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Who Has Seen a Blood Sugar? Reflections on Medical Education

by F Davidoff. pp 232. Amer ican College of Physicians, Philadelphia. 1996 ISBN 0-943126-47-9

The conundrum used as a title for this book intrigues and engages the potential reader, but does not provide much help in indicating its likely contents. This role is left to the subtitle that informs such a reader that here will be found explorations on medical education, of necessity, within a North American context. As many others would have done, I read first the essay (for this is a collection of essays) that provides the title to this book. This helped me release the tension posed by the puzzling question and introduced me to an important and recurring concept. This is that like its interest in blood sugar concentration (which is invisible reality, being a mental construct), the practice of modern medicine has become much more about giving concrete form to the invisible realities revealed by the use of science and technology on a patients body than about the visible sick person in need of help (in body, mind, or their relation with society and environment).

These 41 essays (most are five pages long) are brief insightful meditations or explorations (occasionally they are also gentle exportations, and pointers, to change) on a wide variety of medical topics and particularly the education and training of effective physicians. They were revised and expanded from versions, all but one of which first appeared in the American College o f Physicians Observer between March 1992 and November 1995. Four were written with one of three co-authors. As the Introduction points out they are not about educational method or technique (although not a few have a bearing on this) and do not form a systematic treatise (or monograph) on medical education. Rather, in the manner of Thomas Lewis or Harold Morowitz (recent, well-known essayists on mainly medical and biological topics), each focuses on a particular aspect or component of the practice of internal medicine and the professional preparation for it and leisurely reflects on it from a particular perspective (eg, of statistics, or recent publica- tions on medical education or sociology).

Davidoff is a gifted analyst. He is meticulous in preparation of his arguments, and persistent in stating and elaborating them clearly, concisely, effectively. This is to be expected from the Editor of Annals o f Internal Medicine. He describes himself as a clinical diabetologist. This may explain the choice of 'blood sugar' in the title. However, this is as near as biochemistry gets to being mentioned in these pages. His essay 'Is Basic Science Necessary?' gives a rather neutral and pragmatic answer to this perennial question, at least as regards the role of basic science in the general practice of clinical medicine, while acknowledging its role in developing new tools to be used in that practice.

Since a wide variety of topics is reflected on, the collection could have been grouped in several ways. The chosen grouping proceeds from the inner world of Mental Models (Part 1, eleven chapters) and feelings (Part 2, nine chapters), to the interaction of cognitive and affective aspects under the heading of Symbiosis (Part 3, nine chapters), and then to the outer world of Social and Political Contexts (Part 4, twelve chapters). Almost a quarter of the pieces deals with one aspect or another of Continuing Medical Education (CME, an activity still largely industry-sponsored and delivered as 'long linear streams of information presented to passive audiences', p 165). About one half is about education in general. These explore topics like: the limitations of classic cases in teaching; the nature of explanation; lifelong learning; self assessment; the purpose of a curriculum;

the use of an educational value scale; teachers as bankers or midwifes; aphorisms, maxims and metaphors; learning versus teaching; teaching versus research; technologies of education; principles of andragogy and experimental learning. The rest discuss testing of confidence and clinical skills, multiple choice questions, or important topics such as evidence-based medicine, uncertainty, severity as the link between disease and illness, physicians and detections, professional manners and quitting smoking.

F Vella

Handbook of Molecular and Cellular Methods in Biology and Medicine

by P B Kaufman, W Wu, D Kim and L J Cseke. pp 484. C R C Press, Boca Raton, 1995. £65 ISBN 0-8493-2511-0

This handbook is designed as a bench-top recipe guide for the molecular biology laboratory of the 90's. Trying to follow the three volumes of Molecular Cloning, A Laboratory Manual by Sambrook et al. (which appear to be used ubiquitously in every lab worldwide) is no easy job! However, in a single volume Kaufman et al. have outlined many of today's essential molec- ular biology techniques. Most techniques are described with great thoroughness; each step of a protocol is successively numbered in a user-friendly manner and all the reagents required to perform the method are stated at the end of each method. Many descriptions contain trouble-shooting guides describing symptoms and solutions. The initial chapters describe how to purify nucleic acids and proteins, making of cDNA and genomic DNA libraries and DNA mutagenesis. In subsequent chapters the techniques required to re-introduce the gene of interest, once isolated, back into a plant/animal are described. Many chapters are devoted to topics not covered in Sambrook et al, such as protein purification, the production of antibodies, microscopy, plant cell culture and chromatographic fractiona- tion techniques. Importantly, like all good lab method books the text is comb-bound for a long life in the lab environment!

I was surpised and disappointed to discover that the technique of in situ hybridization was not outlined at all; some proteins are extremely recalcitrant as antigens and in situ hybridization may be the only means of assessing expression of a gene of interest. Perhaps a more serious limitation is that the polymerase chain reaction (PCR) is covered only very superficially. This is disappointing as PCR is the one technique which has revolution- ized molecular biology. The future importance of PCR will only increase as the applications of the technique continue to diverge enormously. I an imagine that only a few readers of the book may need to create a genomic DNA library in their career, for example, but I suspect that every reader will perform at least one major application of the PCR technique.

Regretably, two deficiencies are immediately clear which compromise the quality of this book. The first is the poor quality of the figures, some of which appear to convey little information, seem superfluous or might have been created for some other purpose. Second, each chapter ends with only a limited selection of references. I believe that a methods book should be a rich source for guiding further reading. Nevertheless, although this book will not be as widely cited in the literature as Sambrook et al, Kaufman et al have produced an accomplished guide to supplement many of the existing method books required at some point in the molecular biology laboratory of today.

R Moore

BIOCHEMICAL EDUCATION 24(4) 1996