Family Practice Boards Review Software
 
 
accepted for publication in Medical Computing Today October 1997
February 1998
 
Originally published in edited form Sepember 1997 in Medical Software Reviews

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All packages run on both Macintosh and Windows platforms, unless otherwise stated. Minimum specifications are a 486 (PC) or 68030 (Mac) processor, 4 MB RAM, 4 MB hard drive space, mouse, SVGA graphics card/monitor and a 2X CD-ROM drive. Additional requirements, the number of disks and any extra items included are noted at the end of each review.

 
AAFP Home Study Self Assessment: The Monograph Collection
Year/Version: 1991-1996

Reviewed September 1997
by: Marjorie Lazoff, MD
Emergency Medicine
Philadelphia, Pennsylvania
Medical Editor
Medical Computing Today
 
Ratings (1=poor, 5=superior)
Content.........................5
Programming.................3
CAI...............................2
Error handling................4
Support.........................4
 
Six years of the American Academy of Family Physicians' monthly monographs on a searchable, indexed CD-ROM is this review's most authoritative family medicine reference. From Clinical Genetics to Cardiac Arrhythmias to Common Foot Problems, each is a series of clearly written articles that, for Boards review purposes, strike an appropriate balance between academic and practical interests. In spirit the monographs seem comparable to ACP's MKSAP, although internal medicine is not as broad a discipline as family practice and MKSAP is completely updated every three years.
 
Every monograph begins with a handful of pretest Q&As and a more generous selection of post-test Q&As, and the CD includes six Cumulative Examinations each containing 125 Q&As covering 12 monographs. A unique feature other electronic reviews should emulate: questions, answers, and a computer-template answer sheet can be printed out for those who wish to duplicate exam conditions. Physicians can also test themselves at the computer by scrolling down the page, where clicking on the correct letter reveals a pop-up window containing a thorough explanation and link to the specific section within a monograph. Sadly, there is no automatic scoring or ability to randomly generate questions, although having questions accessible both by subject (within each monograph) and also as Cumulative Exams helps.
 
This software is pleasant to use and includes straightforward navigation, all personalization tools, and footnote references conveniently available as pop-up windows, a nice feature several packages reviewed here share. Unfortunately, like many CMC ReSearch products, there is evidence of careless production. For example, all the references under Eye Problems are from the Stroke monograph, and there are symbols interrupting text in at least two places. I did not test the print function extensively on this disk.
 
Promotional and jewel box descriptions of this CD as a "full family practice curriculum" covering the "scope of family practice" are misleading. Epilepsy, for example, is only mentioned as a sequela of stroke. Asthma is limited to a chapter under allergy and is virtually ignored from a pediatric perspective. On the other hand, women should appreciate that seven of the 72 AAFP monographs are devoted to obstetrics or gynecology (men should rightfully protest the lack of monographs and utterly pedestrian coverage of urology). On balance the majority of monographs are excellent resources for review, but a few monographs are clinically outdated. For example, articles on pediatric infections give a historic pre-Hib vaccine perspective and the monograph on strokes, despite references as recent as 1994, rejects thrombolytic therapy without any mention of its recent hoopla. Finally, several monographs, most notably Fractures and Dislocations, are in desperate need of radiographs of improved quality and quantity. Poorly reproduced x-rays and lack of even basic multimedia are not acceptable in a 1997 medical education CD-ROM.
 
For boards preparation this package has many advantages, but the AAFP and family practitioners should insist CMC ReSearch actualize its electronic potential further. Reviewing comparable software by ACS and even ACP may be helpful.
 
$195, updates $95; 1,000 questions; 60 AMA hrs. CME ($225); one CD-ROM; minimum hardware requirements.
 
