Tag Archives: med student

Careful Consideration: Pocket Neurology

Pocket Neurology LippincottPocket Neurology (also known as “The Yellow Book”) can be readily found in the white coats of many Neurology residents. Unlike its Medicine counterpart (The Green Book), Pocket Neurology does not seem to hold the same popularity among medical students. There are a few reasons for this. First, it hasn’t been around as long, and thus it hasn’t had time to built up the full extent of its reputation. Few attendings will readily reference it during rounds, and residents simply won’t expect students to own or have access to a copy. Second, Neurology is usually a clerkship of shorter duration compared to Internal Medicine in most medical schools, and therefore comprehensive pocket guides are less bang for the same buck.

What Pocket Neurology covers, it covers very well.  However the target audience for this title is not the same as for Pocket Medicine as a result of the focus in our medical education. We are taught the core principles of Internal Medicine from an early point on entering medical school, including history taking, physical examination, general findings, and many organ system courses focused on Internal Medicine subspecialties. It is because of this focus that new third year medical students can open a copy of Pocket Medicine and understand the more advanced topics without the need for referencing the basics.

This is not the case on a Neurology rotation, where most students are just starting to learn the specialty’s language, techniques, and the significance of common findings. For example, students may be frustrated if trying to use the book to assess the common presentations of migraine prodrome, despite a concise and comprehensive overview of headache differential diagnosis and workup. Getting past the basics quickly to fully utilize this book is highly recommended, as it will certainly be a strong resource to those who can wield it well.

As with all of the titles in the Pocket Notebook series, downsides include lack of space for annotation, and small print font, but these come with the territory of creating pocket reference guides.  Another consideration for this title specifically is an index section that is somewhat lacking.  Topics not contained within tidy concepts involve a good amount of searching in the appropriate chapter.  As a result, many residents will place labeled flags or earmarks on pages to quickly access commonly referenced topics.

Specific sections include neurologic emergencies, lesion localizing in clinical neurology, neuroimaging, vascular neurology, neurocritical care, acute intracranial hypertension, interventional neurology, seizures and other spells, electroencephalography (EEG), delirium, dementia, movement disorders, behavioral neurology, poisons and vitamin deficiencies, meningitis / encephalitis / brain abscesses, infectious diseases, headache, central nervous system vasculitis, pain, dizziness and deafness, demyeliminating diseases of the central nervous system, spine and spinal cord diseases, motor neuron diseases, peripheral neuropathy, radiculopathy and plexopathy, neuromuscular junction disorders, myopathy, electromyography (EMG), neuro-rheumatology, neuro-oncology, sleep medicine, pregnancy neurology, neuro-ophthalmology, consult issues, and selected pediatric disorders.

Overall, this is a title worth purchasing for all Neurology residents and medical students interested in the field. Medical students who wish to excel in their Neurology clerkship or enter a field that uses neurology such as Internal Medicine, Trauma, or Ophthalmology should consider purchasing Pocket Neurology with the above considerations, based on their personal preferences. This is probably not heavily needed for students who have no interest in neurology.


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Otoscope and Ophthalmoscope Set Alternatives: Med School Supply

Compare halogen and LED diagnostic kit bulbsWelch Allyn is the leading manufacturer of otoscopes and ophthalmoscopes, however the quality is also reflected in their higher prices. While many medical students want to purchase top name-brand equipment, and indeed this should be the case for such instruments as stethoscopes, this strategy is not always needed for diagnostic kits. Here’s the usual scenario: second year medical students from AMSA or some other group organize a “money-saving fundraiser” (let’s ignore that blatant oxymoron) and only highlight larger, more expensive, name-brand companies.   Often times there are even incentives to purchase the more expensive $500-$800 diagnostic sets to “save” on smaller instruments such as tuning forks or reflex hammers.

As mentioned in the Compare Welch Allyn series, it is incredibly important to talk to senior medical students at your school to ascertain the actual usage of instruments. This cannot be accurately assessed from manufacturer representatives, or even the second year medical students running the instrument sales.  If third and fourth year students carry their diagnostic sets with them at all times, a Welch Allyn set may be more beneficial.  If such diagnostic kits are used in a small handful of learning sessions that teach physical exam techniques during first and second years and are never utilized throughout the rest of medical school, we recommend the following.

