Surgery Boards Review Software
 
 
accepted for publication in Medical Computing Today October 1997
January 1999
 
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.

 
ACS Surgical Education and Self-Assessment Program
Year/Version: 1996-8

Reviewed September 1997
by: Marjorie Lazoff, MD
Emergency Medicine
Philadelphia, Pennsylvania
Medical Editor
Medical Computing Today
 
Ratings (1=poor, 5=superior)
Content.........................5
Programming.................5
CAI...............................5
Error handling................5
Support.........................4
 
Leave it to the American College of Surgeons to develop the most innovative, multimedia-rich, yet straightforward Boards review software: the Surgical Education and Self Assessment Program (SESAP).
 
The opening index screen is a table listing 17 categories covering what appears to be a broad base of surgical specialties, pre- and post-op care, anesthesia, cancer, transplantation, trauma, pediatrics, etc. This screen also keeps tallies of each category and total number of questions answered, and answered correctly. Click on a category, and a new screen introduces the first question and selections, often accompanied by a photograph or radiograph of surprisingly poor quality. Immediate feedback is given but any selection engages the "critique" button, and that's where the fun begins. The critique screen gives full explanations, lists journal references supporting the answer, and not infrequently provides a multimedia snippet: an audio clip explaining an accompanying radiograph, an animation illustrating the progression of a condition over time, the gross pathology specimen of the traumatically ruptured organ whose studies were presented with the case, an ultrasound that complements an earlier CT scan. When needed, the user can toggle a red circle on the graphic to clarify what is being discussed. A timer sits on the top of the screen clicking away the minutes. If the condition progresses or complications arise, a number of questions and/or multimedia are presented together. Before quitting, the user can download scores to a floppy for CME credit.
 
SESAP enjoys an excellent reputation among surgeons. In areas where I have clinical familiarity, such as trauma and wound care, I found the questions of appropriate depth and relevancy. Design and layout are elegant, and navigation is intuitive. Aside from one small bug, the software ran flawlessly.
 
There is room for improvement. X-ray resolution and exposure are dismal. While most of the multimedia elements are well constructed and educational, some are more clever than instructive. The screen that lets one calculate percentage of whole body burn by clicking on ages and body parts, for example, could use an audio clip to summarize and direct the user's attention. I miss not having access to all multimedia separate from the questions, a search engine to select out groups of questions rather than depend on the categories provided, and the ability to randomly generate questions. I suspect this software has many advantages over the print version, which may encourage purchase by surgeons who might otherwise avoid computers. For them, a more generous instructions booklet, perhaps one fitting into the front cover of the jewel box, would be considerate.
 
Surgeons who review best by answering questions rather than reading monographs, review articles, or booklets have chosen the right specialty. The rest of us should encourage our specialty organizations to request a surgical consult on our sickly electronic Boards preparation software.
 
$450; 650 questions; 60 AMA hrs. CME; one CD-ROM or three diskettes; requires 8 MB RAM, sound card (for CD) or 15 MB on hard drive (diskettes).
 
Source: American College of Surgeons, P.O. Box 92425, Chicago IL 60675-2425; 312-664-4050; http://www.facs.org
 
Comments
 
Contributed January 1998
by: Peter M Taft, MD, FACS
Chief of Surgery
Kaiser Permanente
San Diego, California
 
As a general and vascular surgeon who has practiced for 18 years, I have taken several recertification exams, usually spending the prior week with a major textbook as a study guide. This year I tried the computerized version of the Surgical Education and Self-Assessment Program (SESAP, also known as COMPUSAP) instead. When exam time came, I finished it promptly, and felt that I knew the correct answer in the majority of the questions.
 
SESAP presents 650 multiple choice questions divided into 17 categories that are accessed via an Index screen. This screen reappears as each section is completed, and it shows the total questions in each category, the number of questions answered, and the number answered correctly.
 