Source: CMC ReSearch, 322 N.W. Fifth Ave., Suite 201, Portland OR
97209; 503-242-2567 or 800-854-9126; cmcresrch@aol.com;

 
 
Family Practice Recertification on CD-ROM
Year/Version: 1997 edition (1990-1996)
 
Reviewed September 1997
by: Marjorie Lazoff, MD
Emergency Medicine
Philadelphia, Pennsylvania
Medical Editor
Medical Computing Today
 
Ratings (1=poor, 5=superior)
Content.........................4
Programming.................3
CAI...............................4
Error handling................5
Support.........................4
 
The peer-reviewed clinical journal for primary care physicians, Family Practice Recertification (FPR), annually places on CD-ROM the previous seven years' subject reviews, research article summaries, news briefs, patient care information, and review/CME tests. Contents can be accessed in three ways: a table of contents divided into year and month of publication; an index by subject, article title, or author; or a free text word search that accepts Boolean operators. The review articles are short and well referenced, and have a clear emphasis on general topics and practical information. In controversies such as the management of an infant with a fever, the authors usually present a practical, conservative approach, with documentation, rather than a full discussion more characteristic of academic reviews of the literature.
 
Each monthly issue alternates among 15 to 20 questions based on articles for CME, questions designed specifically to prepare for recertification, and questions based on ABFP in-training exams. Access to these questions is either through the table of contents of each monthly issue or from a separate page divided into groups and listed by month and year; there is no subject listing. Each question and its several choices follow one by one down a scrollable page. Below each question is an answer button which, when clicked, reveals the answer to the question above and, if there is no link to an FPR article, a succinct explanation. Like the articles, questions are basic if not easy, and practice-oriented. References are question-specific and include classic textbooks or peer reviewed journals.
 
The interface is attractive and relatively easy to navigate, includes bookmarks and annotations, and runs quickly and without discernible bugs. Unlike many other packages reviewed here, FPR accomodates those users who wish to move back and forth between an article and that issue's table of contents. Pop-up windows provide for graphics and multimedia, and are especially effective with regard to footnote references. Medical illustrations are artistic and instructive, and the 40 audio pearls and three video pearls are of reasonable quality and content. Multimedia is used as an adjunct to learning, if not as fully realized CAI.
 
Unfortunately, the content, while rich, isn't comprehensive enough to support a full review. Equally important, the content is poorly integrated. For example, kidney stone and renal calculi are listed separately in the subject index and refer to two different articles, and the search engine brings up two different groups of references. Surprisingly, the video explaining the swinging light test was not integrated with the excellent section discussing a Marcus Gunn pupil. Finally, there is no computer scoring or ability to generate questions randomly or by subject, as would be expected in software of this type.
 
This CD offers a relatively superficial review of a wide range of selected primary care topics with basic if not easy questions, an index and search engine, 43 multimedia pearls, and articles a mouse click away from their questions. This may be appropriate for family practitioners seeking a lightweight review to supplement more intensive study, at a not-so-lightweight price.
 
$295 individuals, $395 inst./network, updates $150; 2,400+ questions; 30 AAFP hrs. CME; one CD-ROM; minimum hardware requirements.
 
Source: CMEA Inc., 11770 Bernardo Plaza Court, Suite 351, San Diego CA 92128; 800-227-CMEA; hdg@cmea.com

 
 
Family Practice Review
Year/Version: April 1996
 
Reviewed February 1998
by: David W. Bauer, MD
Associate Director
Memorial Family Practice Residency
Houston, Texas
 
Ratings (1=poor, 5=superior)
Content.........................5
Programming.................4
CAI...............................1
Error handling................3
Support.........................5
 
T he 25th Annual Family Practice Review is a six-CD set, designed to prepare family physicians for the American Board of Family Practice recertification examination. Content of the package comes from the University of Nebraska's two-week Family Practice Review course, held in April 1996. Clinical content consists of a total of 86 lectures in 32 broad areas, such as adult cardiology, endocrinology, and family violence. The authors have recorded the original audio from the lectures, along with on-screen slides, and more than 2,000 printed pages consisting of copies of slides and each author's handouts are also included. This last feature is very useful.
 
Pretests, random testing, and post-tests are also supplied. A set of tutorials provides step-by-step instructions for using the program.
 
The program has three modules. After seven introductory screens (which cannot be bypassed), the main program screen appears. The main menu screen allows the user to select from nine broad content areas: Traditional Systemic, Pediatric, Surgery/Trauma/Movement, Elderly, Women, Cancer, Society, Head/EENT, and Miscellaneous. Selecting any of these with a mouse click brings up a submenu with specific topics. The user can also select a lecture by speaker name. From this main screen the user can also enter a testing module.
 