Med School Supply Fiberoptic LED Otoscope Ophthalmoscope SetThe company Med School Supply (completely unrelated to this site despite the similar name) sells full-sized otoscope and ophthalmoscope sets for around $100.  Their standard model works just fine, although their LED otoscope set is actually more highly recommended due to the brighter, better lighting it produces.  You can clearly see the difference between their fiberoptic LED bulb and an older Welch Allyn halogen bulb in the top image of this article, and read more about the differences in the article How to Pick the Best Light Source.

Both kits work with standard otoscope tips, which means there is no reliance on this company for tips after purchasing one of their models.  Like the Standard Otoscope in the Welch Allyn description, Med School Supply otoscopes use a groove system to hold tips internally.  The ophthalmoscope uses the same halogen bulb for both kits, and is a solid basic model, without the bells and whistles as its WA counterpart. Unlike Welch Allyn, there is no built in rechargeable option for the handle.  These models take two C batteries, and that will last the entirety of medical school for the average user.

It is important to note that this company does not have the same quality control standards as Welch Allyn, so it is possible for them to sell and ship a set with a suboptimal component.  Nonetheless, they have a full lifetime warranty on all of their products, so any piece will be replaced free of charge with free return shipping at any point during your use of the instrument.  For the $400 difference between this and the Welch Allyn version, some find this compensated downside to be more than tolerable.


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Tips for Surviving your Obstetrics and Gynecology Rotation

To complement the recent release of our book recommendation for Ob/Gyn clerkship and Step 2 review, we offer the below experiences in hopes that rising medical students can learn from past mistakes and successes. Obstetrics and gynecology is usually perceived as one of the more labile rotations you will face in medical school.  While there are clear differences between hospitals across the nation, and even great variability between teams within the same hospital, this tends to generally be the case with respect to other rotations.

In distinction to many other clerkships, most medical schools rotate students through a number of different ob/gyn sites and settings, usually highlighting outpatient gynecologic exams, inpatient or surgical gynecology, outpatient obstetrics, and labor and delivery. This generally prohibits cohesive or longitudinal teamwork, and leaves residents and attendings with very little exposure time from which they must draw their evaluations. As such, the first piece of advice is to pre-read before starting obstetrics and gynecology.  This is in distinction to other stable rotations where reading can be done along the way. You will get pimped on day 1, and have few days past that to redeem yourself. Come in knowing your basic terminology and abbreviations.

Outpatient Clinics

Outpatient ob/gyn clinics are usually mixed.  Some will probably be shadowing, while others are primary care based, where focus should be on prevention and good planning.  For gynecology, you should know your in-office STD and vaginosis screenings, what to look for on microscopy, and how to treat each. Every exam should have a complete history on sexual partners, obstetrics (G’s and P’s), contraception, pap smears, STDs, vaccinations. If you’re uncomfortable talking about these topics, now is the time to get over it. Be sure to bring your stethoscope.

For obstetrical checkups, you should go in knowing your screening tests, timeline, and the most common reason for first and third trimester bleeding.  Presentations should always start with something sounding like “28 year old G3P1011”.  G (gravity) stands for the number of total pregnancies. P (parity) has four numbers which correspond to full term pregnancies, pre-term pregnancies, abortions/miscarriages, and live children, in that order. You will be commonly treating bacterial vaginosis and trichamonas with flagyl (metronidazole). You should remember this medication has a disulfiram effect, so it should not be taken with alcohol.  Some patients will actually forego treatment until the weekend is over because of this unwanted reaction.  Yes, really.

Gynecology Surgery

Experiences are usually divided between benign and gynecology-oncology. You should have a pair of gloves and lube packets in your back pocket at all times. Each surgery will start with a pelvic exam on your unconscious unconsenting patient. When the resident lubes up, extend your pointer and middle fingers towards them like a handshake for a “high two” to share their lube. This is how Ob/Gyns bond in the wild, along with matching surgeon caps, black zip-up tops, and playing their favorite game: “find then avoid the ureter.” The pre-op exam is a great opportunity to get your pelvic exam down, so don’t pass it up.

