The iPod Touch Medical PDA: Med Student’s Best Friend

Previously, I began adapting my iPod Touch to be used as a medical PDA during my clinical clerkships and beyond. Thus far, the results have been rewarding and are in part supported by the notable rapid spread of iPhones (and a handful of iPod Touches) that I have seen in the workplace among attending physicians, residents, medical students, and even a few nurses. (I chose an iPod Touch instead of an iPhone because of the cost of AT&T phone and data plans and the poor reception of its network in the hospitals where I work; I felt that it would seem unprofessional to not be reachable by cell phone since Tulane medical students are not provided with pagers.) Riding the popularity of the iPhone as a revolutionary device, the iPhone/iTouch platform has attracted a variety of medical resource publishers and software developers that have turned them into indispensable devices. In honor of those people who have made this early stage of my medical career so much easier with the power of knowledge and technology, I would like to list my top 10 medical resources for the iPhone/iTouch and the ways they have empowered me.

10. Apple’s Calculator – INCLUDED

When your last math class was sophomore year of college, nothing beats having a calculator to aid one’s atrophied mathematical skills (especially when they were questionable in the first place). In particular, having a calculator is essential during the Pediatrics clerkship when calculating nutritional balance (whether with infant formula or total parenteral nutrition) in the NICU, assessing urine output and fluid intake, and determining the amount of fluid with which to replenish and maintain a pediatric patient. Fortunately, there were plenty of calculators at each bed in the PICU and NICU, but resources on the Pediatrics general ward (including computers, chairs, and flat surfaces) were always scarce.

Replaced: a pocket calculator

9. Translator – FREE when obtained

This one would be higher on the list if I had an iPhone (i.e. a dedicated internet connection) and had discovered it sooner. However, I have only been using it for the past few days, and I am delighted to note that translations within the program are saved until manually cleared. The program accesses Google’s online translation engine so it is less useful for iPod Touch users, but the retention feature is an advantage. I can keep an entire Obstetrics/pregnancy workup in Spanish on hand while on my Ob-Gyn rotation during which I have encountered many patients who only speak Spanish. ¿Se ha sentido contracciones? ¿Ha tenido sangrado vaginal? Náuseas? Vómitos? I’m not entirely sure that the wording and grammar is entirely correct (I will need to check with my fluent Spanish-speaking fiancée), but it is enough to get the right idea across.

Replaced: a pocket translation book (Translator + PDF viewer with medical Spanish PDFs does the trick for me)

8. Games – variable

So, this has nothing to do with medicine, per se, except that there can be downtime during the medical student training experience. Ideally, downtime should be spent studying and reading up on information regarding the illnesses of one’s patients (and others cared for by your team). However, when you’re on-call for 24 hours, your resident is asleep, and you are switching off with her for the q2 hour laboring notes that have to be done on the Labor & Delivery patients overnight, you sometimes want something else to do besides reading in Blueprints or First Aid or Case Files. Also, while I seem to now have the amazing ability to read Neurology textbooks for fun, I have to work very, very hard to remember anything about the types of urinary incontinence and their treatments. At times like those when one feels daunted by the task of reading about urinary incontinence, it’s nice to break out a delightful few minutes of Tap Tap Revenge or win another battle in Reign of Swords.

Replaced: being painfully bored and miserable, melting brain cells watching VH1 reality shows (e.g. Scream Queens) on the call room TV

7. Eponyms (for Students) – FREE

This is an excellent resource that helps ameliorate one age-old problem in medicine: the tendency for pioneering doctors to name things after themselves or their mentors. Frankly, I find eponyms annoying and try to avoid using them (in lieu of more explanatory medical terms, e.g. “low transverse abdominal incision” instead of “Pfannenstiel’s incision”) whenever possible to avoid confusion. However, many physicians continue to use eponyms in their teaching, often in deference to the great physicians of yore. This app (the student version is free) provides concise descriptions of the numerous medical eponyms that plague clueless medical students everywhere.

Replaced: constantly asking attending physicians to clarify eponyms or wasting time looking them up on Google

6. Apple’s Calendar – INCLUDED

During the clerkships, it is essential (even more so than during the preclinical years) to manage your time well and to know where you need to be at each moment in time. I can’t imagine going through each day without having a detailed, updated calendar (whether in paper or electronic form): there are far too many training sessions, preceptor teaching sessions, meetings, changes in location and unpredicted reschedulings to account for. One underlying concern of medical students (and their evaluators) during the clerkships is the appearance and demonstration of “professionalism,” and it generally enhances the professional component of your conduct when you have a good handle on each situation.

Replaced: a pocket calendar book

5. Apple’s Mail – INCLUDED

The primary mode of communication by my school’s clerkship coordinators and directors to students is via e-mail: all of the important (scheduling and assignment) information is provided through this venue, and it is expected that we check our e-mail frequently. Even though I don’t always have access to free wireless on my iPod Touch, I usually have enough opportunities to grab a connection (which is especially useful when clerkship coordinators relocate a lecture half an hour beforehand). Furthermore, location assignments and rotation assignments are sometimes provided on a first-come, first served basis, and having access to e-mail is essential at such times.

