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.

 
ACP MKSAP 10 Electronic
Year/Version: 10th edition

Reviewed September 1997
by: Marjorie Lazoff, MD
Emergency Medicine
Philadelphia, Pennsylvania
Medical Editor
Medical Computing Today
 
Ratings (1=poor, 5=superior)
Content.........................5
Programming.................4
CAI...............................4
Error handling................5
Support.........................4
 
This is the first electronic version of the American College of Physicians' Medical Knowledge Self-Assessment Program, whose authoritative content and tests are well known to three decades of Boards-studying and CME-seeking internists. It's hard to imagine anything threatening the internist's pre-Boards ritual of curling up with a MKSAP booklet, a yellow highlighter, and a beverage of choice÷but the simple convenience of all those booklets and questions on a single CD comes close. Other advantages of the electronic version include immediate answers and satisfying critiques to the multiple formatted test questions, automatic score tally with a reset option, the convenience of index and search features, and the nearly 100 Annals of Internal Medicine full-text articles (not abstracts!) linked from the wonderful bibliographic references. Content is tersely written and skewed to major topics and new diagnoses and therapies; while very extensive, MKSAP is not a textbook review of internal medicine.
 
Largely because its nearly 500 color images, animation, and audio/video clips are of mediocre quality (though good examples of CAI, such as they are) and are unequally distributed among its 17 sections, this software doesn't feel rich in multimedia. But the interface is clean and intuitive, navigation is easily accessible and text can be personalized with bookmarks, notes, and highlights. If needed, or for immediate reinforcement, the correct answer is cleverly toggled under each question. Three drawbacks: the software runs the slowest of any software reviewed here; the search engine, which thoughtfully performs both full and partial word searches, is limited to single words and operators (multiple sclerosis, for example, cannot be searched as a single term), and navigating each section's question beyond "next" and "previous" is inexplicably hidden under Test Status. Also, I could not find a way to randomly generate questions, and linking questions/critiques to the specific text references would be a nice touch.
 
MKSAP material and its transfer to the electronic medium are far from flawless, and its contents may not be basic enough to serve as the sole Boards review source for many internists, but this is the internist's Boards review software-to beat for 1997. However, I suspect it will fast lose its advantage if the quantity and technical quality of the multimedia CAI isn't vastly improved with its next release; MKSAP 11 print program is scheduled for release in October 1997, and the electronic version for release in Spring 1998.
 
$495; 1,700+ questions; 146 AMA hrs. CME; one CD-ROM; requires 8 MB RAM, 6 MB on hard drive, sound card.
 
Source: Mosby-Year Book, 11830 Westline Industrial Dr., St. Louis MO 63146; 800-426-4545; info@mosby.com; http://www.mosby.com

 
 
CCF Intensive Review of Internal Medicine
Year/Version: 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.................4
CAI...............................3
Error handling................5
Support.........................3
 
Many physicians recommend attendance at a good Boards review course for its expensive, time-intensive, but highly useful method of exam preparation. Unfortunately, no software yet combines the practical advice and educational expertise available at these courses with the unique features characteristic of the electronic format. However, Cleveland Clinic Foundation (CCF) demonstrates that computers can be used to reproduce at least part of a Boards review course experience.
 
The heart of the Eighth Intensive Review of Internal Medicine software is the skillfully delivered, up-to-date, and authoritative lectures, heard through the speakers as the lecturer's slide show automatically advances on the monitor screen. This lecture set emphasizes problem-based learning, and audience participation using the Audience Response System throughout. Here, each attendee electronically records an answer to a single multiple choice question presented on a slide, and the results are instantly tallied into percentages of correct and incorrect respondents for the lecturer to share with the audience. For software users, as for attendees, comparing one's answers to an audience of physicians makes for effective self-assessment.
 
As is typical for review courses of this caliber, the 75 medical topics cover virtually all topics and new specialty material in appropriate depth and breadth. The program also includes a series of Board Simulations Q&A presentations. I was not sent the 1997 internal medicine CD comprising an additional dozen topic updates, or the package's accompanying syllabus and other materials.
 
The software I did receive is well designed, with a clean intuitive interface. The main screen lists lectures by title, lecturer, keyword (particularly helpful), and time/place of the lecture. When selected, the user is informed, if necessary, which of the remaining four CDs to insert in the drive, at which time the selected lecture's main screen automatically appears. Controls located on the lower right corner permit excellent navigation back or forward through each slide in particular and through the lecture in general. A 640 x 480 resolution is required to read slide contents within the slide menu provided for perusal and navigation. When portrayed, most slides are of acceptable quality at any resolution; some slides are presented paired and so smaller than ideal, but here either slide can be enlarged while the audio is automatically paused. These navigation features give the software version an advantage over audio or video tapes. However, from an educational software perspective, multimedia is limited to the audio of the lecture with a slide show, interactivity is only for navigation, and personalization features such as bookmarks or annotations are sorely missed.
 