You will most likely need to be able to gown up yourself. If you haven’t had surgery, ask an intern or fellow med student to teach you on the first day of your rotation, regardless of whether you’re starting on something surgical. You should also come into this rotation knowing basic knot tying techniques, regardless of whether you’re going into anything surgical. It’s just a good basic skill to have throughout medical school.  If you aren’t familiar with knot tying, a quick search on youtube and spare string or sutures will be helpful.  If you have these basic skills down, you will be allowed to do a few things aside from retract. Remember, if you are down below, it is considered “dirty” even though you are in sterile garb. Never move from pelvis to abdomen without changing gloves. Crazy pimp question: most med students are taught in anatomy that nothing runs with the round ligament, so naturally many attendings love asking about it. The correct answer is the Sampson artery.

Labor and Delivery

obgyn clerkship fetal ultrasoundIf you are interested in catching babies, try to take shifts when there are minimal residents, such as nights. If your hospital has private attendings who allow medical students with them, jump at those opportunities. They’re the ones who will let you actually deliver, whereas many of the interns (especially new interns around July) will soak up the opportunities with staff attendings. A lot of labor and delivery is just going into rooms and asking “is there anything I can get you?” and then fetching ginger ale. However you should push into the action when it starts.

The best way to learn how to deliver a baby is to find someone who will let you put your hands on top of theirs for a few deliveries so you get an idea of just how much pressure and movement is needed. Next step up is having your hands under theirs. Once you have a good feel for that, you’re good to deliver with observation. This technique isn’t necessarily offered or known to many residents, so be sure to ask, but it really works well. Be careful when you put on gloves in the room, because it is not uncommon to get surprise-lubed by one of the nurses, whether you wanted it or not (although you almost always want it). If you have the opportunity, try to spend a little time on triage (be sure you know the signs of labor!).

If you have tips or suggestions you would like added to this article, please add them in the comments.

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Compare Welch Allyn Series: Building a Full Diagnostic Set

This is the sixth and final part of a series of posts on comparing Welch Allyn products that will help incoming first year medical students learn about and select different medical instrument components to construct the right Welch Allyn diagnostic set (otoscope and ophthalmoscope).

By now, you should have reviewed the other five articles in the series, and noted your preferences:
Compare Welch Allyn Series: How to Pick the Best Battery and Handle
Compare Welch Allyn Series: How to Pick the Best Case
Compare Welch Allyn Series: How to Pick the Best Light Source
Compare Welch Allyn Series: How to Pick the Best Otoscope
Compare Welch Allyn Series: How to Pick the Best Ophthalmoscope

Trade-offs of Pricing and Usage

It is important to remember that many medical schools only require use of personal diagnostic sets while learning how to perform a physical exam during preclinical years. Many rotations will either not require use of these instruments, or provide them to medical students and staff if needed. You should contact senior medical students at your school to ascertain the usage of these instruments when considering the price. For minimal use, you may want to consider purchasing from another manufacturer entirely. It is also a common mistake for incoming med students to assume these instruments will be used after med school. Specialties that use these instruments have more expensive versions or wall mounted models, and many specialties won’t need them at all.

Selecting Your Model

Most retailers do not carry all diagnostic kit combinations of the above Welch Allyn components. Most local companies will carry about 4 of the 75 total diagnostic kits manufactured by Welch Allyn, and that is actually sufficient for the large majority of med students. It is not uncommon for retailers to highlight the more expensive components, such as the PanOptic ophthalmoscope, and to list all other options by their model number. This can be a rather confusing selection process, which can be remedied below.

The following application is designed to assist in putting it all together and selecting the Welch Allyn diagnostic kit that is best suited for your needs and desires based on the results of the above articles. You may input your selections and the application will output the specific model number for your use with retailers. It will also output a list of the closest matches to your selection, in case your first choice is not carried by your retailer.