Replaced: using the hospital or library computers to check e-mail

4. Apple’s Clock – INCLUDED

In the absence of a wrist watch, I currently use my iPod Touch as my timekeeper (and have developed a decent sense of the passage of time; there are, however, usually many clocks in patient rooms and throughout hospitals and clinics). The included Clock app, however, has served me in a variety of functions: the Stopwatch has been useful for counting fetal heart beats (using a fetal heart monitor, often in the 140 bpm range) or adult heart beats, the Timer is useful when I am budgeting time between clinical duties, and the Alarm is useful when I don’t trust having just my cell phone alarm to wake me up while on-call. Like they say, “Time is of the essence.”

Replaced: a wristwatch, stopwatch, and alarm clock

3. Datacase – $6.99 when obtained

Datacase has been a very useful, adaptable resource for me: it is a file storage program that allows me to read a variety of file times, most importantly PDF. A variety of medical resources are available in PDF format, and Apple computers allow one to “Print to PDF” when viewing webpages. Apply this ability to the “Print Chapter” features on the Access Medicine website (for which my school has a site license), and with a few hours work one can have a digital copy of Harrison’s Internal Medicine, Current Medical Diagnosis and Treatment, and many more on an iPod Touch or iPhone. The one disadvantage is that the program does not automatically resize pages, so one may be stuck with reading text in a small font on the relatively small screen; however, you can increase the font size of the web pages before “printing to PDF” in order to overcome this issue.

These, along with other medical resources and texts in PDF format, have provided me with a library of medical knowledge at my fingertips at all times. While I prefer accessing resources such as UpToDate on the hospital computers when possible, there are many more instances when having access to medical knowledge during rounds, lectures, and on the move has made the investment in a file storage and viewing program worthwhile.

Alternatives: Air Sharing, Files, etc.

Replaced: carrying a horde of books in my white coat pockets (especially ones that make some clinical preceptors unhappy, such as review books)

2. Mediquations – $4.99 when obtained

I can’t overemphasize the utility of a medical equations calculator, and these programs are some of the most popular medical apps I have seen on the iPhones and iPod Touches of students and doctors. There are numerous medical equations and algorithms that dictate patient care, and instead of Googling the equations on a hospital computer or memorizing all of the equations, it is much easier and faster to use one of these apps to accomplish the task. Some of my frequently used equations: Temperature Conversion and Urine Output. Next month on my Internal Medicine rotation: FENa, Corrected Sodium, GFR, etc.

Alternative: MedCalc, MediMath, Medical Calculator

Replaced: wasting neurons memorizing equations and wasting time searching for equations on Google

1. Epocrates Rx – FREE

Lastly, Epocrates has been the golden fleece of iPhone/iPod Touch medical apps: until my Ob-Gyn rotation, I was accessing it more than twenty times per day (on Neurology, Psychiatry, and Pediatrics). For a medical student who has only recently delved into the endless sea of generic drug names and trade names, Epocrates Rx is a godsend: I use it to figure out the indications for a medication, to determine its real spelling (since patients often mispronounce the name) and alternate name, to determine the dosages for writing orders or prescriptions, to determine the cost, to determine contraindications and adverse reactions, etc. Also, Epocrates Rx has an excellent Interactions Checker that allows one to input multiple medications.

The program allows for frequent updates, and it evens provides brief one paragraph summaries on major clinical studies affecting the use of pharmaceutical treatment. In the age of evidence-based medicine, access to up-to-date knowledge is vital.

Replaced: a pocket Pharmacopeia, especially an ugly one (not mentioning names) that you actually have to pay for

Runner-Ups:
• Netter’s Neuroscience Flash Cards ($39.99 when obtained) – These are beautiful and nicely organized and will likely be more useful in the future when I need to reinforce my knowledge of neuroanatomy. However, I rarely had time during my Neurology rotation to consult these cards. They would be useful prior to a Neurology clerkship as a refresher, especially if it is a long time since one has taken the USMLE Step 1 exam (and if one didn’t have quite as many Neuroanatomy questions as I did on mine).

• Apple’s Video Player (INCLUDED) – NEJM has a variety of excellent procedural training videos available on its website that provide instruction on how to insert peripheral venous lines, intubate a patient, incise and drain an abscess, perform a pelvic examination, and more. I have viewed some of these videos on an as needed basis. I think this will become more useful during my fourth year of medical school and during my internship/residency when I will be more involved and also required to perform these procedures.

