Internet Resources for Podiatric Medical Students

Abstract

This paper presents a selection of Internet resources covering most of the subject areas found in standard medical education curricula. Basic sciences sites are emphasized, but clinical resources are also included. Reported sites were judged based on their potential to enhance the learning process, provide practice questions or study guides for examinations, or aid in the preparation of papers. In addition to podiatric medical students, residents and practitioners who require a quick reference source to either the basic science foundations of podiatric medicine or the clinical side of podiatric practice may find this paper useful.

An abundance of educational resources are offered at no cost to health profession students via the technology of the Internet. Many of these Web sites are products of academic institutions, some are government sponsored and, not surprisingly, some are the result of the hard work and diligence of medical students or student organizations. The purpose of this paper is to demonstrate quality Internet sites that can provide timely access to materials that may be of use to the podiatric medical student. Additionally, residents and practitioners who require a quick reference source to either the basic science foundations of podiatric medicine or to the clinical side of podiatric practice may find this paper helpful. All Web addresses were current as of the time of this writing.

Many of the reviewed resources display materials in multimedia format and require a computer that must be able to display various audio, graphic, animation, video, and other files. An effort has been made to mention the names of plug-in or other software the reader may be required to download for viewing the components of certain sites, but not all such programs are mentioned. The reader may be required to install one or more programs before being able to fully appreciate all the features discussed.

As mentioned in prior articles[1-5] written by the lead author (C.R.F.) and others, the information presented on all Web pages must be attentively screened according to one’s personal standard of excellence. An attempt has been made to provide authoritative sites for this article, but each student or practitioner should judge their usefulness on an individual basis. The lead author welcomes notification of Web sites found to be of help to students and will consider presenting them in future updates of this report.

One must be aware that graphics, video clips, sound files, or other digital items on Web pages are the intellectual or artistic creations of persons or groups and as such may be protected by copyright law. Although these items may be freely available and easily downloaded, one may not have the right to distribute such work to others. The United States Copyright Office Web page at the Library of Congress site contains practical information about copyright law.[5]

Basic Sciences Web Sites

Table 1 presents a listing of selected basic sciences Web sites. Most of the subject areas covered in the first two years of the typical podiatric medical curriculum have been included. Academic areas emphasized include anatomy, biochemistry, embryology, genetics, histology, immunology, microbiology, pathology, pharmacology, and physiology.

Martindale’s Health Science Guide, presented in previous Internet articles, provides a jump-start to a truly amazing amount of very useful material. James G. Martindale of Irvine, California, is the owner, author, and copyright holder of this metasite. Metasites are Web pages that act as tables of contents to the Internet, providing organized groups of links to specific topics or subject areas. One section of this site, entitled “Martindale’s Anatomy & Histology Center,” is itself a metasite page containing hundreds, if not thousands, of links to useful resources. Included in the Anatomy & Histology Center are links to sites offering interactive anatomy, course outlines, examinations, quizzes, atlases, and tutorials. A number of embryology and neuroanatomy sites are also included.

McGill University, located in Montreal, Quebec, Canada, is the copyright holder of the Molson Medical Informatics Student Projects Site. This is a rapidly growing collection of multimedia projects in medical teaching developed by McGill University medical students under the supervision of McGill’s medical faculty. Project supervision is by Dr. Leon Glass, Professor of Physiology, McGill University. Basic science topics such as anatomy, cardiovascular physiology, embryology, and immunology are included. Clinical topics such as physical examination, lumbar puncture, gait disorders, and complementary medicine are also presented. This site is well worth exploring. Full appreciation of the three-dimensional (3-D) anatomical representations presented may require one to download, at no cost, the Cosmo Player software (Platinum Technology, Inc, Oakbrook Terrace, Illinois). Full information is provided at the site.

Academic & Student Resources is hosted and copyrighted by Yale University School of Medicine, Medical Scientist Training Program, located in New Haven, Connecticut. This site is a wondrous collection of links and internal resources with great potential benefit to podiatric medical students. Syllabi and lecture notes of courses given at Yale are available in many basic science subjects. Although some of the material is only available to Yale students and faculty, much of this material is available to any viewer. A prudent selection of helpful Internet resources is also provided.

