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.

 
AAP Pediatrics Review and Education Program
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.................3
CAI...............................3
Error handling................3
Support.........................4
 
Bundled into a single CD (Pediatrics Review and Education Program, or PREP) are three powerhouse Pediatric resources: 10 years of scholarly review articles, abstract commentaries, case discussions, editorials, and self-study questions (alas, most without answers) from the journal Pediatrics in Review (PIR); five years of the American Academy of Pediatrics' excellent Self-Assessment Exercise (SA); and four years of American Board of Pediatrics' Content Specifications, a 31-topic outline syllabus for self-study updated yearly by the American Board of Pediatrics (ABP).
 
PIR's main menu lists issues by year, then month, and offers direct access to several sections and to ABP's 12 Record Review Guides. PIR's content aims to represent both the depth and breadth of pediatrics, although covering a span of 10 years necessarily means a fair amount of the material is outdated. Sadly, PIR is not linked or cross-linked to the Content Specifications. When compared to its electronic database equivalents in family practice or internal medicine, PIR as presented isn't easily usable as a systematic review.
 
The second resource, AAP's Self-Assessment Exercise, is organized by year and also by the 31 topics defined by Content Specifications÷a very nice touch. These thoughtful, clinically-oriented multiple choice questions are posed at the top of the screen and the answers, along with extensive explanations, become visible only after the user scrolls or Pages Down. There is no automatic scoring or ability to generate random questions, although the ability to access groups of questions by date or specialty helps offset this limitation. I did not encounter a question that used radiographs or illustrations, and while all questions are referenced not all references from PIR are linked. For example, in 1996 SA #48, the PIR reference to acute alcohol ingestion had to be manually searched for on the CD, although the PIR reference above it was linked.
 
The Specifications are an excellent resource that does not seem to vary much from year to year, and would be more useful if also presented by topic, with the year(s) noted in parentheses. Indeed, CMC ReSearch should consider linking relevant PIR references, SA Q&As, and a consolidated listing of all the previous years' outlines under each of the Content Specifications' 31 topics. Pediatricians studying for the Boards will want the current year's Specifications, not on the CD.
 
The interface is similar to most CMC ReSearch software, although this program's multiple and poorly integrated resources bring out the navigational weaknesses. For example, there is no direct access from an article to its issue's table of contents, an inexplicable deficit other software reviewed here shares. There is no way to scan all major articles as one can abstracts and case studies. Also, several menu options overcomplicate the software, such as additionally listing Record Review Guides and the specialty division of Self-Assessment Exercise by individual year while already distinguished by year on other menus. PIR articles are unlinked until 1994, although their tables and figures are accessible via the overhead menu bar. However, answers to these earlier articles' PIR self-study questions are not provided, and the font and layout make for tiresome online reading.
 
In using PREP I felt more like a beta-tester than a reviewer. Until 1992 the PIR menu calls up half the previous year's issues, which results in navigational confusion and, presumably, the absence of every May and June issue through 1990 and all the 1991 issues from July to December. Under 1996's Content Specifications, #10 is listed as Eye Infections, yet the actual information relates to Metabolic Disorders (and only its first few lines). The search engine commonly calls up double listing of articles, and in at least one case (October 1996's In Brief on Infantile Spasm) there was enough difference in formatting to demonstrate they actually were two near-identical versions of the same article.
 
Everyone will benefit if AAP, and pediatricians with computer and educational expertise, work with CMC ReSearch to help organize and present this wonderful information electronically.
 
$195, updates $95; 1,500 questions; 0 hrs CME; 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;
http://www.cmcresearch.com/~cmcr

 
 
CCF Pediatric Board Review
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.........................4
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 Second Pediatric Board Review software is the lectures, heard through the speakers as the lecturer's slide show automatically advances on the monitor screen. As typical for review courses of this caliber, the 66 pediatric topics cover virtually all topics and new specialty material in appropriate depth and breadth. It also includes a series of Board Simulations Q&A presentations, although I was not sent the package's accompanying syllabus and other materials. 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.
 
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 software package also includes about 300 pediatric 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.
 
CCF's Internal Medicine review is characterized by skillfully delivered, up-to-date and authoritative lectures. Yet each of the dozen or so Pediatric lectures I listened to were of inferior quality in one way or another. Even a pediatrician introduced as a top lecturer gave a tired delivery, although the educational content was very good. Two of the pediatricians had distracting speech impediments in addition to mediocre presentations, and lecture slides as a whole were less impressive; unlike the internists, only one of the pediatricians documented the source of the data. Medical Support Systems (MSS), which created both products, informed me that the software was deliberately constructed "to reproduce the ambiance of a live lecture," implying that the differences in software quality is wholly accounted for by differences between the two live conferences. They verified the Pediatric package was accidentally distributed using the Internal Medicine name along the jewel box's spine.
 
Several of the lecture slides are out of synch with the audio. When made aware of the specific slides, MSS explained these lecturers' accidental delays in presenting the next slide were deliberately not corrected to retained the ambiance of the live lecture. Based on review materials Cleveland Clinic sent me regarding the 1997 Foundation conference, the Internal Medicine course directors reviewed 40 research studies and concluded that the lecture format alone is less effective when compared to lectures including other educational formats. Since they recognize this, I don't understand Cleveland Clinic's priority in reproducing the lecture ambiance over correcting audio/visual dissonance.
 
From the perspective of self-study and exam preparation, the efficiency if not actual utility of these programs 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 but the pediatric lecturers supplied information that only permitted software links to the specific lecture. Therefore, during the Pediatrics final test, the user is left to discover the correct answer among the slides or within the 30 minute lecture. 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.
 
$699; 300 questions; 44.5 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

 
 
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.
 
$520; 3,000+ questions; 155 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
• Internal Medicine
• OB/GYN
• Psychiatry & Neurology (no product reviewed yet)
• Surgery