Please click one of the following from each category:

Relative Price $

Recommended Diagnostic Kit Model Number:


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250 Biggest Mistakes 3rd Year Medical Students Make

Book Review: 250 Biggest Mistakes 3rd Year Medical Students Make And How to Avoid ThemMany will argue that the first mistake third year med students make is buying this book, while others will claim that it is an essential and invaluable survival guide. 250 Biggest Mistakes 3rd Year Medical Students Make and How to Avoid Them by Dessai and Katta is the semi-popular successor of the 101 Mistakes book.  As the title suggests, it reviews all of the big issues bound to cause trouble on the wards. But how helpful is it really?  The answer depends upon the direction and perspective from which the book is examined.

If an attending were to be pulled aside and asked to write a list of all the things that bring down 3rd year med student evaluations, it may very well produce this book.  Therefore, many reason that the opposite must be true: buying this book prevents students from making these 250 mistakes, thereby instantly increasing their grades.  That’s essentially the fear hidden in the title of this book: buy it or you won’t get good evals.

Looking at the same scenario from the medical student’s point of view produces different results.  If a fourth year medical student were asked to write a list of all the things they wish they knew for themselves coming into med school (one of the very goals of MedStudentBooks.com), only a small portion of this book would be reproduced.  The reason for this distinction is because the large majority of “mistakes” in this book are common sense items that the large majority of medical students either don’t make, or adapt to with effortless efficiency.

So why the discrepancy in appreciation of this book from readers?  For medical students who have worked in “the real world” or have been held to rigid professional standards previously, pieces of advice such as “show up on time” or “dress professionally” or “get your work done on time” come as an expectation. Others however need gentle reminders that there is a clear distinction in the environment between preclinical and clinical med school years.  The majority of medical students come directly from college, and may face an actual professional setting for the first time in their lives at third year.  This latter group comprises the students who would most benefit from the nuanced recommendations of 250 Mistakes.

The big picture consists of the following.  First, med students should be professional. Second, they should ascertain the characteristics on which they are evaluated by directly asking residents or attendings at the start of each rotation, and reevaluating methods based on feedback along the course of the rotation. It can be an intimidating process for someone unfamiliar with the culture of medicine, but such open communication is a common occurrence.  Most attendings at teaching hospitals are happy to help, and do not mind offering feedback. It should be noted however that this falls under a common rule of medicine: don’t ask the question if you don’t want to know the answer.  Feedback is only helpful if it is used, and being defensive about feedback is looked down upon.

If you can accomplish these goals of professionalism and open communication that seeks out feedback for improvement, there’s not much else this book has to offer.  If however you are new to the working world or want a few gentle pushes in the right direction, this can certainly help.  Despite it’s 200+ pages, it’s a rather fast read with big bullet points.  The book itself is relatively cheap (compare prices below), but it can usually be found at your local medical library, or borrowed from friends or student lounges.


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Compare Welch Allyn Series: How to Pick the Best Ophthalmoscope

This is the fifth part of a series of posts on comparing Welch Allyn products that will help incoming first year medical students learn about and select different medical instrument components to construct the right Welch Allyn diagnostic kit (otoscope and ophthalmoscope). The focus of this discussion is on Welch Allyn diagnostic kit ophthalmoscope heads.

This is the topic that will have the most options and provide the basis behind one of the larger price differences in your diagnostic kit. Ophthalmoscopes, as the name suggests, are instruments used to look at the eyes, specifically the retina. Some med students will get through all of medical school without learning how to actually perform an exam using their ophthalmoscope, let alone utilize many of the bells and whistles that come with it. As with otoscope heads, all of the below ophthalmoscopes are the 3.5 volt version, which refers to the standard power handles, and are in contrast to miniature “pocket sized” versions of these instruments. If you’re interested in the bottom-line short version, scroll to the bottom.

Welch Allyn Compare Series: Standard Ophthalmoscope

Standard Ophthalmoscope

We’ll start as usual by reviewing the baseline model, seen right.  This has the basics that any med student would want, and will allow for visualization of the retina.  It feels and looks just like any other ophthalmoscope you would see in clinic, which means learning on this will prepare you for whatever you may find along medical school, with three additional filters you will most likely never use.

