Achieving Excellence in Medical Education: book review

  This book by Richard Gunderman was just reviewed in the November 30 issue of the New England Journal of Medicine. I looked around and found some more reviews of the book:

Gunderman, Richard B. Achieving Excellence in Medical Education, New York: Springer, 2006. ISBN-13 978-1-84628-296-6, ISBN-10 1-84628-296-9

From the publisher:  A goldmine of theoretical insights and practical suggestions, “Achieving Excellence in Medical Education” explores the essential question facing medical educators and learners today: What is our vision of educational excellence, and what can we do to enhance our performance? Among the topics explored within this engaging, informative, and thought-provoking text are: Education’s position as a priority of medical schools, seminal educational insights from non-medical educators, best practices of outstanding educators and learners, promises and pitfalls of new educational technologies, key resources for promoting excellence in medical education, medical education’s role in preparing future leaders, leadership roles for medical schools in universities and society.

From NEJM: In this unusual book, there are discussions of a very broad range of issues in medical education — from learning theory to educational technology, and from diversity in medicine to the economic challenges of academic practice and the relationships between medical schools and teaching hospitals. Such an attempt by a single author to be comprehensive often veers off into personal, sometimes idiosyncratic perspectives, but in this case I was pleasantly surprised. This book not only succeeds in what I doubted a single author could accomplish — the book is, in fact, a useful and balanced overview of the state of . . . 

From JAMA:  “Academic medicine is like a tripod, standing on three legs. One leg is patient care, one is research, and one is education. Over the course of the twentieth century, the emphasis placed on each of these missions has changed. In recent years, education has become the short leg of the tripod.” So begins Richard B. Gunderman, MD, PhD, in his plea to understand, preserve, and expand medical education. His work is well-grounded in educational theory and colored by historical review. His passionate dedication to medical education is evident in the tone of his writing, which uses such phrases as “we must” and “we should.” Throughout the text, the author draws from educational theory, but his second chapter is devoted exclusively to it. He discusses learning theory, reviewing the four most important theories influencing modern educational practice. He explores what it means to exhibit expertise and how to train to expertise . .

Look inside this book, courtesy of Amazon.com

Selling Sickness [book reviews]

    I just read a review of Selling Sickness  (published in the July/August issue of the ACP Journal Club) and thought you might be interested to read this and other reviews of this book.  [Link to more reviews at the end of this post.] 

See also A Collection of Articles on Disease Mongering;  Ethics and the Pharmaceutical Industry; Pharma fears and “Sicko” [on Michael Moore's new film, from Sue Pelletier's Capsules]

Moynihan R, Cassels A. Selling Sickness: How the world’s biggest pharmaceutical companies are turning us all into patients. Vancouver: Greystone Books, 2005.

An excerpt from the review:
Thirty years ago, Henry Gadsden, chief executive of Merck, told Fortune magazine he wanted Merck “to be more like chewing gum maker Wrigley’s.”
Gadsden said it had long been his dream to make drugs for healthy people, because then Merck would be able to “sell to everyone.” This is the starting point and central thesis of Moynihan and Cassels’ book, Selling Sickness—that pharmaceutical companies are working to turn us all into patients, and in the process generate ever-bigger profits for themselves (and ever-greater health care costs for health care systems). They make a compelling case that big pharma has deliberately used its influence to broaden disease definitions to expand its markets. For example, they report that GlaxoSmithKline (formerly SmithKline Beecham) has claimed that social anxiety disorder (SAD) affects 1 in 8 Americans. Other definitions put the prevalence variously at < 1% or, in some studies, up to 4%. By more broadly defining the criteria for SAD, the pharmaceutical company created a greatly expanded market for its drug Paxil, the first drug approved for the treatment of SAD.

The reviewer concludes:
Most of the examples and the citations are American. The
United States has < 5% of the world’s population but 50% of the global market in prescription drugs. Cassels is Canadian, and Moynihan is Australian. Both of these countries are protected against the full force of big pharma by having publicly funded health systems and evidence-based agencies that make decisions about provision of prescription medicines. Furthermore, unlike the
United States, these countries have limited direct-to-consumer advertising. Nevertheless, this book is informative and alarming reading regardless of where you live. The authors claim, and I agree with them, that along with regulatory and advertising controls, a major antidote to selling sickness is skepticism—of drug industry claims and drug company–funded research. Evidence-based medicine has a big role to play in maintaining balance between the important benefits of appropriately used prescription drugs and the risks for unsubstantiated claims and promotions by the industry.

