore how your answers to each of theses questions should influence your purchase decision. In addition, I include sections describing used iPad options and AppleCare+. All recommendations are based upon the models available for purchase in the Apple Store at the time of writing (September 2013).

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Asking yourself how you plan to use your iPad will help you to determine your best option regarding storage space. Storage space refers to the amount of disk space the device has. The various iPad models include options with storage of 16GB, 32GB, 64GB, and 128GB. The number refers to the total space on the disk, however, a portion of that space is used by the operating system (iOS) and various integrated applications, such as the App Store. Generally speaking, the more apps, data, and multimedia that you plan to use, the more storage space you need.

For example, my first iPad was a 16GB WiFi model and it worked well for reading an annotating hundreds of academic articles, as well as browsing the Internet and watching streaming video (that is, video that is not stored on the device itself but rather it requires you to be online to access it). I was able to load one or two movies on the 16GB iPad for viewing while travelling without Internet access. Once my rate of travel increased, I found myself wanting additional space so that I could store 5 or 6 movies.

Consider the 16GB version if you are only planning to use the iPad as an eBook reader and portable web browser.

Consider upgrading to the 32GB version if you want offline access to many eBooks, or if you plan to use the device for interactive games. In addition, if you expect to use the iPad to access apps with large databases, such as medical reference apps then you will want an iPad with more storage.

Consider upgrading to the 64GB version if you want offline access to several movies or audio files, or you plan to use several apps with large databases.

Consider upgrading to the 128GB version if you are a power user of the iPad and want to store a lot of data intensive apps or videos.

You cannot upgrade or attach additional storage space. As a result, I recommend that you purchase a device with more storage space than you anticipate using.

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The iPad is primarily designed to be an Internet connected device. This means that many of the apps will not work properly (or at all) without a connection to the Internet. As a result, where you are most likely to use your iPad will influence whether you need an iPad that uses Cellular data to connect to the Internet.

Cellular models (either 3G or LTE) have additional hardware that makes them able to connect to cellular data networks, as a result, there is an additional cost (approximately $130) for iPads that support cellular data. In addition to the added cost of the iPad itself, cellular models require that you have an SIM card and subscription to a cellular data service, which can be expensive. Finally, the cellular models are slightly heavier (approximately 10g).

Depending on the iPad model, the options to connect to the Internet using cellular data are either 3G or LTE. All models of iPad can connect to WiFi networks. The older iPad2 uses the older 3G cellular technology. The newer iPad models (iPad Mini, iPad with Retina display) use newer and faster LTE cellular technology. Note that there are multiple LTE protocols, and as a result there are multiple iPad LTE models. Apple provides a reference as to the various country/carrier options at: http://www.apple.com/ipad/LTE/

If you have access to WiFi at home and at work, and you don’t anticipate using your iPad to access the Internet while you are commuting, then the WiFi model is a good choice.

Consider the cellular model if you want to use cellular data while travelling, or if you plan to use your iPad in locations that do not have WiFi but do have good cellular data coverage. Note that the iPad Mini takes the nano-SIM rather than micro-SIM. At the time of this writing nano-SIMs were not readily available as prepaid SIMs in most countries.

An alternative to purchasing the cellular iPad model is to tether your device using the personal hotspot feature of your Smartphone. This allows you to use your Smartphone data to provide Internet access to your iPad; however, it does drain the battery on your phone. This is recommended as a more cost-effective solution to cellular data access only if you can easily charge your phone.

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There are two sizes of iPad, the regular and the mini. In addition to physical size, each model has different display parameters. Both the iPad Mini and iPad2 have the same screen resolution (1024×768) but the iPad Mini displays more pixels per inch. This means that applications display same information on both devices, however, the iPad Mini version will appear smaller. The retina display has both a higher resolution (2048×1536) and more pixels per inch. This makes the display appear a lot crisper, and it allows apps to display more information on the screen.

The choice of regular size or mini depends on how you plan to use your iPad and how likely you are to take it with you. With my first iPad (an iPad2), I found that I had to think about whether or not to take it with me, as it added too much extra weight to my purse or bag. I now have an iPad Mini and I love the smaller, lighter device. I no longer need to think about whether or not to take it with me.

If you want the added portability, the iPad Mini is a good choice; however, the smaller screen means that some apps are more difficult to use. Specifically, if you plan to use apps that involve various gestures (e.g. Pinching to resize images) and you don’t have small hands, then a regular size iPad is a better choice.

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The iPad can be connected to a projector using a VGA connector cable (sold separately). Note that this feature is not supported on the original iPad. There are two types of connectors, a 30-pin connector and a lightning connector. Unfortunately, the 30-pin connector is very fragile, and easily wiggles free anytime you bump or move the iPad while connected. Fortunately, the lightning connector provides a solid connection (you can hang the iPad Mini from the connector cable!). As a result, if you are planning to use the iPad to connect to a projector for presentations, then you will want an iPad with the lightning connector (iPad Mini or iPad with retina display).

