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Inkling ReviewShalu Gillum aa University of Central Florida College of Medicine , Orlando ,Florida , USAPublished online: 08 Mar 2013.

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Journal of Electronic Resources in Medical Libraries, 10(1):32–44, 2013Copyright © Taylor & Francis Group, LLCISSN: 1542-4065 print/1542-4073 onlineDOI: 10.1080/15424065.2012.762213

eBOOKSHELF

Kimberly Mitchell, Column Editor

Inkling Review

SHALU GILLUM University of Central Florida College of Medicine, Orlando, Florida, USA

Inkling is an interactive electronic textbook publishing platform for the Apple iPad, iPhone, and, more recently, the Web. The Inkling app for iPad has transformed traditional print textbooks into engaging educational experiences for the end user. Unique features of Inkling include audio and video clips, dynamic images, self-assessments, and social networking, all integrated into the text of the e-book. Inkling textbook titles are available in a variety of dis-ciplines, including medicine, business, travel, technology, arts and photography, and several others. Within the topic of medicine, sub-categories of titles available include anatomy, internal medicine, biochemistry, and 15 others. In total, 119 medical titles are cur-rently available.

KEYWORDS electronic books, health sciences, Inkling, iPad, tablet, product review

INTRODUCTION

Inkling is an interactive textbook publishing platform for the Apple iPad, iPhone, and the Web. A relatively new company based in San Francisco, California, Inkling Systems, Inc. is a team of designers and engineers who have created a “touchable textbook” meant for the Apple iPad. The company

Comments and suggestions should be sent to the Column Editor: Kimberly Mitchell (kimberly.mitchell@acphs.edu).

Address correspondence to Shalu Gillum, JD, MLS, AHIP, is Public Services Librarian, Harriet F. Ginsburg Health Sciences Library, University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Suite 210D, Orlando, FL 32827. E-mail: shalu@ucf.edu

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has worked with big name publishers such as McGraw-Hill, Pearson, and Lippincott Williams & Wilkins to transform print textbooks into interactive electronic books (e-books). This review will discuss the Bates Guide to Physical Examination and History Taking as available on the Inkling iPad app and is meant as a follow up to the review of the same book (JERML, April–June 2011), previously only available as an e-book on the Lippincott Williams and Wilkins platform, The Point.

E-books on the Inkling platform are available in a wide variety of disci-plines, including medicine, business, technology, travel, arts and photogra-phy, and cooking. The Inkling interface moves beyond the static PDF and HTML-based e-books of recent years. Users can easily tap to open chapters, swipe to scroll between sections, and pinch two fingers to zoom in and out of images. Interactive features in many Inkling titles include quizzes and other self-assessments, audio, video, and social networking. Inkling has thus created a new kind of educational experience for medical students.

While the Inkling app itself is free from the Apple App Store, actual e-textbooks must be purchased from the Inkling website. Titles range in price depending on their subject matter. Medical e-textbooks cost anywhere from $3.99 to $449.00 for an anesthesiology title. The average price of medi-cal e-textbooks available on Inkling is approximately $70.00. Prices are set by the publisher of each title. Currently, for example, Bates Guide to Physical Examination and History Taking is one of Inkling’s top purchased titles and is available for full download for $119.99. Individual book chapters are also available at a range of prices, starting at $0.99. All Inkling titles have one chapter available for free, allowing users to preview the title. According to Inkling’s website, titles available on its platform are up to 40% cheaper than their print counterparts, although this may not hold true for medical books. The high interactivity of these e-textbooks and the labor involved in creating that interactivity tends to keep the price of medical e-textbooks relatively close to the print versions. Full e-textbooks are available free to educators (with some exceptions), who can contact Inkling for further details.

Due to the interactive features built into each e-book, Inkling titles range in size from 15 MB or less to 596 MB for a large title like Bates, which is heavy on audio, video, and interactive features. Other titles are larger still. Medical titles in general can take up a substantial amount of space on an iPad. If a number of Inkling titles are to be downloaded, a larger capacity device, such as a 32 GB or 64 BG iPad, is recommended. This would avoid space constraints that could occur when adding other user content to the iPad, such as music, videos, or photos. Inkling titles that are not frequently used can be deleted from a user’s library in order to save space on a device. Titles that have been purchased are always available on Inkling’s servers and can be re-downloaded as needed, although this could be time consuming for large titles such as Bates. A wireless connection would also be required. One of the benefits of using Inkling, especially for medical students rotating

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through various facilities, is that once content is downloaded, it is self-con-tained on the iPad; a wireless connection is not needed. This also applies to the interactive features built into a title. Video clips, for example, can be viewed without a wireless connection, once the title is fully downloaded to the device.

