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Case-Based Medical Physiology.
Christopher Bell, Cecil Kidd, and
Trefor Morgan.
Oxford, UK: Blackwell Publishing, 2005, 176 pp., illus., index, $29.95.
This book consists of 19 clinical cases that together “cover” much, but
certainly not all, of the physiology normally encountered in a medical
physiology course.
Each case begins with a “Case Introduction” which is a brief description of
the presenting complaint of the patient. As the case unfolds and additional
data is made available, questions are interspersed throughout the text, most
in a multiple choice format, others requiring a brief free response from the
student. Patient data, or illustrations of normal physiology, are presented
in graphical and tabular form. Following completion of the case “MCQ Answers
and Feedback” are provided. Next is found a “Case Review” or summary and a
short list of “Key Points.” Finally, there is a brief “Additional Reading”
list.
It is critical in evaluating this book to ask how it is meant to be used by
medical students, the stated audience for this volume. Unfortunately, the
authors provide almost no help in resolving this issue. They indicate, in a
brief Preface, that this book can be used by students in a “problem-solving”
or a more “traditional” curriculum (their terms). But nowhere do they offer
any suggestion about what it would mean to “use” this book in a medical
curriculum.
So, let me propose several possible uses for a book of clinical cases like
this one. One way to use cases is as problems to be solved by small groups
of students (At Rush we call them “small group problem solving workshops,”
but the label really doesn’t matter). The case can be addressed piece by
piece first by smaller groups of students and by all of the workshop
participants in plenary session. This format helps students integrate the
knowledge that they accumulated. It also helps them develop the reasoning
skills needed to start with a set of signs and symptoms and determine
possible (patho)physiological mechanisms that could explain how the patient
came to be in the state described in the case.
Alternatively, one might organize a lecture block in the course around a
clinical case, using it to help students generate learning issues (“what
physiology do I need to understand to understand this case”) and practice
applying their growing understanding of physiology to solving problems (the
questions in the case).
Finally, some students might find this book of use in reviewing for course
exams or even national licensing exams.
How well will this book serve students attempting to use it in any of the
ways described above? The cases seem to be well chosen and appropriate for
students learning physiology. Any particular instructor is likely to rue the
absence of a favorite teaching case or two, but, on the whole, the selection
included in the volume is a good one.
However, the questions inserted into cases are rather a mixed bag. Most of
the questions are in a multiple choice format, with many using features that
the psychometricians tell us are to be avoided (all or none of the above,
stems with “except”). Many of the multiple choice questions are simply aimed
at testing recall of information. Others address questions about (inferences
from) the patient data presented in the case. These are more challenging as
they require the student to apply what they know to solving a problem.
The quality of the explanations for the answers is as important as the
quality of the questions, and here I was frequently disappointed. Many
explanations, even when correct (as far as I know), were not particularly
helpful to students whose understanding of the physiology is limited. The
fact that there is only a little didactic explanation of physiological
phenomena imbedded in the case means that students may find it difficult to
fully understand the important ideas that the cases are meant to illustrate.
One small concern about this book arises from the nationalities of the
authors - Irish, Scottish, and Australian; the spelling is British (“oedema”)
not American (“edema”) although in most cases this shouldn’t be a real
problem. On the other hand, some of the medical terminology is different
from the terminology used in American medical practice and this could be a
source of some confusion.
On the whole, then, this is an interesting and potentially useful learning
resource for both students and teachers of medical physiology. It provides a
clinical context for many of the most important concepts that physiology
teachers would like their students to master. It is NOT a replacement or a
substitute for a physiology textbook, although it might usefully supplement
a textbook. Nor is it a substitute for the board review books that so many
American medical students use to prepare for the USMLE exam, although it
might very well help students prepare for an exam that is now much more
integrative and clinical than it was it once was in the past.
Joel Michael
Rush Medical College, Chicago, IL
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