Journal Record [subscription required]  Search inside the book at Amazon
BMJ Review     CMAJ Review

Adult Education: Three reviews from the Adult Education Quarterly

The May 2006 issue of Adult Education Quarterly includes reviews of three books on adult education:

Simone Conceição.  Book Review: Philosophical Foundations of Adult Education. Adult Education Quarterly 2006 56: 223-224.
Philosophical Foundations of Adult Education, by John L. Elias and Sharan B. Merriam (3rd ed.). Malabar, FL: Krieger, 2005. 286 pp., $39.50 (hardcover). DOI link to review

Extract: An essential book for anyone working in adult education is John Elias and Sharan Merriam’s third edition of Philosophical Foundations of Adult Education. The book addresses seven theoretical approaches to adult education: liberal, progressive, behaviorist, humanist, radical/critical, analytic, and postmodern. It provides a historical background and key foundations for each approach. The third edition maintains the same organization of chapters as the previous edition (i.e., review of historical roots and basic principles of each philosophy, an examination of its manifestations in adult education practice, and assessment of the philosophy’s usefulness to adult education practice). However, it provides major changes to each chapter and a new chapter on postmodern adult education due to updates in understandings in the field of adult education during the past 10 years.
Journal Record    Amazon

Gretchen T. Bersch.  Book Review: Adult Education and Lifelong Learning: Theory and Practice. Adult Education Quarterly 2006 56: 224-225.
Adult Education and Lifelong Learning: Theory and Practice, by Peter Jarvis (3rd ed.). London: Routledge Falmer, 2003. 382 pp., $42.95 (paperback).  DOI link to review

Extract: Peter Jarvis has long been a strong British voice through his writing and personal connections in the field. He had two earlier versions of this book, one in 1983 and a second in 1995. Now he has produced the third edition, adding some new sections, such as technology/distance education, and updating others. Each chapter of this edition has a brief overview, followed by the content of the chapter and finally a short summary. At the end of the book, there are selected further readings by topic and an extensive bibliography, just less than 20% of whichwas published since the second edition of this book in 1995. Twelve chapters are included, ranging from adult education/adult learning, teaching, theoretical perspectives, distance education, curriculum and program planning, and several final chapters that focus on developments and situations in the United Kingdom.
Journal Record    Amazon

Talmadge C. Guy.  Book Review: Review of Adult Learning and Literacy: Connecting Research, Policy, and Practice. Adult Education Quarterly 2006 56: 227-229.
Review of Adult Learning and Literacy: Connecting Research, Policy, and Practice (Volume 5), edited by J. P. Comings, B. Garner, and C. Smith. Mahwah, NJ: Lawrence Erlbaum, 2005. 288 pp., $69.95 (hardcover). DOI link to review

Extract: The American system of adult literacy has been around for nearly 40 years. For most of this time, it has been highly fragmented and subject to fits and starts in its development, advocacy, policy making, and organization. It is possible to argue that the field has now moved from childhood into adolescence. One indicator of this is the publication of an annual review of the field under the sponsorship of the National Center for the Study of Adult Literacy and Learning (NCSALL) with the purpose of drawing into focus the key issues, questions, and developments in research, theory, policy, and practice. In this fifth edition, the editors have selected chapters that glimpse important issues facing the field. The book is intended for researchers, policy makers, and practitioners interested or working in the fields of adult basic education (ABE), English for speakers of other languages (ESOL), and adult secondary programs (ASE). NCSALL is a collaboration of four universities (Harvard Graduate School of Education, University of Tennessee, Rutgers University, and Portland State University) andWorld Education, a nonprofit international organization devoted to improving education for the underprivileged. The fifth volume was published in 2005 but this is a bit misleading, as the year under review in this edition is actually 2002.
Journal Record    Amazon
 

Ethics and the Pharmaceutical Industry: two new books

New reviews of these two books appear in the July 27 issue of the New England Journal of Medicine. See the excerpts below.

Ethics and the Pharmaceutical Industry. Edited by Michael A. Santoro and Thomas M. Gorrie, 492 pp, $40, ISBN 0-521-85496-2, New York, NY, Cambridge University Press, 2005.
JAMA Review      
JAMA excerpt: [full text by subscription]
The pharmaceutical industry has had a prized business role in society because of its ability to provide tools for treating illness and alleviating human suffering. However, in recent years public perception of pharmaceutical companies has become increasingly negative. While the title Ethics and the Pharmaceutical Industry may suggest a paradox, Michael Santoro and Thomas Gorrie have compiled a series of essays that provide a fair, balanced, and insightful examination of an increasingly troubled relationship between the pharmaceutical industry and society. They highlight that much of the challenge in this relationship is driven by an imperfect alignment of objectives. Society wants affordable, effective, and safe drugs. Businesses want to maximize profits. The free market brings these two sets of objectives together while providing powerful incentives for creativity and innovation but also for businesses to restrict access to products and distort medical priorities.