Aside from being able to change the light size or dim the light, this ophthalmoscope allows the user to change the light into a slit beam, for easier visualization of objects on the surface of the eye, as well as the depth of the anterior chamber. It also comes with a fixation aperture, which basically turns the light into cross hairs in case you want to double your ophthalmoscope as a sniper rifle scope. The actual reason for this configuration is for relative measurement and assessing blind spots.  This feature is rarely used even by ophthalmologists, usually in the setting of hospital consultation when there are limited instruments. The final added feature is the red-free filter, which is a funny way of saying “green light” used to contrast structures in the back of the eye from the otherwise red background on which they reside.  Again, chances are you won’t use any of these, and they won’t be taught in med school physical exam classes.

Welch Allyn Compare Series: Ophthalmoscope Apertures, including big, small, micro, fixation, slit, and red-reducing aperturesThe key component that will be used and comes standard on these types of ophthalmoscopes are the focusing lenses, which allow the user to adjust for the physical size of the eye and focus on a crisp image at the back of the eye.  This will come up in subsequent models.

Overall, this is the model of choice for the average med student looking to purchase a quality instrument without the markup associated with unneeded features.  However, many retailers do not offer Welch Allyn diagnostic sets with this lower-priced option, even though such sets are manufactured.

Welch Allyn Compare Series: Coaxial and AutoStep Coaxial Ophthalmoscopes

Coaxial Ophthalmoscope

The next step up is the coaxial ophthalmoscope, which is commonly one of the two models offered by retailers as an ophthalmoscope option in a Welch Allan diagnostic kit. Like the Standard Ophthalmoscope above, it has the same number of focusing lenses, and includes all of the above apertures, plus the cobalt filter.  This is a blue light used in conjunction with fluorescein stain placed in the eye, which produces neon green or orange concentrations of the dye within scratches or irregularities on the surface of the eye. The idea is that it highlights lesions on a clear medium that are otherwise difficult to visualize. This is helpful in field work during emergencies, but will not be a needed skill to use as a medical student, or a necessary tool in the middle of an actual emergency room that has full slit lamps with this feature.

Welch Allyn Compare Series: Opthalmoscope Cobalt Blue Filter

Welch Allyn claims, in their usual fashion, that this upscale model provides less glare, superior visibility, and a larger field of view compared to the standard ophthalmoscope. While bad or broken ophthalmoscopes are indeed a detriment to an ophthalmoscopic exam, I doubt anyone would be able to practically tell the difference between the coaxial and standard Welch Allyn ophthalmoscope.

For completeness, I will also mention that Welch Allyn manufactures the AutoStep Coaxial Ophthalmoscope, which is the exact same instrument, but with additional focusing lenses for super-fine tuning.  This model is not offered in any Welch Allyn diagnostic kit, and would need to be purchased separately.  However, as you can imagine, these additional focusing lenses are not a significant improvement and in no way recommended for medical students (or anyone else).

Welch Allyn Compare Series: PanOptic Ophthalmoscope

PanOptic Ophthalmoscope

The final Welch Allyn Ophthalmoscope to review is the PanOptic Ophthalmoscope, also known as the bazookascope. As you can see from the image, this is in a different league as the other varieties, as its price tag will also prove. Like the above opthalmoscopes, the PanOptic also fits on any standard Welch Allyn 3.5 V power handle.

Welch Allyn states the advantages of this scope include a five-times greater view of the back of the eye, and 26% increased magnification. As mentioned in the otoscope review, an oddly specific 26% increase in magnification is unnoticeable. The PanOptic Ophthalmoscope does however provide a significantly larger view of the retina, with significantly less skill required to use the instrument compared to the learning curve of the above models.  Simply holding this up to a patient’s eye will produce nice results.  Less time spent figuring out how to use the instrument means more time dedicated to figuring out what you’re looking at.  This is an underestimated double edged sword.

As long as a PanOptic is used, better visualization will be acquired.  However the large majority of clinics and hospitals in this country do not have this expensive piece of equipment.  It is exceedingly common for a medical student who learned on a Welch Allyn PanOptic to subsequently have no technical ability to use a standard ophthalmoscope in a practical setting, placing them at a severe disadvantage without their own instrument.

