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February 1999 For the Office-based Teacher of Family Medicine Paul M. Paulman, MD Community Physician Bookshelf
(Fam Med 1999;31(2):84-6.) The students and residents traveling to our community medical offices have been exposed to many facets of high-tech learning in the university setting. They have used CD-ROMs and laser disks in place of microscopes. They have searched the Internet and national medical libraries for resources. At times, they have turned to computer programs to augment differential diagnoses or therapy options for their patients. While many community offices are beginning to use similar technology for some aspects of their practices, the development of a core bookshelf for use in day-to-day patient care and teaching benefits everyone: the students, the patients, and the physicians. Our community physician offices can use a few well-selected references to provide opportunities for student-clinician educational exchange, along with improved patient care and patient education. While the specific books on this core bookshelf may vary, some general content areas should be covered. Having books about methods of clinical teaching as well as those related to clinical practice information is beneficial. The ideal bookshelf will have a mix of both. The teaching methods books are particularly useful when you are beginning a teaching program in your office or when you are interested in expanding your teaching methods. The teaching methods books continue to be a valuable reference for the times you are presented with a different level of learner, a difficult student, or a particular problem. Therefore, I will also suggest some teaching methods books, recognizing that these are likely to be used on an intermittent basis. Clinical Textbooks With the above goals in mind, a gross anatomy textbook or Netter Series (All textbooks recommended in this article are listed in Table 1.) is a frequent resource to remind students how the normal anatomy has been altered or to explain the rationale for a type of treatment. A patient presenting with a urinary obstruction who does not recall the function or location of the prostate gland provides an opportunity for the medical student to review the anatomy text with the patient. This devotes time to the patient, educates both the student and the patient, and facilitates the flow of office visits. A secondary benefit is that students begin to recognize their already-achieved expertise and their contribution to the practice, while patients appreciate the students’ time. Some physicians find basic pathology or physiology books useful to have on hand. If your books are outdated, purchasing a new edition through the medical school might be worthwhile. Other clinicians prefer to use the fundamental medical, pediatric, or surgical textbooks to help refresh their memory on basic alterations of normal physiology. It is also useful to have a pharmacy reference book, such as the Physician's Desk Reference or the American Hospital Formulary Service on Drug Information to aid students in their frequent review of medications, side-effects, interactions, or contraindications. You may also encourage them to share this information with the patients. Three strong areas of a typical community practice where students and residents can receive valuable training often not available in tertiary centers involve musculoskeletal medicine, dermatology, and outpatient procedures. For a musculoskeletal reference, I use Physical Examination of the Spine and Extremities because of the excellent focus on the basic musculoskeletal exam. I also rely on several sports medicine books for treatment and therapy options. Examples that I have found useful include Primary Care Sports Medicine, Handbook of Sports Medicine, and Sports Injuries. For dermatology, I find several books necessary to have enough variation of photographs for comparisons. The primary reference that I use is Clinical Dermatology, because it provides excellent treatment recommendations and useful information on teaching students to describe the rash or lesion that they are seeing. This text is well supplemented by many other primarily photo books like Diagnosis and Treatment of Common Skin Diseases. A most important role for community physicians in student education is increasing the student’s comfort with a great number and a diverse range of new procedures. Primary care offices provide students with opportunites to become familiar with a breadth of procedures, including those used for screening and therapy. These will include endoscopies, skin surgeries, and multiple biopsy techniques. Procedures for Primary Care Physicians is an excellent resource and frequently used by students, residents, and clinicians alike. Ambulatory Surgery provides useful information, discussion related to equipment needs, methodologies, and potential complications. General medical books, such as Harrison’s Principles of Internal Medicine, Cecil’s Textbook of Medicine, or Scientific American Medicine, can be useful for discussing the pathophysiology of specific disease processes. Basic pediatrics books, such as Nelson Textbook of Pediatrics, are excellent sources for reviewing uncommon or congenital problems, as well as normal pediatric development and behaviors. Most gynecologic questions can be answered with the well-organized Clinical Gynecologic Endocrinology and Infertility; it has particularly good chapters on dysfunctional bleeding, infertility evaluation, menopausal changes, and hormone replacement therapy. The practical clinical approach and diagrams provide a useful review for senior medical students and residents, as well as patients. Teaching Resources Whitman and Schwenk’s The Physician as Teacher provides a practical and easy-to-read handbook. They discuss styles of teaching and provide an excellent review of various teaching methods useful in different situations with different types of students or groups in a community practice. Deutsch’s more-recent Community-based Teaching provides an overview with a particularly strong focus on evaluation and curriculum development. In summary, the community physician’s office can offer an important practice model through the use of well-chosen reference books to improve patient care and education while creating opportunities for student education. The use of technical and scientific journals and the role of newer technology in information retrieval can complement these. However, a small number of key and familiar on-hand resource books is still the core resource for community-based teaching.
Corresponding Author:
Address correspondence to Dr Benzie, University
of Minnesota-Duluth, Department of Family Medicine, 139 Med, 10
University Drive, Duluth, MN 55812. 218-726-7574. Fax: 218-726-6235.
E-mail: dbenzie@d.umn.edu.
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