NEJM excerpt: [full text by subscription]
Santoro and Gorrie have woven together a rich collection of perspectives in Ethics and the Pharmaceutical Industry, with contributors ranging from activists and academicians to regulators and representatives from the industry. Santoro, an academician, and Gorrie, who has a background in the industry, bring different conceptual orientations to the work. In their words, Gorrie believes “that healthcare is a commodity” and Santoro believes “that healthcare is a fundamental human right that circumscribes the exercise of intellectual property.” They also hold differing views of the proper role of government in the oversight of the pharmaceutical industry. These conflicting outlooks are reflected in the contributed chapters, which provide accessible and nuanced descriptions of the views of various stakeholders. The range of topics that are covered is quite broad, much like the reach of the industry itself. These topics include drug development and clinical testing, marketing and the availability of health care resources, and intellectual property and fair pricing. Because the contributors come from different camps, it would be imprudent to read a single chapter with the assumption that it offers a complete picture of a particular problem or issue. Rather, the book may prove to be the most useful in offering chapters with competing perspectives. As such, the integrative work is left in large part to the reader, although introductory material written by the editors preceding each major section provides an overview.
Another Review

The Law and Ethics of the Pharmaceutical Industry. by Graham Dukes, 409 pp, $129.95, ISBN 0-444-51868-1, San Diego, Calif, Elsevier, 2006.
JAMA Review     JAMA excerpt: [full text by subscription]
The preface of this book begins, “Any sector of society has both its written and unwritten rules of behaviour, which develop and change as time goes by.” Graham Dukes, professor emeritus of Drug Policy Studies at the University of Groningen in the Netherlands, builds the entire book around that sentence. He traces the origins of laws, regulations, and codes of behavior developed around the world to guide the pharmaceutical industry. In this regard, the book is very ambitious. It describes the history of the pharmaceutical industry and the definition of standards for that industry. It goes on to document the acceptance and implementation of those standards in areas such as safety, demonstration of efficacy, and ensuring quality. It describes the behavior of the industry in terms of pricing and profits and its role in innovation and marketing. It covers the industry in both the developed and developing world and even deals with issues such as animal studies and the role of generic manufacturers.NEJM excerpt: [full text by subscription]
Dukes’s book, The Law and Ethics of the Pharmaceutical Industry, reflects the author’s background in medicine and law. In mapping the wide range of policies and laws that relate to the pharmaceutical industry and the associated ethical issues, Dukes presents an important set of background conditions. Commensurate with the relevant conditions at hand, the scope of the book is vast and includes sections on business standards; standards for drug quality, safety, and efficacy; marketing and its relationship to education; drug pricing; pharmaceutical innovation; issues in the developing world; special situations (such as animal and human research, self-medication, controlled substances, alternative medicines, orphan drugs, and veterinary drugs); the manufacture of generic drugs; and areas of social controversy (such as the use of contraceptives and abortifacients and the patenting of biologic materials). Although Dukes doesn’t attempt to catalogue all relevant laws, he provides categories and examples that serve as a useful starting point for understanding the types of policies and laws that should be considered in particular cases. In addition, Dukes includes stories that led to the adoption of some of the laws and policies, which helps to make the process more accessible to the reader.

How Doctors Think: Clinical Judgment and the Practice of Medicine [JAMA book review]

This book review was just published in the May 3 issue of JAMA:

Moore, Donald E. Jr. How Doctors Think: Clinical Judgment and the Practice of Medicine, by Kathryn Montgomery, 246 pp, $39.50, ISBN 0-19-518712-1, New York, NY, Oxford University Press, 2006. [book review]  JAMA 2006; 295:2080-2081.

JAMA extract: Kathryn Montgomery, PhD, has written a thoughtful and provocative book that challenges us to reconceptualize our assumptions about how physicians think in the clinical encounter, how physicians-in-training are taught, and how physicians and patients interact. In the introductory chapter, Montgomery, who is professor of bioethics and medical humanities at Northwestern University, starts by stating that clinical medicine is not a science. Furthermore, she suggests that the widely held and unquestioned assumption that clinical medicine is a science and that it follows the scientific method leads to approaches to medical education that are too harsh and to clinical practice that is too impersonal and, as a result, unsatisfying to physicians and patients. Rather than considering clinical medicine a science, she proposes that it be conceptualized as a rational, science-using practice. She draws on Aristotle’s phronesis*—the flexible interpretive capacity that enables moral reasoners to determine the best action to take when knowledge depends on circumstances—to characterize physician thinking in the clinical encounter as interpretive practice.

Moore concludes: How Doctors Think is a useful book for everyone involved in medicine, from medical educators, who could use it to develop a more humane approach to medical education, to individual practitioners, who could use it to help reflect on and improve their clinical practice. [full text by subscription]
  
E-mail the reviewer         Journal Record                     BMJ Review   
University of Virginia Podcast: How Doctors Think, with Kathryn Montgomery [scroll down, fourth item from the end]

* From the OED Online: Phronesis: Practical understanding; wisdom, prudence; sound judgement.