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Pediatric physical diagnosis electronic atlas
  1. C Melville

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    Edited by Basil J Zitelli, Holly W Davis. Elsevier Mosby, 2004, £146.00 (DVD for Windows and Macintosh), ISBN 0323029922

    Today, medical education faces huge challenges. The patient contact time essential for developing clinical acumen has been progressively eroded by increased trainee numbers, reduced working time, reduced training duration, shifts, and encroachment of non-medical professionals on traditional medical areas. Skills labs have evolved to cover basic skill sequences, but there remains a gap between core skills and clinical practice. An obvious approach is to “can the experience” using modern multimedia technology to bridge the hiatus, ensuring some exposure at least to core conditions. There are various ways of developing such collections: the proprietary way, as here, or by using the internet, as for example at,,, or

    This single DVD comes in a large glossy box with significant dead space. The authors are American, mainly from the Children’s Hospital of Pittsburgh. The resource consists of “over 2500 visual representations of a broad range of common and uncommon pediatric disorders”. There are over 40 video and audio clips too. The images can be saved to a separate area (like a shopping trolley on the web), then transferred to PowerPoint. The video and audio can be navigated to on the disc and transferred using cut-and-paste. The license does not allow materials to be integrated into other teaching resources (for example, question banks), nor can the PowerPoint presentations be placed on the web or intranet. Images can be viewed without annotations, but there is no interactive self-assessment (that is, scoring or review of wrong answers).

    The term “physical diagnosis” is used broadly, and is not restricted to clinical signs. For example, x ray pictures, blood films, karyotypes, and diagrams are all included. It also includes many normal children, for example in the section on child development. The resource quality is generally good to excellent, with most images presented as full colour JPGs. The highlights for me were the video clips of different forms of epilepsy. These bring to life an otherwise difficult topic. I was a little disappointed with the quality of some of the heart sounds. Coverage is inevitably incomplete: for example, there were excellent radiographs of pneumocystis, mycoplasma, and tuberculous pneumonias, but none of typical lobar pneumonias or bronchiolitis.

    Searching is rudimentary, either by one of 23 chapter headings and scrolling through the thumbnails or by using a simple search string (US spellings) through the annotations. There is no metadata, but audio/video files can be accessed separately using tabs. This means that there is a learning curve associated with using the resource effectively with the potential to miss media that are in it. With repeated use its value increases greatly.

    It is an excellent and reasonably comprehensive resource for any paediatric unit to have available for teaching purposes, particularly those with slow or difficult internet access. A huge amount of work has gone into its production and the authors are to be congratulated. It provides a good way to learn most classical presentations for examinations, particularly DCH and Part 2, though the text version may allow for a more structured approach. I shall certainly be using it for my own teaching. I suspect that the restrictions of DVD capacity, publishing cycle (versioning), searching, and copyright will prove to be long term disadvantages compared with the web based approach. It is worth remembering that, while multimedia are useful they are no substitute for the “real thing”. The clinical experience engages the whole brain at sensory, intellectual, cerebellar, and emotional levels. We are still far from virtual reality here, but this resource is certainly an advance on a traditional textbook with text and few illustrations.

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