The question screens are essentially the same throughout the program, allowing the user to concentrate on the questions, answers, and explanatory material (called critiques), rather than the mechanics of the interface. Each narrative question, which often has an accompanying picture or x-ray, is followed by five multiple choice answers. Some questions do not stand alone but are linked into a series called "stems." As a programmatically nice touch, only the very first choice is counted in the score even though the user can review the question and select other answers as often as desired. In addition, the critiques are not accessible until an answer is selected.
 
Minor criticisms about the quality of some of the illustrations and the rarity of references more recent than 1994 aside, the critiques are the heart of SESAP. They are, in a word, superb etc. Often many paragraphs long and frequently accompanied by pictures, charts, x-rays, or movies, they represent the current state of the surgical art; each is authoritatively presented and complete. In the course of using this program gaps in my knowledge were filled in nicely, especially areas in which I have little clinical experience or exposure. Another gauge of the quality of the program is that, in areas in which I consider myself proficient, well-read, or even expert, the questions (and critiques) were relevant, complete, and fair--not at all obscure.
 
This is not a study aid for the time-pressed, faint of heart, or impatient surgeon. I spent many hours over a number of days. Along the way I was rewarded by a unique educational experience, which was worth the effort I brought to this endeavor. I reviewed areas that I know well, filled gaps in things that I should know, and learned a number of items that were frankly new to me. The diligent user of this well-done program should be similarly rewarded, no matter what the reason for choosing to use it.
 
Surgery
Year/Version: 1998

Reviewed September 1998
by: Peter M. Taft, MD, FACS
Chief of Surgery
Kaiser Permanente, San Diego
Surgery Editor
Medical Computing Today
 
Ratings (1=poor, 5=superior)
Content.........................5
Programming.................4
CAI...............................5
Error handling................5
Support.........................4
 
From the time of Johannes Gutenberg (circa 1450) through the last three decades of the twentieth century, the publishing business remained fundamentally the same: information was transmitted via paper imprinted with ink set in place by moveable type. With the advent of computers, photocopying, and laser printers, a portion of that process has been at least partially changed, but we continue to use paper to transfer knowledge from the author to the recipient. Ask any medical student or resident about the portability and convenience of paper-based books, one will (literally) hear a groan as three-pound tomes are hauled to and from classes, libraries, and other study venues. Yet paper-based books are familiar: we intrinsically know how to use them, how to find the table of contents, index, and chapters. We don't need instructions to read a novel or a newspaper. We can find specific information in a medical textbook with relative ease. Now as we approach the next millennium, we are finding much of our information content displayed, not on paper, but on a computer screen. The sources include 3.5-in. diskettes, CD-ROMs, scanned paper sources, and, most ubiquitously, the Internet and its World Wide Web. Content is still content, but ease of use and ability to comprehend the information as displayed have become important keys.
 
Surgery is an interesting and useful CD-ROM for the medical student, neophyte general surgery resident, or experienced general surgeon. Its content is a relatively straightforward transport of two textbooks and a study guide to the computer screen. There is essentially no multimedia content, nor much in the way of true hyperlinks. There is, however, valuable in-depth general surgical content, which leads me to recommend the CD-ROM for those who prefer the computer screen to a paper page.
 
Surgery: Scientific Principles and Practice, 2nd Edition (Lazar J. Greenfield, MD, Editor-in-Chief) is one of the best surgical textbooks available. It is thoroughly modern and up-to-date with 114 chapters written by 183 contributors covering the entire gamut of surgery, from a broad overview of key basic surgical principles to detailed treatises on major organ systems and their associated surgical diseases and treatments. These treatises can be accessed by using the table of contents, somewhat rudimentary hyperlinks, or a superb search engine. Major surgical approaches, as well as less commonly applied alternatives, are discussed. References (found as pale yellow pop-ups directly accessed within the body of text, or at the end of each major section as a complete listing) are complete and up to date. Illustrations and tables are of only good presentation quality, and are available from the body of the text using either blue-underlined links or mini-icons in the right-hand margin. Overall I was quite pleased by the depth and the accessibility of this text. The search engine is available for either of the two textbooks, as is the ability to annotate the text or add bookmarks to each book.
 