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If you are considering the purchase of a used iPad, there are several additional models available: the original iPad, iPad2 with more storage, and 3rd Generation iPad with Retina display.

The original iPad is both thicker and heavier than the newer iPad models. It also has less RAM and a slower processor. As a result, many applications to do not run on the original iPad. In addition, because the original iPads are a couple of years old, they are more likely to experience issues with battery life. As a result, I do not recommend purchasing an original iPad. They are still useful as a portable web browser and eReader (so only worth about $50).

The iPad2 was previously available in 32GB and 64GB models.

The iPad with Retina Display was originally released with the 30-pin connector, rather than the lightning connector. There were other minor improvements between the 3rd generation iPad with retina and the current 4th generation iPad with retina.

Caution: when purchasing a used iPad in addition to examining the screen for scratches, also examine the camera, speaker, and microphone.

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I have heard AppleCare+ referred to as “an invisible case”, as it provides protection for the iPad without the added bulkiness of a protective case. The cost of AppleCare+ is the same, regardless of which model of iPad you have. With the latest AppleCare+ for iPads, if you in any way damage the iPad regardless of whether it was your fault, you can get a warranty replacement for $50 (available twice within the 2 year window). This means that if you drop it, or scratch it, you can replace it without the major expensive of buying a new one. In addition, Apple’s manufacture warranty is extended two years. If you are buying a more expensive model of iPad, then AppleCare+ is an “invisible case” worth considering.
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Conclusion

In this short article, I have explored various questions to help you determine which iPad is best for you. Based upon your answers to the questions, you should now be able to answer the following questions and make your purchase:

  1. What storage size:  16GB, 32 GB, 64GB, 128 GB?
  2. WiFi or WiFi plus cellular?
  3. Which model (iPad Mini, iPad2, or iPad with Retina Display)?
  4. Do you want AppleCare+?

Website design

I very much debated about whether I’d create this site using WordPress or Dreamweaver. Initially, I very much leaned towards Dreamweaver, but the reality was that it would take me a lot more time to manage a Dreamweaver site. I’m more familiar with WordPress, but also I like some of the content management system (CMS) features that I get with WordPress that I don’t get with Dreamweaver. If I wasn’t so file inept (see blog post), then Dreamweaver might work – but having to manually manage posts, and not being able to take advantage of various plug-ins made the decision difficult.

In the end WordPress won out. I needed a solution that met my needs, where I wouldn’t be spending all my time implementing the design and layout. I need to be spending my time creating content, not figuring out how that content is going to be displayed.

WordPress was also a personal preference. I knew that if I had a WordPress site, I would be able to blog. I know that I am able to blog, that I can write blog posts. I understand the workflow, but  I also have the muscle memory associated with blogging in WordPress. I can do back to my bike touring days. I blogged at http://goingeast.ca almost every day. So I know that if I setup the process, I can blog daily as needed. I think the ability to do that, and giving myself permission to write stream of consciousness (bad first draft) style, will allow me to just get it done … and I really need that right now.

My ‘to do’ list for today contains an item on my website design. Specifically, that is to write down all the content that needs to go on my website. So, here goes:

  • Workshop content, specifically: Icebreaker Activities, iPad Skills Lab, iPad Case Vignettes
  • Stuff to run a workshop: workshop agenda, administrative checklist, workshop evaluation sheets, facilitator guide
  • This blog
  • About this website, How to contact me, how to submit a case vignette (or other site content), credits for the site and site design (this assumed that I was using a graphic artist – I may not – I may just buy a theme and customize it myself.

About this Blog

It has taken me quite some time to figure out the best way for me to reflect on my research. I had originally planned to create a private research journal, but I find that I am not successful at actually writing in such a journal. I have never been good at personal journals – however, I have lots of experience with blogging.

I have initiated this website as a way to capture the artifacts associate with my research. It is also a tool of dissemination. It will contain all the different parts of the program that I’m creating, but also will contain this blog. This blog is a journal of my design decisions. It is intended to capture my thought about the research process, but also about the design of a sustainable and effective iPad professional development program.

With any luck there will be a lot of reflections in the next few weeks, as the first workshop will be delivered at the Department of Family Medicine (DFM) community retreat on March 22, 2014.

I apologize if today there are a lot of entries, or if this journal is long. It has taken me so long to figure out how to journal in a way that works for me that I  have many things to write down – many ideas and many reflections that have lived in my head need to be put on paper. I should also say that this journal will be messy. Although everything I write has been thoughtfully considered for the public forum, it is also still a stream of consciousness, and a collection of thoughts. It is an attempt to capture various ideas as they occur, rather than an attempt to write nicely polished blog posts. If you want to read my more polished posts, check out http://rjh.goingeast.ca. For this blog, I am giving myself permission to, as Stephen King said in his book about writing, “write a crappy first draft” … You have been warned. Only read this if you want to hear my crappy first draft comments, or to have some insight into how an educational design research project unfolds within my context.