Roxann Mouratidis, MSLIS, AHIP  
Head of Scholarly Communications  
Maguire Medical Library  
Florida State University College of Medicine   

This is an update of a review I wrote that was published in the 08/2021 issue of Doody’s Collection Development Monthly. You can find the original review here. 

Aquifer Internal Medicine is a collection of virtual, interactive clinical cases intended for third-year medical students. These patient cases are designed to meet the learning objectives of the Clerkship Directors in Internal Medicine’s General Internal Medicine Core Medicine clerkship curriculum. However, any health sciences student seeking to gain more experience with patient encounters in a virtual environment could benefit from this content. 

Content 

Aquifer’s Internal Medicine course collection contains 36 cases that are available via an institutional or individual subscription. All cases are accompanied by a case synopsis, a list of learning objectives, and a printable case summary that includes a list of medical references for further exploration. Cases are written, reviewed, and maintained by Aquifer’s Internal Medicine Course Board to ensure that they remain current, accurate, and aligned with national curriculum standards. As of April 2024, seven of the 36 cases have been updated this year. 

As of July 1, 2023, Aquifer has begun to integrate curricular threads into select Internal Medicine cases at no additional cost to existing subscribers. These embedded curricular threads attempt to introduce interdisciplinary components to students in a relevant and relatable manner. Curricular thread topics include trauma-informed care, palliative care, social determinants of health, high value care, diagnostic excellence, and telemedicine. Through question-and-answer prompts, students are directed to consider these topics as they evaluate the case, interact with the patient, and formulate a treatment plan. 

Features / Functionality 

Accessibility 

Students and faculty may access Aquifer patient cases online using a computer or mobile device. Aquifer has recently incorporated a multifactor authentication system for faculty that involves receiving and verifying a unique code during the log-in process for mobile and computer access. This multifactor authentication was implemented as a safeguard to protect student data accessible to faculty. When faculty register for an account, they can specify the method by which they receive the verification code. Codes may be emailed or delivered via an authenticator app. 

Student Assessments 

Aquifer Internal Medicine includes access to Aquifer Calibrate at no additional cost for 2023-2024 subscribers. Aquifer Calibrate is a student assessment tool designed to reinforce key concepts presented throughout the virtual cases, while simultaneously identifying gaps in student knowledge. Aquifer Calibrate assessments are mapped to learning objectives and are composed of 25-45 questions designed to identify areas of strengths and weaknesses. Ideally, Aquifer Calibrate assessments should be administered to students twice – toward the beginning and end of a clinical rotation. Students can share their assessment results directly with preceptors and coaches to address questions or concerns, develop customized learning plans, and identify self-directed educational opportunities to strengthen clinical skills. 

Browse and Search Functionality 

On March 19, 2024, Aquifer launched newly revamped landing pages for Aquifer Internal Medicine and other specialty collections. These landing pages are unique to the user’s role. Administrators, faculty, and students will be presented with different menu options, tools, and resources that are most relevant to their role. Landing pages can be customized by hiding and unhiding specific content and navigation. 

Faculty and administrators can browse or search the Internal Medicine case collection. Faculty can find cases that address specific topics or medical conditions by entering keywords into the search box on the Aquifer Internal Medicine homepage. There are also several filters faculty can use to locate relevant cases and illness scripts. Using dropdown menus, faculty can narrow down cases by selecting a specific body system, patient age, location, or clinical focus. It is also possible to discover cases using Aquifer’s Condition/Diagnosis filter, Basic Sciences filter, and Clinical Excellence Curricular Threads filter. The implementation and use of these filters makes it easy to locate pertinent content, and is a nice addition to the Aquifer discovery platform. 

Business Model 

Aquifer Internal Medicine cases remain accessible to users that have an institutional or individual subscription. Subscription prices have increased since the date of my original review (08/2021). For example, individual subscriptions have increased from $75 per year to $100 per year (as of April 2024). 

The institutional pricing for Aquifer Internal Medicine has increased as well. However, by participating in Aquifer’s Curricular Partner Program, users can bundle and receive additional courses at a discounted rate. The institutional pricing structure remains the same; it is based on the total enrollment for the program (pre-clinical through clinical years inclusive). The annual institutional billing period continues to run from July 1-June 30, and prorating options are available. 

Breakthrough 

Aquifer Internal Medicine serves as a valuable addition to any health sciences library collection by providing students with an opportunity to practice their clinical reasoning skills in a virtual environment. Since the date of my initial review, the platform and its content has undergone significant improvements. Internal medicine cases have been routinely reviewed and updated with new information, and I’m confident that the material presented to students, and the assessment tools used to evaluate their progress and knowledge comprehension, are current and accurate. The platform, search, and browse capabilities have also improved with the implementation of diagnostic and thematic filters, which appear to justify the subscription cost increase.