The Medical Education Ring, currently featuring 232 Web sites, is a listing that provides links to resources “dedicated to medical education.” This ring is a subset of Yahoo! WebRing (Santa Clara, California). Yahoo! is the copyright holder of the site. Covered topics include both basic and clinical sciences.

Hanson’s Guide to Foreign Medical Schools includes educational resources and medical mnemonics for many different subject areas. Hanson Nguyen from Seattle, Washington, is the copyright owner and author. His Mnemonics and Learning page may itself be considered a metasite.

SDN Communications, Inc (Bonner Springs, Kansas), is the copyright holder of StudentDoctor Network. This metasite offers links to many topics, including study skills, learning tactics, many mnemonics sites, and peer advisor advice. This site also has an active medical student discussion forum that may prove interesting to podiatric medical students.

Medical crossword puzzles in many subject areas, including anatomy, cell biology, protein biochemistry, rheumatology, and neurology, are available at Medical Student Resources Guide (StudentDoc.com, San Francisco, California). This site is designed to provide medical students with easy access to learning resources.

MedicalStudent.com is a digital library of authoritative medical information for medical students. Michael P. D’Allesandro, MD, is the copyright holder of this page. He is located in Iowa City, Iowa. This is a mega metasite of resources for the medical student. Two of the major divisions covered here are virtual medical textbooks and patient simulations. This site is updated frequently.

JayDoc HistoWeb is authored by medical students Milton Wolff and Marc Scarbrough, with the support of the Department of Anatomy and Cell Biology of the University of Kansas. The University of Kansas Medical Center in Kansas City, Kansas, is the copyright holder. This site provides high-quality histologic images from all of the major body systems. Many of the histology images are linked to a pathology section that provides information in outline form of pathological processes affecting the region in question. Histopathology images can then be viewed. The ability to jump by a mouse click from normal histologic features to pathologic, and vice versa, is a very useful feature.

Digital Anatomist Interactive Atlases is a product of the Structural Informatics Group, Department of Biological Structure, University of Washington, located in Seattle, Washington. The University of Washington is the copyright holder. Two-dimensional (2-D) and 3-D atlases of the brain, for example, are available here. Photographs of actual prosections are also featured. One can click on various portions of the specimen and be told the anatomical name of the particular structure. Video clips aid the instructional process, but only a limited number are accessible at the Web site. The complete version can be purchased on CD-ROM from the University of Washington Health Sciences Center for Educational Resources. Interactive quizzes are also available. Detailed images of the knee joint are presented, and a user can click on an anatomical area to learn its name. Space limitations preclude a complete description of the resources available here; therefore, the reader is advised to view this site personally.

Vesalius: The Internet Resource for Surgical Education (Lion Reef Software, Inc, Potomac, Maryland) presents a variety of anatomical images. Many of them are accompanied by clever animations that enhance the learning process. A collection of educational narratives illustrating surgical anatomy and procedures can be viewed by accessing the “Clinical Folios” section of the site. The “Image Archive” is a hierarchically arranged image bank of anatomical and surgical illustrations, photographs, and radiologic images.

Loyola University Chicago Stritch School of Medicine, located in Maywood, Illinois, is the copyright holder for LUMEN: Structure of the Human Body. This Web resource presents regional cross-sectional anatomy as well as tutorials and questions for study. The LUMEN (Loyola University Medical Education Network) main page is a starting point to undergraduate and graduate medical education resources as well as continuing medical education opportunities. Among the resources at this site is a “Lower Limb Dissector,” which features the ability to click on a long list of lower-extremity muscles and immediately view a picture of the muscle along with information on its origin, insertion, action, and innervation. Practice examinations are also available here. Links to a host of other educational anatomy sites are presented on the “Anatomy on the Internet” page.