One of the main reasons med students purchase a diagnostic kit is to learn the technique of using these instruments, more so than to use them throughout (or after) medical school. Most clinics will provide med students with wall mounted versions of the standard ophthalmoscope, making it unnecessary to haul around a personal set. Due to the shape, these are also bulkier items that weigh down white coats and do not sit well in soft cases. Given all of the above, as well as the price below, it is exceedingly common for med students to attempt to sell their PanOptic ophthalmoscopes, finding them unnecessary.  Nonetheless, some percentage of students will continue to purchase these instruments to ensure they have the best possible view of the back of the eye.  This is one that definitely has its trade-offs.

In summary, the direct comparison is as follows:

Price *
Cobalt Filter Ease of Use Exposure
Standard Ophthalmoscope
$170 No Learning Curve 5 degrees
Coaxial Ophthalmoscope
$190 Standard Learning Curve 5 degrees
PanOptic Ophthalmoscope
$550 Optional Easy 25 degrees
* prices are for the ophthalmoscope heads only. handles are sold separately.

Prices are higher if you purchase components separately, so try to buy a value meal (a complete diagnostic kit sold as a single unit) unless you can find a really great deal. With that being said, the above three scopes were added to the price-check plugin as a reference.

Still can’t decide? Let us help! Check all that apply:

My med school requires infrequent usage of diagnostic kits.
Money is of no concern in the purchase of my instruments.
I have a habit of losing things easily.
I want to learn physical exam techniques using equipment that will best prepare me for practical clinical settings.
I want to learn physical exam findings using the absolute best equipment at my disposal.



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Compare Welch Allyn Series: How to Pick the Best Otoscope

This is the fourth part of a series of posts on comparing Welch Allyn products that will help incoming first year medical students learn about and select different medical instrument components to construct the right Welch Allyn diagnostic kit (otoscope and ophthalmoscope). The focus of this discussion is on Welch Allyn diagnostic kit otoscope heads.

Unlike prior posts in this series that assist medical students in deciding on which type of products to purchase, this one will focus more on the variability normally encountered by medical students when they first hit the clinic.  Most retailers offer only one option for otoscopes in their diagnostic kit even though Welch Allyn manufactures two varieties, so purchasing decisions are not really an issue.  However med students still need to know how to use all the historically popular versions and accessories, and what to avoid if buying an older model.  As with ophthalmoscope heads, all of the below otoscopes are the 3.5 volt version, which refers to the standard power handles, and are in contrast to miniature “pocket sized” versions of these instruments.

Welch Allyn Compare Series: Pneumatic Otoscope

Pneumatic Otoscope

First, let’s review the older pneumatic otoscopes, seen right. The thing to take away from the discussion of this type of scope is that you should not buy one.  The general concept is the same as all the other otoscopes, without the shiny distracting bells and whistles you’ll never use.  However the big difference between this and the next Welch Allyn otoscope type is the tip.  Notice how the base of the tip is rather wide?  It is essentially the diameter of the barrel of the scope itself.  There is no inherent problem with such tips, as they work perfectly well if you can actually find them, but the chances of coming across one in hospitals and clinics is rather low unless that clinic is specifically using this type of otoscope.  So, if you happen to come across one in clinic, you now know to shove the wide-base tip into the wide barrel of the otoscope.  However you are also aware that buying one of these most likely comes with providing your own lifetime supply of tips.

Welch Allyn Compare Series: Diagnostic Otoscope

Standard Otoscope

Next, let’s look at one of the latest Welch Allyn models to become obsolete for absolutely no reason: the standard diagnostic otoscope. This is the model you are most likely to come across in clinics and hospitals, because they are generally a solid and reliable means of assessing ears. You will also come across other otoscope makers that produce similar looking scopes (to be reviewed in future posts).  If you do want to save money by buying an older used diagnostic kit, this is the otoscope head to get.

Unlike the previous otoscope, this model and the following one both use standard otoscope tips, but through different means.  The covered end of the scope (under the black plastic tip) is conical metal, and has a groove cut into the top of it that helps lock in a bump of plastic on the inside of the tip.  The common mistake med students make is just shoving the tip on without lining up bump with groove, which means the tip doesn’t actually make a secure connection with the otoscope and readily falls off during the examination. While it is especially hilarious to observe medical students accidentally detach the tip and find it dangling out of the patient’s ear (sometimes without their knowledge), this is generally a newbie move to avoid. You should be able to give a slight tug on the tip to ensure it is secure.

