Book reviews
Many years ago a Hungarian salesman tried to sell the 1970s edition of the Encyclopaedia Britannica to my wife and myself. ‘Mr and Mrs Hodgson’, he said, ‘you have ambition for your children…?’. The editors of this book on the mechanisms of disease clearly have very substantial ambitions for medical undergraduates in the UK.
The paradigm is simple – a set of chapters which outline an area of advance in basic science and link it to a clinical field. Among the 16 chapters the most accessible are those that follow this pattern – such as a crisp chapter on the acute coronary syndrome (Heagerty – but cardiology is quite a simple subject of course), and the chapters on infection, bacterial or parasitic (Lawn and Griffin, Molyneux). Much more difficult as an author to have been faced with summarising molecular and cell biology in 40 pages (Davis), without the leavening of clinical scenarios that other chapters offer. Some authors have taken their subject – notably Cox on lysosomal disorders – and produced a meticulously detailed up-to-date review that appears to leave nothing further to be said on the entire field, but might well terrify an undergraduate who feels that one has to know and potentially regurgitate everything one read on a particular topic. The overall scope of the topics is wide but naturally not comprehensive – topics such as allergy, autoimmunity, stroke, diabetic neuropathy, alcoholic liver disease, renal cell carcinoma, and the interaction between organic and psychiatric disease complete the contents list. One suspects the precise choice of contributions was based on the perceived willingness and skills of the contributors. I was slightly put off by the linking in the preface of the purposes of the book (‘to provide a mechanistic as opposed to traditional list-based approach to medicine’) to the aims of the General Medical Council – but then only reviewers read prefaces.
How does a book like this fit into current undergraduate teaching and curricula? It certainly shows ambition. Does current medical educational practice allow that ambition? I think of my experiences – shared by many – of the tedium of acting as an Objective Structured Clinical Examiner, and I think to myself that in that exercise the students I am examining are being assessed not for how they have been educated, and not even for how they have been trained, but for how they have been drilled in examination technique. As the most extreme – but certainly not too uncommon – example, they may ostentatiously go through the visible motions of assessing the height of the jugular venous pressure (JVP). If then asked how high is the JVP, many will not be able to answer – they had been trained to be seen to observe, not to observe. If asked what the implication of an elevated JVP is, the chapter on heart failure (Neyses and Buch) would certainly have put them right.
So my initial response to this book was that it reflected the high aspirations of its editors for our students, but I wondered whether – in the light of the assessment culture referred to above – it would manage to make the real contribution to the education, as opposed to training, of students that it is undoubtedly well equipped to make. I rather depressingly came to the conclusion that it probably wouldn't. But then I took in the fact that this is now in its second edition – so, gratifyingly, out there someone must be buying it. And if a student reads it, they should indeed be wiser as well as better informed
As to Britannica – no we didn't buy it. But we did get a battered copy of the 1929 edition from the corner shop.
- © 2009 Royal College of Physicians
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