UNSW Embryology HomePage is copyrighted by Mark A. Hill, Faculty of Medicine, School of Anatomy, University of New South Wales, located in Sydney, Australia. This site provides a very detailed description of human embryo development, incorporating hundreds of images that enhance the learning process. This site contains video movies that demonstrate the human fetal developmental process. Students can alter the speed of the videos to suit their individual requirements. Although the videos take some time to download, it is well worth the effort. Ultrasound movies of the fetus are also available.

The Human Embryology Web Site is available from the Medware Homepage, created by medical students at the University of Cincinnati College of Medicine. The College of Medicine, located in Cincinnati, Ohio, is a joint copyright holder along with Margaret Balfour, David Stultz, and Eric Rickin. This site presents animated movies and Web pages related to the Year I and Year II medical school curriculum at that institution. The embryology page is designed to support the current editions of William J. Larsen’s Human Embryology and Essentials of Human Embryology textbook. Whether or not that particular textbook is being used, medical students still can learn a great deal about the subject. Many useful animations also are available to help students visualize embryologic processes.

The Department of Anatomy of the University of Wisconsin Medical School has an excellent neuroanatomy Web site called Global Anatomy. John K. Harting, Professor and Chair, Department of Anatomy, University of Wisconsin Medical School, located in Madison, Wisconsin, is the copyright holder. This site presents an online textbook of neuroanatomy that is well illustrated and accompanied by sections illustrating and explaining neurologic deficits that can occur due to lesions in the region being studied. Problems, along with correct and incorrect answers that are explained in audio files, are provided. This site also contains an online histology atlas.

The Medical Education Committee, Department of Biochemistry and Molecular Biology, University of Kansas School of Medicine, located in Kansas City, Kansas, is the copyright holder for Medical Biochemistry. Students, staff, and faculty of the Medical Education Group, Department of Biochemistry and Molecular Biology, University of Kansas Medical Center, are responsible for its content. This technologically astounding site allows students to see lecture slides for a medical biochemistry course. In addition to providing help in the study of biochemistry, this site can be used to prepare for examinations and review biochemistry for licensing examinations. In many cases, explanatory text and relevant Web links are included. This Web page also contains sophisticated interactive educational tools. Examples include several “Interactive Molecular Modeling Modules” that describe the structural and functional properties of biological molecules. Within each module, one can view and manipulate molecules in 3-D space. These modules require an Internet plug-in called Chime (MDL Information Systems, Inc, San Leandro, California). This plug-in interactively displays 2-D and 3-D molecules directly in Web pages. Individual biochemical molecules can be rotated, reformatted, and saved for use in other programs. Information about Chime and help on how to install and use it are available via a link from this Web site. Registration with MDL Information Systems is required (at no cost) before downloading Chime. It is well worth the time to download this software because it enables one to learn biochemistry in a manner impossible only a few years ago.

Also featured at this site are several “Interactive Biochemistry Animations,” illustrating complex biochemical processes. These animations require the Shockwave (Macromedia, Inc, San Francisco, California) plug-in. Information on this software is available on the Web page, including a link to download it at no charge.

An animated “Biochem Tutorial” is available from the “UCI Movies” portion of the previously mentioned Medware Homepage. Examples of topics covered include oxidative phosphorylation, muscle biochemistry, lipid metabolism, and animated schematics showing the electron transport chain, ATP-ase, and many others. Very cleverly done, this is a site well worth exploring. Also present are a “Urea Cycle Virtual Lecture” and a “Tay-Sachs Virtual Lecture.” In addition, links to other helpful sites for medical students are included.

World Index: Molecular Visualization Resources is created and copyrighted by Eric Martz and Trevor D. Kramer of Amherst, Massachusetts. This site allows a user to search for a molecule by name and find an image. Links to many biochemistry tutorials using 3-D imaging can also be found here.

Another biochemistry site that podiatric medical students should visit is the THCME Medical Biochemistry Page, copyrighted by Michael W. King, Medical Biochemistry, Terre Haute Center for Medical Education, Indiana University School of Medicine, located in Terre Haute, Indiana. This site contains lectures and textual materials for medical biochemistry, along with links to biochemistry examination questions, such as Medical Biochemistry Review Questions presented by the Department of Biochemistry at the Temple University School of Medicine, located in Philadelphia, Pennsylvania.