Welch Allyn Compare Series: Insufflator BulbThe other difference to note between this and its predecessor is the input for the insufflator bulb, which is an accessory used to push air into the ear and gauge movement of the tympanic membrane.  You may never use an insufflator bulb throughout med school, and should not buy one. Pediatric offices that require their use will supply them. Nonetheless, Welch Allyn decided to change up the industry standard of having a tube attach onto an external plug (female port) to an extra piece of plastic that gets plugged into a hole in the side of the scope (male port). You can see the additional end piece in the image on the right. I’m sure they saw a minor rise in sales because of that change, but medical students should not purchase this accessory.

Welch Allyn Compare Series: Macroview Otoscope

Macroview Otoscope

Lastly, we come to the unnecessary but unavoidable up-sell, the Welch Allyn Macroview Otoscope. Despite decades of doctors being able to visualize the ear canal perfectly well with standard otoscopes, Welch Allyn claims “this instrument is a significant advance in hand-held otoscopy…”

Their key selling points are that this otoscope doubles the field of view and increases magnification by 30% compared to other models. The former may be helpful, but otherwise you can simply move the scope if you want to view the tympanic membrane periphery.  That’s how doctors have done it for decades.  The increased magnification simply isn’t noticeable.  Remember back when you last used a microscope?  The lowest setting was the 10X lens, followed by the 40X lens.  That’s 400% greater magnification.  This offers a 30% increase, which would be like moving up to a 13X lens on your microscope.  In the world of light otoscopy, it sounds like a big improvement, but this really isn’t doing much. This also comes with “the ability to adjust focus for variable ear canal length or farsighted eyes,” which is yet another issue doctors have never really had a big problem with historically.

Welch Allyn Compare Series: Standard Otoscope TipThe macroview otoscope also uses standard tips, but instead of holding onto them by a groove internal to the tip, they actually secure the tip externally.  Ridges found near the tip base actually twist under the end of the otoscope head.  This is actually a nice improvement, as it does a better job of securing the tips.  Of note, you most likely should not need to purchase otoscope tips yourself, as clinics provide them.  Be sure to always grab 10 or so extra for your case, just in case you run into a clinic which is not so courteous.

Another key difference in the Welch Allyn Macroview Otoscope is that its lens cannot be rotated or slid aside for direct access to the ear with a curette through the barrel of the otoscope. This is often used to remove ear wax under direct visualization.  However, most attendings will not want medical students to be performing manual cerumen disimpaction, as there have been rare case reports of bones in the ear accidentally being removed during this process.  Remember: never manually disimpact unless you can directly visualize some portion of the tympanic membrane!

Despite this article poking holes in the advertising of Welch Allyn, this is overall a great otoscope to have.  It is reliable, sturdy, and a great tool to visualize the ear canal, which are all excellent qualities as it is most likely your only diagnostic kit option. Unlike differing ophthalmoscope designs that require different learning and skill sets to actually use, there is no difference in the physical use of any of the above otoscopes.  That essentially means you can purchase and learn on the Welch Allyn Macroview Otoscope, and still know how to use any standard wall-mounted otoscope in an office or emergency department setting.

In summary, the direct comparison is as follows:

Price *
of Tip
in New Kit
Pneumatic Otoscope
$150 Large Base yes special order only
Standard Otoscope
$110 Standard yes no
Macroview Otoscope
$225 Standard no yes
* prices are for the otoscope heads only. handles are sold separately.

Prices are higher if you purchase components separately, so try to buy a value meal (a complete diagnostic kit sold as a single unit) unless you can find a really great deal.  With that being said, the above three scopes were added to the price-check plugin as a reference.


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Compare Welch Allyn Series: How to Pick the Best Light Source

This is the third installment of a series of posts on comparing Welch Allyn products that will help incoming first year medical students learn about and select different medical instrument components to construct the right Welch Allyn diagnostic kit (otoscope and ophthalmoscope). The focus of this discussion is on Welch Allyn diagnostic kit light sources, which are the physical bulbs that illuminate the ear canal or retina through the otoscope and ophthalmoscope, respectively.

