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Exam notes became an iBook Store bestseller

As newly graduated medical doctors, Jens Sundbøll and Morten Schmidt from Health decided that their exam notes ought to be put to good use. So they developed the app and bestseller 'Intern Medicin’ (‘Internal Medicine' in English) and founded a company that has now led to new opportunities for collaboration.

It was hugely satisfying to be in control of even the smallest details, which we were, says Jens Sundbøll.
Foreign companies that have shown interest in establishing a collaboration, says Morten Schmidt. In an international context it’s unusual to have a product with such a high ‘market penetration’, which is to say that such a large percentage of the target group actually buy the product.

"The first of its kind in Denmark and the easiest way to learn and revise internal medicine." This is how the iBook Store markets the medical app Sundbøll & Schmidts Intern Medicin, which brings together knowledge about internal medicine’s nine specialties in one software program with features that make everyday life easier — e.g. because the app is always close at hand via an iPhone in your lab coat pocket.

The two newly graduated medical doctors Jens Sundbøll and Morten Schmidt initially made the app available to medical students busy revising and junior doctors back in 2013. While the price of the first beta version was DKK 89, it has risen as the app's features were expanded with several revisions, so it now costs DKK 239. Since the first edition was put on sale more than 2,000 examples of the app have been sold.

"We’re proud of the fact that unlike traditional printed text books, we can offer free updates to all our users. So once you’ve invested in the app, you automatically get all future updates for download on your iPhone," says Morten, who is today in training to become heart specialist and cardiology fellow at the Regional Hospital of Herning.

'Commercialisation' was an unknown concept

Jens Sundbøll and Morten Schmidt belong to the small group of medicine graduates who have made the leap from taking the knowledge they have and turning it into a product. And although it only happened five years ago, Jens Sundbøll looks back on a period during which the product took shape as one where concepts such as product development and commercialisation were almost unknown on the medical degree programme:

"For one thing, Morten and I discussed whether we had the right to charge money for our app. It was kind of inappropriate in an academic world at that time," says Jens Sundbøll, who is today medical doctor and postdoc at the Department of Clinical Epidemiology which is in turn part of the Department of Clinical Medicine.

Today, five years later, not only is the app a bestseller in the iBooks Store in the broad, perhaps slightly misleading category of 'textbooks' – because an app is more than just an e-book. The app has also opened new doors for brand new tasks in the interface between research, education and invention – which we will return to. Firstly, check out the app's options for highlighting, adding your own notes, sharing material with colleagues, looking up more than 10,000 abbreviations in the app's dictionary, or further reading via external links:

2011 – final exams coming up

The story of the app starts in the autumn of 2011 when Jens and Morten became study mates on the final and twelfth semester of the medical degree programme. Their common goal was top marks in the five final exams – and as the syllabus was more than 4,000 pages packed with information in classic textbooks, they needed to be smart about how they studied, as Jens puts it.

"We made a gentleman's agreement where we committed to providing the best notes possible to each other so we could confidently and exclusively use them and get a top result," explains Jens about the work on the basic material for the app.

In practice the syllabus for the internal medical specialities was shared equally between them, after which Jens and Morten took notes for their part so that the other person could use these to swot for the exam. Then they swapped notes and read the other part of the syllabus – now with the other person's notes as support and with the chance to clarify and improve the starting point.

The exam studying was organised so that the notes to the individual medical specialities were completed before the clinical teaching began, meaning that the notes could be continuously  supplemented with words of wisdom from classroom instruction, lectures, hand-outs and clinical guidelines.

Jens and Morten did not think in terms of product in the run up to the exam. They put the books aside and revised exclusively after the system which turned out to work as intended. The whole thing ended with Jens and Morten graduating with top marks, which together with encouragement from fellow students, led them to reflect on how the functional notes could be utilised to benefit more students and junior doctors.

From text to hand-drawn illustrations

"It was clear that it shouldn’t just be yet another traditional printed or for that matter e-book. We were both very interested in the features we thought were helpful – both for learning new material and for working in a busy clinical environment — and the logical choice was therefore an app format," says Morten Schmidt.