Integrated Medical Curriculum (Gold Standard Multimedia, Tampa, Florida), another outstanding site, requires registration that is free of charge. Advertising 3,000 pages of physiology instruction, 7,000 quiz questions, 1,200 histologic slides, and 6,000 cadaveric photos, this site should be useful to podiatric medical students. The section “Essentials of Human Physiology” covers membrane transport and bioelectric activity, muscle physiology, cardiac and circulatory physiology, respiratory physiology, brain function, and renal physiology. A nice feature of this site is that links and references are provided to major textbooks. Animations, video clips, and sound recordings are provided at appropriate sections. Separate indexes are available to locate quickly the different media formats. Students can answer questions in each section by accessing links to relevant text support. Other subject areas, covered in similarly amazing detail, include human anatomy, basic clinical skills (such as history taking and physical examination), radiologic anatomy, microscopic anatomy, immunology, clinical pharmacology, and clinical musculoskeletal pathology.

New York University Public Access Courseware includes topics such as anatomy (“Virtual Skull Model”), physiology (“Counter-Current Multiplication and Water Balance,” “EKG Tutorial,” and “Malabsorption Module”), microbiology, neuroscience, pharmacology, pathology, and more. Copyright is held by New York University Educational Computing, located in New York, New York. Many of these programs are interactive and 3-D. The previously mentioned “Virtual Skull Model” allows the user to physically rotate anatomical models of various skull bones. Some of the modules require special software that can be downloaded free of charge. Instructions are provided at the site.

The Johns Hopkins School of Medicine, located in Baltimore, Maryland, copyrights Interactive Respiratory Physiology by Wilmot C. Ball, Jr., MD. This superb site contains tutorials, labs, quizzes, an encyclopedia of topics in respiratory physiology, and a dictionary of respiratory physiology terms, among others. Included in the interactive laboratory exercises is the “Gas Exchange Lung Model.” Here, one can input specific values of tidal volume, dead space, respiratory rate, inspired oxygen percentage, altitude, hemoglobin, cardiac output, and other ventilatory variables. The program then computes resultant values for pCO₂, pH, oxygen saturation and oxygen content of arterial, capillary, or venous blood, and other parameters. The student can introduce values typical of various pathologic conditions and instantly visualize the effect on blood gas concentrations. This superlative learning tool for basic respiratory physiology parameters is well worth visiting during the appropriate time in a medical physiology course. The “Disease States Lab” encourages students to compare spirogram tracings, compliance curves, and expiratory flow rates for normal, obstructive, and restrictive pulmonary diseases. Students may use a question bank to focus their exploration. The “Statics Lab” enables students to specify a patient’s lung volume and glottis state. The resulting lung and chest-wall recoil pressures are depicted using illustrations, graphs, and equations. This unique virtual laboratory experience hopefully will be well used by podiatric medical students.

Acid-Base Balance: A Tutorial is authored by Alan Walter Grogono, MB, MD, of New Orleans, Louisiana. He is also the copyright holder of this exemplary learning tool. This site provides an “Interactive Acid-Base Diagram” from which one can select a region on the presented chart and be shown numerical values for specific standard physiologic parameters. For each set of values, a description of the physiologic state of the patient is given. This is an amazingly useful interactive chart. “Henderson—without the Hassel” is another exceptional interactive equation page that allows one to modify physiologic parameters and instantly see the effect on the blood pH. One can also interactively test oneself and generate a report for self-evaluation.

Medical Pharmacology: Disease-Based Integrated Instruction is a Web site designed to help students learn the underlying mechanisms of drug action and the implications of drug treatment. Pharmacodynamics and pharmacokinetics are presented with practice questions, case studies, and quizzes. Integrated disease-based instruction is featured. Making good use of hyperlinks, this page provides comprehensive treatment of many topics, including antidiabetic drugs, insulin, and local anesthetics. Also presented here is a quality “Drug Encyclopedia,” access to which is free after online registration. Michael A. Gordon, located in Prairie Village, Kansas, copyrights this site.