ACCESS TO CONTENT ON INKLING

While Inkling is geared for the individual end user, the company is willing to do what many traditional print publishers have not, that is, work with libraries to provide e-book content to patrons. Despite being a relatively new company, Inkling is developing a name for itself by working with medical schools across the country to license their content in bulk for access by medical students and faculty. Their typical acquisition and delivery system is simple yet effective. First, health sciences libraries choose which titles avail-able on Inkling they would like to purchase. Many titles traditionally used in a medical school curriculum, including Bates, Pathophysiology of Heart Disease, and Harrison’s Principles of Internal Medicine, are already available, and the company is regularly adding new titles to its catalog. Bulk discounts are available for libraries purchasing Inkling e-textbooks for medical stu-dents, and are generally in the range of 10–30% depending on the publisher and the quantity of titles purchased.

Once an agreement is reached regarding titles being purchased and payment, users’ (i.e., medical students, faculty, and librarians) email addresses are then provided to Inkling. Each user on this list receives an email from Inkling indicating that a new title is available for download. Users are directed to the Apple App Store to download the Inkling app. Once the app is downloaded, purchased e-books will automatically appear in each user’s library. Titles must be fully downloaded via an Internet con-nection before they can be read. Titles purchased from Inkling are available in perpetuity to the end user, which is especially important for medical students needing to study for Board examinations months or years after having used a particular title in class.

The licensing model described above is currently being employed at the University of Central Florida College of Medicine. At that institution, the Harriet F. Ginsburg Health Sciences Library has become the center of deploy-ment of tablet technology at the college, spearheading the distribution of Apple iPads to all four classes of medical students and all full-time teaching faculty. The library purchased 10 Inkling titles for all of its 100 first-year medical students and one title for its 80 second-year medical students. There is, however, an alternative model that is currently being tested at Nova Southeastern University’s Health Professions Division (HPD) Library. The HPD Library has purchased 12 titles from Inkling, each title with 10

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concurrent users, for one year. Under this model users have access through IP authentication from the library’s website. Users must then login with an Inkling user name and password once they have authenticated from the library’s site. The additional login allows users to save their notes, highlights, and bookmarks. The main disadvantage of this model, however, is that users must use the Web version of Inkling on a desktop or laptop and cannot access the library-purchased Inkling titles on an iPad with the Inkling app, thus losing much of the interactive tactile experience of Inkling on the iPad. Another shortcoming of this system is the unavailability of social networking, a feature that truly sets Inkling apart from other e-book platforms.

BUILDING YOUR LIBRARY—GETTING STARTED

Creating an Account and Logging In

To begin using Inkling users must create a free account on the company’s home page (Inkling.com). All that is required is a name, email address, and password. Users also have the option of signing in with their Facebook account information. Once an account is created, a confirmation email is sent to the user. Once logged in to the Inkling home page, users can use the “Shop” link to browse titles to purchase. A search function allows users to find books by keyword, including title, author, or subject. The final step to begin using Inkling is purchasing the free app from the Apple App Store. It should be noted that the app is for reading books available in one’s library; titles must be purchased from Inkling’s website first. Medical and other academic textbooks can be found under the “Textbooks” subheading on the website.

BASIC E-TEXTBOOK NAVIGATION

Once in the Inkling app users have access to their e-book library. The library is displayed either as large book images or a list of titles with small book images. This display can be changed using the display buttons at the bottom right of the app. Titles in the library can be deleted using the “Edit” function at the bottom of the app. The left-hand side of the Inkling app features a narrow bar with various navigation functions. This navigation bar gives users access to their account, library, the Inkling catalog, social networking (e.g., following friends and/or professors to view their notes and highlights). This navigation bar remains on the screen while the app is open, with its features changing when a book is opened. Tapping on a book from the library opens that book within the app. The navigation bar now has links to the library, search features, notes, view options, and a scroll bar to quickly move between pages within a chapter.

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Within an Inkling e-book in the app, the list of chapters with chapter images is displayed in a column on the left (see Figure 1). Tapping a chapter opens another column in the middle of the screen displaying the title of each section within that chapter, and often a few of the images found in that sec-tion. The third and rightmost column is where the actual text of the book is displayed. These three columns—chapter listing, section listing, and text—can be expanded and collapsed with a swipe of the screen. A left arrow on the Inkling navigation bar allows users to return to the chapter listing while reading a particular textbook.

Once in the body of the e-book, scrolling up and down to read the text can be accomplished in one of three ways: (1) by finger swiping up and down on the screen, (2) by using the scroll bar function on the navigation bar, or (3) by using the up and down arrows on the navigation bar. This last option allows readers to jump from one section to another within a chapter. Page breaks are visible while scrolling up and down.