Mastery of Surgery, 3rd Edition (Lloyd M. Nyhus, MD, et al.) is a superb blend of surgical science and art, with an emphasis on surgical procedures currently performed today, including some of the latest laparoscopic techniques. Here the reader is rewarded with an excellent series of chapters on perioperative care, followed by sections divided into systems or anatomic regions. Relevant anatomy, preoperative evaluation, and patient preparation, as well as surgical indications are often discussed; these precede detailed descriptions and illustrations of the various applicable operative procedures. Postoperative management is also described. A discussion of the role of the procedure and suggested reading usually follows, and there is often an editor's comment to place the procedure in context. This rounds out each chapter in a manner quite helpful to the experienced general surgeon who may be dealing with a patient with a relatively uncommon or unfamiliar (to him or her) surgical problem. Within each chapter, material is accessible through a sub-table of contents, hyperlinks or the excellent search engine.
 
The last text included is the Review for Surgery: Scientific Principles and Practice (Lazar J. Greenfield, MD, et al.). This is a fairly comprehensive multiple-choice quiz with sections corresponding to the chapters in Surgery: Mastering Principles, Practice, and Techniques. Answers to the questions may be viewed at the click of a button with a discussion of the correct responses, and links to the appropriate chapter(s) of the main text. Unlike the SESAP CD (review and comments above), the answers are accessible prior to completing the questions, thus diminishing the value of this book as a true quiz. There was also an elapsed time indicator that potentially makes this section of the CD-ROM valuable practice for specialty board review. My version of the quiz was marred by the product's only real programming lapse: the questions in each section were nearly completely obscured by the User Name and Mode: Self-test tabs. There seemed no way to turn them off so I was unable to take the quiz successfully until a call to Technical Support quickly and completely resolved the issue. Unfortunately this involved globally changing my system Display setting from "large font" to "small font"; poor programming, indeed. Once I was able to use the quiz section successfully, I found it a complete and useful portion of the CD-ROM, although text-based and wanting compared to the spectacular SESAP offering.
 
What about this program as a new way to present the excellent surgical content? Here my report is decidedly mixed, yet I am uncertain if the fault lies with the relatively new mode of presenting a vast quantity of text on a computer screen, or with this particular CD-ROM. I suspect (without solid data) that it will just take time for me to adjust. As far as other -- software -- aspects of the CD-ROM, I can report that the links that are present are useful and appropriate, but are limited to relevant chapters or sections in the other texts, and not to other items or subsections within the same textbook, which would make the CD more useful. Using the search mode is much more rewarding since it is blazingly fast; I suspect the publisher indexed the entire content. The search results were accurate and highly relevant, the navigation buttons work as expected, and the ability to save and/or print sections of text is quite useful. The help files, while not Windows-standard, are also useful.
 
What then is my overall assessment of this new descendent of Gutenberg? Am I ready to clean printed books off my shelves, and trade them in for racks of CD-ROMs? I guess the answer is "no, not yet, but perhaps soon." I think it is the presentation and ergonomics of the new media, and not the content that will sway me. Until then, this superb surgical content is valuable and useful, even if I have to struggle a bit to use it in this format.
 
$249; 1400 questions, one CD-ROM for Windows or Mac; no CME credit, single-user.
 
Source: Williams & Wilkins, 227 East Washington Square, Philadelphia PA 19106; 800-777-2295 or 301-714-2300;
 
 

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• Emergency Medicine
• Family Practice
• Internal Medicine
• OB/GYN
• Pediatrics
• Psychiatry & Neurology (no product reviewed yet)

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• Surgical Web Sites
• Musings on Surgery