Slides of lectures on such topics as synaptic transmission, anesthetics, and antibiotics are presented in the “Therapeutics” portion of LUMEN, the previously mentioned product of Loyola University. Coverage of topics seems to be very comprehensive.

Microbiology Webbed Out is an online textbook of the subject copyrighted by Timothy Paustian, University of Wisconsin in Madison, Wisconsin. Many topics are given extensive coverage, including host-parasite relationships and disease mechanisms. Antimicrobial agents are thoroughly discussed as well as resistance to such agents by pathogenic organisms. This site is a very useful source of information related to microbiology.

A virtual textbook of a course entitled Bacteriology 330 Host-Parasite Interactions is available for study by podiatric medical students. This course presents detailed information, including excellent illustrations, about many pathogenic organisms and the factors that make them virulent. Antimicrobial agents are also well presented here. Kenneth Todar of the University of Wisconsin Department of Bacteriology edits this page. Copyright is held by the University of Wisconsin located in Madison, Wisconsin.

Ronald E. Hurlbert of Washington State University in Pullman, Washington is the copyright holder of the Microbiology 101-102 Homepage. In addition to providing a wealth of material about microorganisms, many self-assessment examinations are available to podiatric medical students for self-study.

Antibody, copyrighted and authored by Eric Martz of the University of Massachusetts at Amherst, has a series of 3-D tutorials, using Chime software, on the topic of antibodies. Antibody molecules and subunits can be turned in space, with a click of the mouse, to demonstrate molecular architecture. This is an invaluable tool for learning immunology. As explained on the homepage, this site is best seen with the Netscape (Netscape Communications, Inc, Mountain View, California) browser. Eric Martz presents a separate index page of Chime resources available at the University of Massachusetts at Amherst. “Material on DNA,” an “Amino Acid Quizzer,” and a presentation on hemoglobin are available for student study.

“Essentials of Immunology” is available from the previously mentioned Integrated Medical Curriculum site, but it cannot be directly accessed since a password is required to utilize it. The “Essentials of Immunology” page provides a comprehensive, but manageable, update on the field and incorporates animations and links to related material via hypertext. Interesting animations present various aspects of immunology as continuous processes rather than a sequence of still pictures. The Medical College of Georgia, located in Augusta, Georgia, is the copyright holder. Animations demonstrating the complement cascade leading to cell lysis may be viewed. The speed of animation can be modified to accommodate the learner. No conventional textbook can display such animations as an aid to learning. Many practice examination questions also are included.

WebPath: The Internet Pathology Laboratory is copyright by Edward C. Klatt, MD, Department of Pathology, University of Utah, located in Salt Lake City, Utah. This comprehensive site is designed for students in the health-care sciences studying pathology. Basic mechanisms of disease, infection, inflammation, neoplasia, organ system pathology, plus additional topics are profusely illustrated in gross, microscopic, electron microscopic, and other formats. Cases of the week, laboratory exercises, and examination questions are also offered to interested students.

Pathology Online Case Studies is available from the University of Cincinnati College of Medicine’s previously mentioned Medware site. A comprehensive collection of case studies is presented with both gross and microscopic illustrations. Fully answered questions add to the usefulness of this presentation of basic pathology.

Clinical Genetics: A Self-Study for Health Care Providers is authored by Virginia P. Johnson, MD, and Carol Christianson, MS, of the University of South Dakota School of Medicine. The authors and the University of Iowa, located in Iowa City, Iowa, hold the copyright. The basic genetic instruction available here may prove useful to podiatric medical students. In addition to coverage of basic genetic concepts and genetic tests, an excellent discussion of clinical genetic problems is provided.

Clinical Web Sites

Lung and heart sounds are reproduced and explained at the “Virtual Stethoscope” component of the previously mentioned Molson Medical Informatics Student Projects Site. Heart Beats (Synapse Publishing, Inc, Edmonton, Alberta, Canada) is another site that features excellent quality reproductions of many heart sounds and murmurs.

