Symptom-based Case Studies on CD-ROM: Diagnostic Reasoning Series - Software Review

Journal of Family Practice, March, 1998 by Joseph J. Gallo

Novartis Pharmaceuticals Corporation, 556 Morris Ave, Summit, NJ 07901-1398.

How Supplied: CD-ROM.

Hardware/Software Requirements: For Macintosh: HyperCard/Player 2.3 or higher, 3500K of available RAM, and a 13 in. or larger color monitor (256 colors minimum). For System 7.0, HyperCard application requires memory of at least 3500K For IBM-compatible PC running Windows 3.1 or higher: 10MB hard disk space, at least 4MB of RAM (6MB recommended), 13 in. or larger VGA monitor with at least 640x480 resolution and a minimum of 256 colors. Windows users who want to hear the breath and heart sounds in the physical exam need a Sound Blaster-compatible sound card and speakers or headphones and Quick/Time for Windows.

Ordering/Technical Support: By telephone:(908) 277-5127; by fax: (908) 277-4478; or by E-mail: kelly.soop@pharmanovartis.com

Demonstration Disks: A self-running demonstration CD-ROM is available.

Money-Back Guarantee: Yes, 30 days.

Rating: Excellent.

Price: For a single physician, individual case studies cost $39.95 and a set of four cases costs $99.95. A workstation multiuser license is available for $650 for the first workstation and $325 for each additional workstation; and a network site license is also available ($1000 for the first site and $500 for each additional site). The academic version is only available with a site license, for which the first two case studies cost $950, and each additional case study costs $950. Discounts apply if you buy in sets of 5, 10, or 20.

As the name implies, Symptom-based Case Studies on CD-ROM provides symptom-based CME case studies. These case studies are a wonderful way to simulate the types of interactions so common in primary care settings, and they are fun to use, too. The symptom-based approach, which takes the user through the diagnostic process, is much more realistic than a written review of a topic.

There are two versions of this CD-ROM: a professional version and an academic version. The professional version has five case studies available (rheumatology, neurology, osteoporosis, heart failure, and hypertension). I reviewed four patient cases: a 22-year-old man with joint and back pain, an 8-year-old girl with staring spells, a 52-year-old woman with back pain, and an 80-year-old man with dyspnea on exertion. CME credits are available after working through the cases (5 hours of category 1 credit per case).

The academic version includes software for student evaluation, editing and customizing the cases, creating new cases, and a learning resource module that links to other materials pertaining to the relevant topic. Fifty-eight cases are currently available, including topics such as abdominal pain, amenorrhea, colic, cough, headache, weakness, and the well-child visit. The academic version also permits instructors to examine and rate the students' inquiry strategies and has other features that permit some customization of the cases by faculty. Each case is structured so that the user works through the case from presenting complaint to history, physical examination, laboratory and radiological testing, therapy, and finally to case conferencing with the case expert (Figure). The learner is encouraged to produce a list of differential diagnoses that they hone as the case develops. The user can move back and forth between components of the assessment in developing the differential list. Interaction with the patient is through simple, searchable menus. Users can ask patients about the nature of their pain, and hear and see the patients tell their stories.

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After users have completed the patient's history and physical examination, and have reviewed the results of any tests ordered, they enter their final diagnosis, and begin treatment. For the treatment module, users are asked a series of questions regarding therapy. At the conclusion of the case, the program rates the learner's performance in five domains (diagnosis, differential, history, physical, laboratory testing, and treatment). To improve the ratings, the student can return to the case and read the explanations for individual choices and they can correct their incorrect responses. The performance rating for the differential diagnosis is by the honor system: How on track do you think you were when comparing your list with the final diagnosis?

Symptom-based Case Studies on CD-ROM was easy to install and easy to use, with little need for the accompanying documentation. To hear the patient's voice answering questions and the expert's explanation of the case enhances the realism. The case expert's narration gave me the impression of being at a case conference, grand rounds, or a CME lecture. The symptom-based presentation of the cases, compared with answering a series of questions on a specific topic, was much more interesting and fun. The case studies provided an excellent review of the practical approach to common problems, especially for medical students or physicians-in-training. For experienced physicians, the case studies also review current treatment approaches to common conditions, such as seizure disorders in children.