Not Yet Explored:
• ReachMD (FREE) – a CME resource with downloadable, 15-minute mini-lectures and quizzes redeemable for CME credit

• SkyScape (FREE) – a multipurpose resource including a drug database, evidence-based “outlines” for medical practice, and a medical equations calculator

• Netter general anatomy, musculoskeletal anatomy, and surgical procedure flash card – similar products to the neuroscience flash cards I purchased, but I’m not sure I need to spend $40 on each one; the anatomy cards are probably more useful for first and second year medical students

• BRS flash cards – information cards from a popular review book series

Future Gems:
• Epocrates Essentials ($149 for one year) – One highly anticipated software package is the Essentials diagnostic and treatment resource provided by Epocrates that has been used by many physicians on their past PDAs. Some medical schools actually provide this software free for their students (using their site licenses), so take advantage of it if you have that option available! I’m not certain I will spend the money on this resource when it arrives (especially if it is provided through my residency program) as my Pocket Medicine binder has proven to be a useful, expandable complement to my iPod Touch.

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21 comments
  1. Ben said:

    Wow — these look pretty awesome. I had heard Epocrates was pretty good. Just curious, what’s in Epocrates Essentials that isn’t in Rx?

  2. Apollo said:

    Epocrates Rx is primarily a resource on medications, while Epocrates Essentials is a more comprehensive package including information about diseases, treatments, diagnostic studies, some packages including ICD-9 coding information, etc. I’ve never used it before, but I’ve seen other doctors use them on Palm Pilots and Treos.

  3. Thanks so much for mentioning that Epocrates Essesntials is coming soon for the iPhone.

    There’s a discount running right now — if you pre-order Epocrates Essentials for the iPhone before December 19, 2008 you get 25% off ($38 savings) plus a chance to win a $500 Apple Gift Certificate!

    Here’s more info:

    http://www.epocrates.com/landing/essentials/

    Best wishes,

    The Epocrates Team

  4. Brian Hanson said:

    Where did you get the ‘Translator’ app? Seems to be a couple of them named that out there…..

    Thx (my daughter is ob/gyn intern in Houston…lots od spanish only patients…..think it would be extremely useful to her.

    Brian

  5. Apollo said:

    Hi Brian – It’s actually listed as “Language” by NibiruTech. Unfortunately, they just raised the price back to $9.99, but I think it would still be quite useful for someone with an iPhone and the patient population that could benefit from it.

  6. can said:

    do u think an 8gb itouch is sufficient for a few downloaded programs? im a nursing student currently.

  7. Apollo said:

    Hey can – I use an 8 gigabyte iTouch, and it has plenty of space for all the programs I have been using + lots of music and videos.

  8. can said:

    thank u!

  9. Ed said:

    Apollo

    Could you answer a few questions for me:

    Is the external speaker loud enough to wake you up?

    I have read from other sites that the calendar only play beeps for just a short interval as a reminder. Is that true?

    Are the applications stored in the 8 gig area or the 300 megabyte area that is also used by the OS?

    Thank you.

    • Apollo said:

      I have a first gen iPod Touch, so the external speaker is only used for the timer and alerts. I’ve used it as an alarm clock for naps and on call nights and it seems to work pretty well. Whether or not it would wake me from the dead on a regular work-day morning remains to be seen.

      I have not actually used the calendar alerts so I can’t comment on that at this time.

      The applications are stored in the 8 gig area along with music, movies, pictures, etc.

  10. For those who may be interested in acquiring an iPod Touch as a replacement for a PDA, I have found it to be quite useful. The primary function used in this regard is syncing with Microsoft Outlook, which works flawlessly. Now I can check appointments and find those phone numbers for early morning conference calls without waiting 10 minutes for my laptop to boot up.

    The new software improves the functionality by adding the notes capability, and I even find myself frequently viewing video podcasts – something I never thought I would use.

    The most important functions for me in a portable device are calendar, music, notes, photos, and Audible book playback, all of which this iPod handles very nicely. I have also used the maps feature for driving directions – load it up while on the home WiFi network, then the directions are retained for reference – in a much more useful format than if you print out the directions on Google. Just bring along a navigator, as I would not recommend trying to read the iPod while driving. The same applies to paper maps, of course.

  11. Sha said:

    Hi Apollo,

    I am studying to be an lpn, am not at all tech savy (and possibly even a touch tech scared) , and yet I am considering purchasing a pda of some sort for use in clinicals and beyond.

    You have done a pretty good job at selling me on the iPod Touch. (So good that I ran down to my local Apple store to play with one for a bit.) I have never owned an MP3 player or a PDA. I still have several questions and am wondering if you could help with some of the answers…

    1. Have you tried skyscape yet?

    2. Forgive my ignorance, but are you basically saying that Datacase lets you put whole books on your iPod Touch?

    3. If I have something like Tabor’s on a CD-Rom, is there some way to get that onto the ipod touch?

  12. Sha said:

    Thanks for any and all help 🙂

  13. Sha said:

    Here’s another question…

    Are you always able to access all of these programs even when you are not in range of an internet connection?

  14. Alot of bloggers are not very pleased with the new iPad.There was 2 much hype about it and alot people got turned off.Quite frankly, I can actually see great deal of the awesome potential of the gizmo. Third-party applications for doing tunes, games, papers and magazines and books, tons of good stuff, but IMHO they just didn’t really sell it properly (excluding the books). It smells kind of not finished

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