Indiana University Radiology Teaching Files is an exceptional site that includes many topics, including osteomyelitis of the second toe, a stress fracture of the second metatarsal shaft, rheumatologic involvement of bones, and orthopedics. The images are of excellent quality and may be enlarged. The sophomore medical students at Indiana University School of Medicine participate in an organ-based “Introduction to Clinical Medicine” course in which the Department of Radiology has significant participation. All radiographs utilized in this course, along with their interpretations, can be found at this useful and instructive site. The Department of Radiology at the School of Medicine, Indiana University, located in Indianapolis, Indiana, copyrights this site. The Department of Radiology also hosts a Learning Resources page that provides access to a musculoskeletal teaching file, a multislice CT lecture, an MRI anatomy atlas, and more.

Michael L. Richardson, MD, of the University of Washington, located in Seattle, Washington, is the copyright owner of the University of Washington Radiology Webserver. This site contains anatomy teaching modules, an “Online Musculoskeletal Radiology Book” with significant lower-extremity coverage, teaching files, and patient cases.

James R. Taylor, MD, of Creighton University School of Medicine, located in Omaha, Nebraska, copyrights Radiology Board Review Notes. This page presents an extensive collection of notes for study and review. Of particular interest is extensive coverage of the musculoskeletal system, including bone cysts (benign, malignant, congenital) and metabolic bone disease. Detailed and illustrated lecture notes on the subject of basic imaging are presented as well as “Cases of the Month.” An extensive collection of links to teaching resources is also listed.

The Nuclear Medicine Mediabook is copyrighted by the Crump Institute for Molecular Imaging, University of California at Los Angeles, located in Los Angeles, California. A large series of very detailed case reports can be viewed along with imaging findings. Cases can be searched for by organ or organ system, a specific disorder, or the type of study or tracer used. Image quality is quite good. A series of positron emission tomography (PET) images also can be found at this site.

RSNA Link: Education Resources is copyrighted by the Radiological Society of North America, Inc, located in Oak Brook, Illinois. Many links to radiologic and other medical sites on the Internet are featured here. Topics include anatomy, diseases, education, medical ethics, and history.

The Countway Web Resources page is maintained and copyrighted by the Countway Library of Medicine, Harvard Medical School, located in Boston, Massachusetts. It offers a variety of clinically relevant resources. The Hardin Metadirectory of Internet Health Sources, copyrighted by the Hardin Library of the Health Sciences, University of Iowa, Iowa City, Iowa, also offers a directory of links to Internet clinical medical resources.

The University of Iowa Health Care, University of Iowa, Iowa City, copyrights Virtual Hospital. Its mission is to help meet the information needs of health-care providers and patients. This very useful Web library provides access to hundreds of books and brochures, including more than 350 peer-reviewed digital texts and booklets. This popular site receives about six million visits per month. Many of the textbooks available offer superb accompanying illustrations.

The National Library of Medicine enables free searching of MEDLINE and other databases via Internet access to PubMed. Students also can access this wonderful resource from their home computer. The National Library of Medicine is the copyright holder and is located in Bethesda, Maryland.

Table 2 presents a selected listing of Internet resources that offer clinical medical resources to podiatric medical students. Most of these sites have been presented in previous JAPMA articles.[1-6] Readers are encouraged to consult these articles for a selection of Internet podiatric medical resources to supplement clinical portions of the podiatric medical school curriculum. Additional Internet general reference material in these papers also may be useful.

Conclusion

Offering a multitude of information at no cost, the Internet can provide many resources to enhance the educational experience of podiatric medical students. Both basic and clinical sciences sites have been presented and tables listing the Uniform Resource Locator (URL) addresses of these Web pages have been provided. The medical school curriculum is not an easy one, but perhaps the resources presented here can make the learning experience a little easier and a bit more fun.

Table 1. Basic Sciences Resources on the Web

Table 1. Basic Sciences Resources on the Web

Table 2. Selected Clinical Web Sites

Table 2. Selected Clinical Web Sites