The package also includes about 350 medical questions that can be approached either as pretest or post-test. As pretest, the user enters a selection and is informed only if the answer is right or wrong. As the final or post-test, a right answer automatically advances the user to the next question whereas a wrong answer prompts a second try; if desired, the user can automatically return to the lecture before answering. If the second selection is again incorrect, the user is automatically advanced to the next question without feedback. Answers are not provided, and I was informed by Unitech (a subsidiary of Cleveland Clinic Foundation) that "to avoid cheating" answers will not be provided until the user submits the answers for grading or CME credit.
 
From the perspective of self-study and exam preparation, the efficiency if not actual utility of this program is arguably compromised without the answers to test questions. MSS confirmed that the Internal Medicine software directs the user to the exact slide referencing the post-test's incorrect answer. Purchasers will have to decide if this sole option for providing answers to test questions is efficient and/or helpful.
 
The good news is that with software like this, not much is gained by personally attending a Boards review course lecture, aside from the imposed discipline of group activities and the opportunity to ask questions (a potential Web feature). In fact, the lecture presented in electronic format allows for individual use, navigation, and retrieval at any time. Cleveland Clinic has thoughtfully considered how best to present its Boards review lectures to maximize group learning. Whether hearing and watching these same lectures is the most efficient or best educational format for individual computer users remains the important, unanswered, and expensive question.
 
I would hope the course directors and software developers reevaluate their use of the otherwise excellent Q&As in this software format. Test-takers not interested in obtaining CME but rather in self-study are left without immediate, direct, and efficient feedback on incorrect answers. Referencing a slide rather than a primary resource is not satisfying unless the slide itself has references, which most here do not. Indeed, given lecturers' imperfections and users' learning idiosyncrasies, returning all respondents who answer incorrectly to a slide or lecture may not educate them any better the second time around.
 
$989; 350 questions; 54 AMA hrs. CME; five CD-ROMs and syllabus; journal supplement. Requires MPC compliant sound card.
 
Source: Unitech Communications, c/o The Cleveland Clinic Educational Foundation, 9500 Euclid Ave., Cleveland OH 44195; 800-238-6750 or 216-444-8419; http://www.ccfunitech.com

 
 
Internal Medicine Interactive Text and Review
Year/Version: 1997
 
Reviewed September 1997
by: Marjorie Lazoff, MD
Emergency Medicine
Philadelphia, Pennsylvania
Medical Editor
Medical Computing Today
 
Ratings (1=poor, 5=superior)
Content.........................5
Programming.................4
CAI...............................2
Error handling................5
Support.........................4
 
I nternists who prefer using a textbook and study guide for Boards preparation should note that Kelley's Textbook of Internal Medicine, third edition, is the only major IM textbook presently bundled with a self-test companion: Schlossberg's Review of Internal Medicine. Also wisely included is Kelley's Rapid Access Guide, a pocket resource for quick summary and review of 375 clinical topics÷perfect for the Boards review. Without entering into the "which textbook is best" debate, extensive footnote references arguably place Harrison's and Cecil's higher in academic stature, although some feel Kelley's more contemporary cost-effective approach is critical given today's practice realities. From a Boards review perspective Kelley's is an authoritative reference, although more dated in places than its 1996 copyright suggests.
 
The opening screen presents Kelley's main table of contents, with easy access to either the Review or the Rapid Access Guide. Its typical Windows format includes the menu bar and a horizontal toolbar of commonly used features, including bookmarks and annotations. Unfortunately, incomplete integration results in none of these features being available to the Rapid Access Guide. Links within Kelley to charts, tables, and flow charts are via the text and as thumbnail images listed along the screen's right border. The color plates are beautiful, and the imaging studies are very impressive but far too stingy. A search engine permits Boolean operators and can include any or all three references. The search engine is essential for this CD, which has no index, especially given Kelley's complex table of contents that mixes clinical approaches to symptoms with diseases and conditions.
 
Each Review section includes a thoughtful Hot Topics for the Boards and tens of Q&As. The clinically-oriented questions are followed by five choices, four of which link to an "incorrect" pop-up window. The correct selection or clicking on the correct answer link produces a pop-up window with a full explanation and link to a chapter reference. Unfortunately, many references do not link to a helpful or relevant chapter, and I inexplicably found myself disagreeing with a number of answers despite agreeing with the answer's explanation. There is no automatic scoring, no way to randomly generate questions, and no mechanism for identifying completed questions unless the user manually annotates each after answering.
 
This flawed product may nevertheless be a solution for internists looking for a relatively inexpensive CD that offers an overview of internal medicine with hot topics and 1,100 Boards-type questions, all linked to a respected textbook.
 
$1,295; 361 questions; 64 AMA hrs. CME; one CD-ROM; requires 8 MB RAM, 11 MB hard drive
 
Source: Lippincott-Raven, 227 East Washington Sq., Philadelphia, PA 19106-3780; 800-777-2295 or 215-238-4200

 
 
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; 143 AMA 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
• Family Practice
• OB/GYN
• Pediatrics
• Psychiatry & Neurology (no product reviewed yet)
• Surgery