Obstetrics, Gynaecology, and Women's Health
http://www.100md.com
《新英格兰医药杂志》
Well-being, autonomy, and social justice are the basis of this book's approach to the care of women. This modern textbook of obstetrics and gynecology sets out an approach to medical education that pays attention to the process by which a naive, skeptical medical student can be transformed into a competent, ethical medical professional.
Medical students typically do better on their examinations at the end of their clinical rotation in obstetrics and gynecology than they do at the end of medical school. The facts we learn do not remain with us unless we use them, so it is better to learn how to learn. Most textbooks provide us with facts; others that purport to teach us how to think often prove to be too polemical. Editors O'Connor and Kovacs, two Australian gynecologic educators, recognize this problem and give us a bit of each approach. A success, for example, is the section on how to use the medical literature to consider a clinical question. Should the young woman with severe migraine headaches who needs effective birth control be allowed to use oral hormonal contraceptives? The authors provide a model for using a Web site, such as PubMed, and review the articles retrieved in some detail. Such an approach offers the student a tool for lifelong learning.
Despite its strengths, the book falls short in certain key areas. In the section on unplanned pregnancy and medical abortion, the authors present a truncated clinical protocol that misses most of the evidence-based information on medically induced termination of early pregnancy. In addition, the prostaglandin used in this protocol is not available in the United States, which renders the protocol even less useful for American medical students. However, if the book is used as a teaching tool, these shortcomings can offer the student an unexpected opportunity to review the evidence-based approach to medically induced early abortion — a teachable moment.
Each chapter emphasizes the importance of the physician's role in facilitating the autonomy of patients, including the need to listen carefully to patients' stories. The authors seek to communicate this message through many case examples in every chapter. They focus on the corollary message as well: a competent doctor must provide the patient with sufficiently up-to-date information in order to promote her participation in her own care. Rather than using the differential-diagnosis approach to medical problem solving, this book focuses more on clinical skills in decision making. The authors pose a clinical question and then concentrate on how the student can find the best information for making an evidence-based decision. The editorial work shows a consistency of style and approach, although terms are occasionally used before they are defined.
Overall, the textbook provides tools for problem solving but is not intended to be an exhaustive resource on evidence-based causes of disease and treatment options. For instance, resident-level physicians will find the book helpful in researching a subject such as menorrhagia, for which the book lists pelvic inflammatory disease as an organic cause. However, if readers wanted to know the evidence for making such a diagnosis, they would then have to go to the literature. This book would be best used as part of a regular tutorial program for medical students in which the students are assigned a clinical problem to solve and use the textbook as a starting point and guide.
Steven Sondheimer, M.D.
University of Pennsylvania
Philadelphia, PA 19104(Edited by Vivienne O'Conn)
Medical students typically do better on their examinations at the end of their clinical rotation in obstetrics and gynecology than they do at the end of medical school. The facts we learn do not remain with us unless we use them, so it is better to learn how to learn. Most textbooks provide us with facts; others that purport to teach us how to think often prove to be too polemical. Editors O'Connor and Kovacs, two Australian gynecologic educators, recognize this problem and give us a bit of each approach. A success, for example, is the section on how to use the medical literature to consider a clinical question. Should the young woman with severe migraine headaches who needs effective birth control be allowed to use oral hormonal contraceptives? The authors provide a model for using a Web site, such as PubMed, and review the articles retrieved in some detail. Such an approach offers the student a tool for lifelong learning.
Despite its strengths, the book falls short in certain key areas. In the section on unplanned pregnancy and medical abortion, the authors present a truncated clinical protocol that misses most of the evidence-based information on medically induced termination of early pregnancy. In addition, the prostaglandin used in this protocol is not available in the United States, which renders the protocol even less useful for American medical students. However, if the book is used as a teaching tool, these shortcomings can offer the student an unexpected opportunity to review the evidence-based approach to medically induced early abortion — a teachable moment.
Each chapter emphasizes the importance of the physician's role in facilitating the autonomy of patients, including the need to listen carefully to patients' stories. The authors seek to communicate this message through many case examples in every chapter. They focus on the corollary message as well: a competent doctor must provide the patient with sufficiently up-to-date information in order to promote her participation in her own care. Rather than using the differential-diagnosis approach to medical problem solving, this book focuses more on clinical skills in decision making. The authors pose a clinical question and then concentrate on how the student can find the best information for making an evidence-based decision. The editorial work shows a consistency of style and approach, although terms are occasionally used before they are defined.
Overall, the textbook provides tools for problem solving but is not intended to be an exhaustive resource on evidence-based causes of disease and treatment options. For instance, resident-level physicians will find the book helpful in researching a subject such as menorrhagia, for which the book lists pelvic inflammatory disease as an organic cause. However, if readers wanted to know the evidence for making such a diagnosis, they would then have to go to the literature. This book would be best used as part of a regular tutorial program for medical students in which the students are assigned a clinical problem to solve and use the textbook as a starting point and guide.
Steven Sondheimer, M.D.
University of Pennsylvania
Philadelphia, PA 19104(Edited by Vivienne O'Conn)