Choices here are limited throughout the industry to either halogen bulbs, which have been the long-standing default in the field, or the newer sexier light-emitting diode (LED) technology. If you’re interested in the bottom-line short version, scroll to the bottom.

Welch Allyn Halogen BulbFirst let’s hit the older (read: cheaper) option that is still the default for diagnostic kits today. Halogen bulbs have been the standard for otoscopes and ophthalmoscopes for a while now, and Welch Allyn has (in their usual fashion) claimed theirs is the best. Halogen lights in general produce a yellow or off-white softer light. This actually comes in handy when viewing a retina, as brighter lights will constrict the pupil, thus making it more difficult to actually see the retina.

The downside to halogen bulbs is that they are somewhat easy to break, and they degrade and burn out faster than LEDs. Historically, halogen bulbs have cost up to $60 to replace, making this a sub-optimal option that doctors just had to put up with. Today, the price has thankfully lowered. Overall, this is now the cheaper option simply because it is the older technology, even though it works reliably well.

Welch Allyn LED Bulbs for Diagnostic KitsDiagnostic kit LED lightsaber bullets bulbs on the other hand are the more expensive option, which is somewhat surprising simply because LED technology of this variety has been around for a lot longer than it has been used in otoscopes, and should theoretically be cheaper. Welch Allyn had previously scoffed at LED lights, but are now making the transition over since competitors have been offering this option. Due to these recent changes, you can still find contradictory representatives that claim LED lights are not needed, while portions of their website claim LED lights as superior. They have however taken some time to create shiny exaggerated graphics, which I will share below. Regardless, do not be surprised if this newer option is not yet offered by most retailers.

Not quite sure how to interpret this one…

LED bulbs produce whiter and brighter light, allowing for clearer visualization of ears and noses. Check out the direct comparison of the two light sources in the top image. The LED is like a light-bazooka in comparison. Med students can just use their LED otoscope and actually forgo carrying a separate penlight to check pupils or look in someone’s throat, as they run on similar LED bulbs (that only cost the expected $2). LEDs use a fraction of the power compared to halogens (which means your handle battery lasts longer), are near-impossible to burn out, and don’t degrade in light quality during extended use. In almost every way, LED bulbs produce harder, better, faster, and stronger light.

The first real downside at this point is the cost, but that is expected to dramatically drop as soon as generic options are created that fit Welch Allyn diagnostic kits. Refuting the claim that the LED can be “too bright” is as easy as dimming the bulb on the power switch. As an aside, I find it amusing that Welch Allyn believes that dimming a halogen bulb, as seen in their demo on the right, somehow produces black-light (I said they were exaggerated). My personal solution, and the setup that I use in my instruments, is keeping the ophthalmoscope halogenated, and using an LED only with the otoscope. I get the best of both worlds. Keep in mind that you may need to open your instruments to insert the LED bulb yourself if your retailer does not provide this service for you. If you have the smarts to get into med school, this shouldn’t be too difficult to figure out. I’m sure there’s a “how many med students does it take to screw in a light bulb” joke somewhere in there.

Selecting an LED bulb may seem like a no-brainer. However, choosing this optional component in your diagnostic kit should come down to the question as whether this sexy super-light is actually needed. For the large majority of medical students, the answer is no, and the prices offered by Welch Allyn should serve as a deterrent, if the option is offered by retailers at this point.

In summary, the direct comparison is as follows:

Approx. Price Lifetime *
Color and Intensity
Halogen Bulb
$25 ~7 months Soft yellow
LED Bulb
$90 ~25 years Bright white
* refers to the total time when the bulb is actually on and in use

Still can’t decide? Let us help! Check all that apply:

My retailer doesn’t even offer LED, and I’m not really a do-it-yourself kinda person.
Money is of no concern in the purchase of my instruments.
I have a habit of dropping my cell phone frequently.
I want to learn on the same components as everyone else, including the people teaching me.
I want to learn physical exam techniques using the absolute best equipment at my disposal.
I’m never going to use this diagnostic kit after med school, and will probably not use it that much in med school either.


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