Even though neither Jens nor Morten had prerequisites or experience of making apps, they decided to develop the app from scratch.

"It was hugely satisfying to be in control of even the smallest details, which we were. For example, we sat and drew the illustrations of the nine specialty logos by hand using a drawing program on an iPad. But when I look back on it today, I think about the unbelievable number of working hours we put into the app," says Jens Sundbøll with a little shake of the head.

His summary of the time they used: during the twelfth semester where the notes were written, work began at 7:30 at the medical campus of Aarhus University and typically ended at 22:00. Which they repeated for seven days a week over six months. Following the exam in January 2012, Jens began his clinical basic education in Esbjerg while Morten travelled to Ohio, USA to do research. Concurrently they began the development work where the super notes were rethought and translated into a software program.

Utilised the time difference

"We organised things so we could take advantage of the time difference because Morten was doing research during the day and working on the app in the evening American time. When he stopped work and went to bed, I typically came home from work at Esbjerg Hospital and took over where Morten left off," explains Jens Sundbøll – and that was how things continued for nine laborious months with staggered around the clock work on their app-project.

"All-in-all, we’re talking about perhaps almost a year's effective work, and that’s on top of firstly full-time studies and then full-time work and research. You can only manage to do it for a period of time," he adds.

Along the way, Jens and Morten co-founded the private company StudySmart ApS, which, as Jens Sundbøll puts it, created the necessary structure for continued collaboration.

"Although sales can now be counted in the thousands, the hourly pay would have undoubtedly been better if we’d taken on two newspaper routes instead," says Morten Schmidt with a smile.

New tasks await

On the other hand, they are left with a priceless feeling of having produced something which – according to the approximately fifty user reviews in the iBooks Store – has helped both exam-stressed medical students on the Master’s programme and junior doctors in the middle of a busy clinical working day. Almost all users have given 5 out of 5 stars and comments such as "Indispensable", "Nothing less than a stroke of genius", "The best reason for buying an iPad!", "Cheap help for your studies!", "A must-have for internal medicine!" and "Great balance between overview and details ".

Neither has the app gone unnoticed in the app industry and it has opened new doors:

"We’ve come to realise that in an international context it’s unusual to have a product with such a high ‘market penetration’ as has been the case here, which is to say that such a large percentage of the target group actually buy the product. There are therefore foreign companies that have shown interest in establishing a collaboration, so it’s probably not the last project we’re going to get involved in," says Morten Schmidt.

More about the product

'Sundbøll & Schmidts Intern Medicin' is a systematic review (in Danish) of the syllabus for internal medicine that is structured with the help of:

  • Interactive tables of contents that mean all nooks and crannies can be reached with three clicks. For example, if you search for diabetic ketoacidosis, the route goes via three clicks, namely Endocrinology, Diabetes mellitus and Acute complications.
  • A fixed order in the review of the different disease definitions, occurrences, symptoms, signs, paraclinical features, differential diagnoses, treatment and prognosis.
  • Easy access to highlight, add notes or share them with study mates/medical colleagues.
  • References to recognised medical works, national treatment guides, scientific articles and other online information sources such as national handbooks and YouTube.
  • An interactive dictionary that consistently explains > 10,000 abbreviations and definitions in a deeper layer so that the flow is not disturbed.

Since 'Intern Medicin', Jens Sundbøll and Morten Schmidt have produced another app, 'Journalkoncept' (‘Medical Journal Concept’ in English) which has also become a success among medical students and junior doctors.

More about prices etc.

  • The app can be bought in the iBooks Store and costs DKK 239.
  • Buying the app gives you the right to download and install the product on both iPhone, iPad and Mac with free access to all future updates. The product includes 562 pages of interactive material on internal medicine. It has thus far been updated five times.
  • The money from purchases is shared with one-third going to Apple and the remainder to StudySmart ApS.
  • Revenue does not yet match the costs and time spent on development