Iris Kovar-Gough, MA, MLIS, AHIP
Michigan State University Libraries
Liaison Librarian to the College of Human Medicine

Content

McGraw-Hill’s AccessSurgery is a comprehensive surgical education platform consisting of 46 textbooks, basic and advanced surgical procedure videos, 16,000+ images, an interactive board review question bank with more than 3,000 American Board of Surgery In-Training Examination (ABSITE)-style questions, and clinical reference tools. One section is devoted to clerkship-related content, including case files, study questions, and videos. Patient education handouts are written in English and Spanish for adult and pediatric populations by Change Healthcare LLC, a third-party healthcare technology company. The intended audience is medical students, surgical residents, and clinicians working on their surgical maintenance of certification. However, continuing medical education (CME) credits are designed for family physicians and only two AccessSurgery titles are eligible for CME credit.

AccessSurgery content is guided by an advisory board headed by Editor-in-Chief Gerard M. Doherty, MD (Moseley Professor of Surgery, Harvard Medical School; Surgeon-in-Chief, Brigham and Women’s Hospital and Dana-Farber Cancer Institute; Crowley Family Distinguished Chair, Department of Surgery, Brigham and Women’s Hospital) and F. Charles Brunicardi, MD (Chair, Department of Surgery Chair at the University of Toledo College of Medicine and Life Sciences), who is also editor-in-chief of Schwartz’s Principles of Surgery.

The “quick reference” section includes daily literature reports compiled by the Two Minute Medicine Publishing Group on new and practice-changing medical literature, Quick Answers Surgery, a book devoted to short concise summaries of major surgical anatomy and concepts, ABSITE Slayer, a book devoted to review questions for the surgical licensure exam, and a differential diagnosis index for common symptoms and diseases. AccessSurgery also includes drug monographs with information pulled from Wolters Kluwer Clinical Drug Information Inc. Drugs are listed by generic, trade name, and class, and monographs include pictures of the medication. The “multimedia” tab features over 400 videos of surgical techniques and radiological findings, the Behind the Knife podcast, and patient safety modules on topics like medical errors, communication, and handoffs. AccessSurgery has sections on exam preparation and case files that include access to the full text of Case Files: Surgery, exam and board review questions, Resident Readiness: Surgery cases, a quiz bowl style question bank, and several exam preparation books.  

AccessSurgery’s generic terms of service allow educational use of textbook images and PowerPoints. It states that “users may display, download, or print out PowerPoint slides and images associated with the site for personal and educational use only.”⁽¹⁾ This includes both print and electronic distributions to authorized user groups.

Features / Functionality

The interface is relatively intuitive to use and lays out the materials included on the platform in a tab-based format. The website uses mobile responsive design and works well on desktop and laptop computers as well as mobile phones and tablets.

The common interface used by all the Access products, including AccessSurgery, has accessibility issues for users with disabilities. While the videos are subtitled with closed captions, the interface itself is not coded optimally for users who rely on screen readers to interface with content. Major accessibility concerns include: a lack of alt-text for images, incorrect information organization and structure leading to screen reader difficulties, and insufficient color contrast.⁽²⁾

One can search AccessSurgery by using the various content tabs and drill down based on subspecialty or by using the large search box located below the content ribbon on all pages. There is an option to perform a federated search across all the Access products one subscribes to using the drop-down menu in front of search bar to search “all sites” that are part of the subscriptions. The search box does not support Boolean, although it algorithmically uses AND between terms used in the search. It does support phrase searching and has an auto suggest feature, which may be particularly useful for novice users.

Search results are ranked by relevance based on semantic tagging and text matching/frequency. Advanced search options are limited to searching by exact title and author, and results can be filtered by format, resource title, or topic. When searching, the relevancy ranking appears to push the quick reference synthesis topic pages created by Two Minute Medical to the top, followed by videos, drugs, and textbook content in the results list. Putting short clinical summaries above textbook content may not meet the needs of a large portion of the audience – student learners.

AccessSurgery, like all the Access products, allows users to sign up for a personal profile that links their institutional affiliation and access rights, allows access to question banks, and turns on curation features like creating a list of favorite ebook chapters. Signing up for a MyAccess account enables remote access without going through the library subscription link each time.

The outstanding feature of this resource is the breadth of material. Including textbooks, multimedia, cases, and review materials makes for a very comprehensive suite of resources for all levels of surgical learners. Having the most recent editions of major surgical textbooks – including Schwartz’s Principles of Surgery, surgical and surgical subspecialty versions of the Current Diagnosis & Treatment series, and Zollinger’s Atlas of Surgical Operation — makes this platform useful for students, residents, and practicing physicians. In addition, previous editions are moved to an archive on the platform instead of being removed completely. Older editions links do not stop working, which makes curricular planning easier.

One feature that was removed in October 2018 but should be reconsidered is the custom curriculum module. This allowed a faculty member or administrator to import a list of students and build quizzes and other information modules to augment existing curriculum. As McGraw-Hill does not allow its review questions to be used outside the platform with the standard license model, this was an excellent way to quiz students from the resources they were already required to read and get course credit.

Business Model

AccessSurgery is licensed to institutions using an unlimited concurrent user model. User access is granted through IP authentication, Ezproxy, referring URL/domain, open Athens, or a unique username/password. This resource is most suitable for academic libraries that serve medical schools and hospitals with surgical residencies. The criteria for determining institutional subscription pricing is opaque and highly individualized; librarians should contact their local McGraw-Hill sales representative for an institutional quote. A subscription allows unlimited access for the duration of the subscription. AccessSurgery is available in individual and institutional subscription models. An individual may subscribe for $995/year; there are also 24- and 48-hour subscription options.

Institutional administrators can log in to a central user portal and get both COUNTER 4 and COUNTER 5 statistics. COUNTER 5 statistics are available for January 2019 and newer usage data. A variety of reports can be automatically generated within an institutional summary, including successful section requests by month and title, access denials, and successful full multimedia content views.

Breakthrough

AccessSurgery is a comprehensive ebook, multimedia, and review platform focused on general surgery and surgical specialties. The breadth of content makes it appropriate for surgical clerkships and residencies because of the inclusion of gold standard textbooks, procedure-based multimedia, and review resources that support clinical practice and education. Bringing back the custom curriculum feature would be a value add and would create a single platform for comprehensive surgical education. Additionally, physicians, nurses, and other healthcare professionals could benefit from the practice-oriented resources and patient handouts in multiple languages.

References

1. McGraw-Hill Medical. 2019. “Image and PowerPoint Usage Guidelines.” Available from: https://mhmedical.com/ss/help.aspx#image%20guidelines

2. Michigan State University Usability/Accessibility Research and Consulting. July 16 2019. “Accessibility Evaluation of AccessMedicine.” The Big Ten Academic Alliance Library E-Resource Accessibility Group. Available from: https://www.btaa.org/docs/default-source/library/accessibility-reports/mcgraw-hill-accessmedicine.pdf?sfvrsn=d9dc49f3_4