Once a lecture is selected, the program requests that the appropriate CD be placed in the computer. Lectures may be run continuously (as in the original lecture), or stepped through at the user's pace. A previous slide may be re-reviewed with a Back button. In addition, each slide has a drop-down menu listing all of the slides in the lecture. The user may move to any slide by simply clicking on its name in the list. At the bottom of each lecture slide screen are several labeled icons. From here, the user can exit the program, return to the main menu, go to the testing module, search for a word or phrase in any lecture, or save and review notes. The text from any slide may be copied to an internal notepad, and then can be viewed, edited, saved, and printed. Unfortunately, graphics may not be copied to the notepad. Nevertheless, being able to copy lecture slide text to a notepad facilitates note taking, and is an excellent feature.
 
A good, basic search capability is provided. All words in the slide text (but not from either the graphics or the speaker's spoken words) are available for searches. Typing "ear infection" results in a list of half a dozen or so lectures, whose slides contain those words. Advanced search techniques are not supported. For example, a logical OR is not available.
 
In general, the audio quality of the lectures is excellent. It appears that the speakers were recorded during the live presentation of their lecture. The format of the slides has been standardized across lectures, and is visually clean. However, errors in the original slides were not corrected during this reformatting. Disappointingly, the program makes no use of animation, video clips, or other creative application of multimedia.
 
The speakers are uniformly good, their topics are relevant, and material is organized in a logical fashion. In a discipline as broad as Family Medicine it is difficult to cover the entire specialty, but the creators of the course have addressed core areas well. Much of the information is not completely up to date, though. For example, there is no mention of some of the exciting developments in atherogenesis, such as the possible role of chlamydia in plaque formation, nor is there any discussion of homocysteine. The conference from which this program derived was held in April 1996, and the program was delivered to this reviewer in December 1997. By the time this review is read, the material will be two years old. With the rate of change of medical knowledge, this lag could be significant.
 
Three test types are offered. A 68-question pretest allows the user a way to determine his or her fund of knowledge prior to working through the lecture material. A post-test is also available, and can be mailed back to the University of Nebraska for CME credit (up to 70 hours). Both pre- and post-tests offer feedback at the end of the test. The third type of testing allows the user to specify how many questions to generate. The user can request feedback after each question, or opt for feedback at the conclusion of the test. Incorrectly answered questions are listed, along with the lecture in which the relevant material is discussed. The user may click on the lecture title to go to that lecture. The user is taken to the beginning of the lecture, not to the section of the lecture where the topic is discussed. The pretest is useful to provide a rapid assessment of the user's starting knowledge base. The random testing module allows the user to specify any number of questions from the 350-plus questions. The post-test is helpful for assessing improvement, and may also be used to obtain up to 70 CME hours.
 
This program has two major weaknesses, the first being the time lag between the actual lecture and release of the software. The Family Practice Board exam takes place in July, so to be truly useful the CD version of the University of Nebraska's review course (held each year between March and May) would need to be published almost immediately after the course. Second, a number of topics would benefit from the creative use of multimedia techniques such as animation and video. Their absence is disappointing.
 
The company has no current plans to produce an updated CD, but continues to offer audio and videotape versions of the annual conferences. A mailing for the University of Nebraska's live 1998 Board review course reveals that the tuition for this two-week seminar is $1,275, not including transportation, lodging, or meals. It would appear that the CD-ROM version is a bargain.
 
$650; 350-plus questions; 70 AMA hrs. CME; six CD-ROMs; 6 MB RAM, 15 MB hard drive storage space.
 
Source: CME Information Systems, 2000 Crawford Place, Suite 100, Mount Laurel NJ 08054; 800-284-3433 or 609-866-9100

 
 
Med-Challenger
Year/Version: April 1997
 
Reviewed September 1997
by: Marjorie Lazoff, MD
Emergency Medicine
Philadelphia, Pennsylvania
Medical Editor
Medical Computing Today
 
Ratings (1=poor, 5=superior)
Content.........................3
Programming.................5
CAI...............................3
Error handling................5
Support.........................5
 
Initially created for emergency physicians, Challenger Corporation has expanded its huge computerized bank of questions and answers to accommodate family practitioners, internists, and pediatricians, and to subjects common to primary care specialties such as ECG, dermatology and radiology. This review is limited to the comprehensive versions of the four specialty Med-Challengers; depending on the specialty, the comprehensive material is also divided into five to seven modules, each of which may be purchased separately.
 