View Options

An “AA” icon on the navigation bar opens the View Options for the Inkling app. Here users can adjust text size. Four size options are available. Under View Options, page numbers can be turned on and off, along with paging

FIGURE 1 E-textbook navigation.

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hotspots. Paging hotspots allow for advancing the page up or down by tap-ping on the bottom or top of the screen. In Bates, these hotspots were hit or miss and did not always work well.

The View Options screen also allows users to turn off highlights and notes so they are not displayed. A “How to use Inkling” tutorial is also avail-able under View Options. This tutorial is rather confusing, consisting of sev-eral options all over one black screen. It is also rather too basic and explains features that are almost intuitive to anyone having even nominal experience with the iPad (e.g., tapping and holding to highlight).

Search

One of the best features of Inkling interactive e-textbooks is the ability to search within a title. A magnifying glass on the navigation bar opens the search option. From here users can enter a search term, for example, “mur-murs.” A list of suggested searches appears as search terms are typed. Recent searches are also displayed. Search results are displayed within the search feature in a dropdown box, as displayed in Figure 2. Results can be sorted by Relevance, Content order, or Type. Under content order, results are shown in the order they appear in the text, with subheadings appearing in blue along with a short annotation. These subheadings are links and tapping

FIGURE 2 Search.

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them takes users to the appropriate place in the textbook. Examples of results filtered by type include images, reading, quizzes, and videos.

A vast improvement over other traditional e-books is the inclusion of page numbers. As most librarians have experienced, e-books typically do not contain page numbers corresponding to the print version. This can lead to frustration in students who want to read the e-book version, but have diffi-culty doing so because they have been assigned a series of pages from the print book and have no way to find those pages in the e-book. Page num-bers in Inkling are displayed in light gray font on the left side of the main reading pane. The search feature in Inkling allows users to quickly jump to a particular page. Typing in “124” in the search box in Bates, for example, prompts users if they want to jump to page 124 or search for “124.” Jumping to a page allows users to quickly go to a certain page, while searching for “124” would do a search for that number and not necessarily go to that page.

INTERACTIVE FEATURES

The true uniqueness of Inkling lies in its interactivity. Audio and video clips, case studies with self-assessments, images with the ability to hide and show labels, and sharable notes and highlights with social networking capabilities take Inkling e-textbooks light years beyond not only the static print text-book, but the typical e-book.

Audio Clips

Some Inkling e-textbooks include audio clips. This is especially helpful in medical texts. For example, in the cardiovascular system chapter in Bates, medical students can read about heart murmurs and then hear various normal and abnormal heart sounds. Similarly, in the thorax and lungs chapter, audio clips of various breath sounds are available. As illustrated in Figure 3, audio clips are graphically displayed with a “Listen Now” icon under each type of sound. The volume can be controlled via the main iPad volume control.

Once a particular audio clip is selected, a narrow audio player appears at the bottom of the app screen with a play and pause function (see Figure 4). The total length of the clip is also displayed. Users can move forward and back easily within an audio clip to repeat a portion if desired. One advan-tage to studying with the Inkling app is that users can seamlessly listen to audio clips related to the material they are reading. This provides a more enriched reading and learning experience.

Videos

In Bates, the Visual Guide to Physical Examination in the form of videos is available. Previously, these videos were only available to readers via scratch

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off codes on the Point, or on CD-ROM accompanying the print book. Like integrated audio clips, having videos available within an e-book may help create a more efficient and effective learning experience for medical stu-dents, who can watch procedures or techniques they have just read about without having to consult a separate resource at another time.

FIGURE 3 Audio clips.

FIGURE 4 Audio clip player.

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Quizzes and Self-Assessments

CASE STUDIES

One form of self-assessment built into Inkling medical e-textbooks is case studies. Bates, for example, has several case studies at the end of various chapters. A “Case Studies” banner appears in-text where these are available. Clicking on this opens the cases full screen, as illustrated by Figure 5. The patient’s chief complaint is given, along with a history of present illness. Then specific questions are asked. Answers are hidden behind a “Show Answer” link. Clicking on this reveals the correct answer(s), and the link reads “Hide Answer.”

TEST YOURSELF/IMAGE LABELS

Another form of self-assessment integrated into Inkling is the “Test Yourself” feature, as shown in Figure 6. Some illustrations in Bates allow readers to test themselves on the structures pictured. A blue “Test Yourself” box with a question mark indicates that the figure has labels that can be hidden and revealed. Clicking on the Test Yourself box opens the figure full screen with all structures labeled. Clicking on Test Yourself again flips the image, and all labels are replaced with question marks. Each question mark can be tapped to reveal the correct label. Not all figures in Bates have this capability. Other figures will simply be enlarged to full screen when tapped. This interactive feature has the potential to have the greatest effect on medical students’

FIGURE 5 Case studies.