All comprehensive versions are cleverly housed on one CD accessible by code keys purchased through the company. Each specialty is divided into chapters and topics comprising well-designed review-type questions with a very brief supporting explanation. Content is shared; for example, both family medicine and internal medicine contain the same 29 neurologic assessment Q&As. But content is also selective, so that only the former program includes head and neck trauma (as does the emergency medicine version), and questions within topics are sometimes individualized to the specialty as well. Unfortunately, there seem to be strained inclusions and missed exclusions. For example, the family practice version includes three chapters on trauma but none on preventive medicine, and despite the obvious importance of a skilled neurologic assessment in the newborn and infant, the pediatrics version contains the same 29 adult neurologic assessment questions noted above. Challenger describes itself as covering all aspects of acute primary care medicine, which very arguably excludes preventive medicine and neonatal neurologic assessment in the family practice and pediatric versions÷but certainly these are central topics from a Boards review perspective. There are enough exclusions that purchasers are advised to review the list of chapters and topics, and pediatricians should be aware that many questions are drawn from the bank of adult Q&As.
 
The Q&A data bank is treated as primary reference and as such is appropriately and extensively indexed with a topic (not free text) search that links directly to a question. Lists of images and references are similarly presented but are not linked to either the index or question. This is particularly disappointing with regard to references, since users seeking further information on a specific question can not reliably find that question's supporting data. The most recent references are four years old and many come from the 1980s, and the index's topic-related Items to View window is too small at 600 x 800 resolution to show the full title. Taken with a greater than usual disagreement with a number of answers, I find it difficult to regard Med-Challenger as a primary reference.
 
Although its content is less credible then one would hope, Med-Challenger excels as quick, solidly programmed software. The main menu is busy but organized, with click-on tabs on top for review, test, index, images, and reference lists. Access to Q&As is via several well-thought out formats, each under the user's full control: either all or only new questions, with answers provided for content review or in test mode, within a topic or randomly generated. I found the many accompanying photographs, radiographs, and illustrations to be of acceptable quality, with a welcome zoom feature although without much-needed arrows to hone in on important anatomy or pathology; SESAP's marker toggle, disabled while in testing mode, may be a good solution here. Both recall and recognition can be tested since at first only the question is presented. Accompanying images in pop-up windows with zoom features and captions are identified by an open eye on the vertical toolbar at the left of the screen. Clicking a Show Answer button at the bottom of the screen reveals the multiple choice or check-all-that-apply reply options, and new buttons that let one include the selection in one's official tally, keep it as practice, or ask the software to provide the answer. A correct selection is accompanied by an optional tada.wav sound file but I could find no way to disable the messages of encouragement in the status bar. Scores are saved from session to session and can be downloaded for backup or CME credit, although scores can also be reset at any time. Personalization features on the vertical toolbar include bookmarks and notes, either of which can be searched. The minor software bug in the find dialog box that disengages keyboard entries until the first letter is entered via a mouse click should be easy to fix.
 
Challenger's sophisticated programming is unfortunately weakened by the limited scope of its non-EM specialty content, by its lack of supporting and suggested references for each question (the only program in this group that fails to do so), and by providing relatively few references from the 1990s.
 
$615; 4,000 questions; 192 AAFP hrs. CME; one CD-ROM (comprehensive), or one or more diskettes; diskettes require up to 25 MB hard drive space.
 
Source: Challenger Corp., 5530 Summer Ave., Memphis TN 38134; 901-385-1840 or 800-676-0822; http://www.Chall.com

 

of other articles
 
Reviews of other Boards Review Software:

• Introduction and Comparative Chart
• Emergency Medicine
• Internal Medicine
• OB/GYN
• Pediatrics
• Psychiatry & Neurology (no product reviewed yet)
• Surgery