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studying habits. These image labels could make handwritten flashcards—the mainstay of medical students’ repertoire of study tools—obsolete. They also make it easier to study for subjects where large amounts of information must be retained, such as anatomy.

REVIEW QUESTIONS

The final form of self-assessment built into Inkling is review questions, an example of which is displayed in Figure 7. Several chapters in Bates feature a short set of multiple choice review questions at the end. Users can click to show the correct answer, or they can check if the answer they chose is cor-rect. A “Scoreboard” at the top left of the screen shows how many questions remain, how many have been answered correctly, and how many have been answered incorrectly. All answers can also be cleared here.

Notebook

A page icon on the navigation bar takes users to their “notebook.” The note-book contains users’ notes, highlights, and bookmarks. These are displayed in a dropdown list by date and area filterable by most recent or content order. See Figure 8 as an example.

FIGURE 6 Test yourself.

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NOTES

Notes can be added by tapping and holding any text in an e-book. A yellow callout icon appears on the left margin of an e-book if a note has been made. Clicking on the callout reveals the note, its author, and the date it was made. A user’s notes will appear in yellow, with other people’s notes appearing in different colors. Users can comment on notes made by others and vice versa.

HIGHLIGHTING

Highlighting is done by tapping and holding any text in an e-book. Highlights appear in yellow, while highlights made by other users show up in a differ-ent color. Like notes, highlights are saved in the notebook under the page icon on the navigation bar. Also like notes, highlights can be filtered by most recent and by content order, which lists highlights by chapter.

BOOKMARKS

A star icon in the upper right corner of the app screen allows users to book-mark sections in a chapter. Once bookmarked, the star turns yellow. Bookmarks are also saved in the notebook. Clicking on the page icon on the navigation bar allows users to quickly see which sections were bookmarked

FIGURE 7 Review questions.

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and on which date(s) the bookmarks were made. Tapping on one of these immediately opens that section in the e-book. Bookmarks can be filtered by most recent or by content order. Filtering by content order shows all book-marks by chapter.

Social Networking

One of the most unique features of the Inkling platform is its integrated social networking. This allows Inkling users to follow others reading the same e-book, and to see their highlights and notes (potentially in real time). Users can thus create a running discussion about the content they are read-ing. Users can also star notes they find useful, for quick reference. From the main screen within the Inkling app users can select the “Community” icon to find people to follow on Inkling. Following someone allows users to see that person’s notes and highlights in a particular e-book. This could be useful in an academic setting, with faculty creating notes to clarify certain material, or to highlight content that students should review. Similarly, students can create study groups and follow each other, creating notes as study guides. The Community screen within the app shows users “People I’m Following” and “People Following Me.” Users can find people to follow by the clicking the “Find People” link. Inkling immediately returns suggestions for people to

FIGURE 8 Notebook.

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follow; for example, librarians in a library who have access to the same text-book are automatically listed. Other Inkling users can be found by email address. A user’s followers are displayed as First name Last initial. Each per-son’s profile indicates their institution, how many followers they have, how many notes and highlights they have made, and when they last made an update.

A “Notifications” button at the top of the Notebook screen indicates when someone has requested to follow the user, or if someone has inter-acted with a user’s discussions. Sharing notes and highlighting can be dis-abled for those who do not want to use this feature. This can be done under the View Options menu from the “AA” icon on the navigation bar.

SUPPLEMENTARY MATERIAL

Tables and other supplementary material in Bates are found at the end of chapters. Some chapters also include a bibliography of citations. These are not linked to PubMed or other databases; however, URLs for websites are hyperlinked and will open full screen within the Inkling app.

CONCLUSION

The Inkling “touchable textbook” can provide a revolutionary learning expe-rience for users. These e-textbooks allow for multiple learning modalities, from visual and aural to tactile. This is especially beneficial to medical stu-dents. While reading Bates Guide to Physical Examination & History Taking, for example, users can benefit from not only reading the text but also from listening to various heart and lung sounds, watching medical procedures and proper examination techniques, and manipulating content, and from assess-ing their own knowledge, all during the same sitting and within one plat-form. Inkling’s eagerness to work with libraries to get e-book content once limited only to individual purchasers has allowed libraries to move beyond the traditional print and e-book models.

REFERENCES

1. Inkling Systems, Inc. Inkling. Available: <http://www.inkling.com>. Accessed: November 27, 2012.

2. Inkling Systems, Inc. About us. Available: <http://www.inkling.com/about>. Accessed: November 27, 2012.

3. Bickley, L.S., and Szilagyi, P.G. Bates’ Guide to Physical Examination and History Taking. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009.

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