Series: Volume 1, Issue 1 2010

This is the inaugural issue of the Australian Medical Student Journal.

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Feature Articles

So you think you can research?

I had always considered myself an exceptional dancer. In my mind, my dance moves were unparalleled. However, in reflection, I must admit that the majority of my moves were employed to impress the scrub-nurses by turning my gown in tune to the bopping background beat of the theatre iPod. However, my delusions of dancing grandeur were shattered after watching a number of the popular dance-based shows on television. I realised it took far more than genetic talent, which I still choose to believe I have in abundance, to make a dancer. It requires hours of practice combined with fitness, good music, choreography and originality to succeed. Research, it appears, is not too dissimilar.

I had never been the most proactive student and my CV was barer than a middle-aged German tourist holidaying in Thailand. I had reached a stage in my career where it was time to contribute to medical research. Those who partake in evidence-based medicine know how important research is to the field of medicine.

If you have ever considered undertaking some formal research yourself, here are a few lessons I learnt the hard way:

What do you need?

So, you want to research? Not sure where to begin?

In dance, you need to start with either good music or a good choreographer. In research, your music is your idea, question or inspiration, and your choreographer is your supervisor.

The music (idea)

The chances are that someone, somewhere, has already attempted to adapt “the sprinkler” to your chosen music. As in research, if you think you have a good idea, someone else may have had it before you. To find out, the next step is to conduct a literature review. Medline is a good place to start.

Don’t be disheartened if someone has already researched your hypothesis. In medicine, most people can only answer very specific questions. So, if your good idea has already been partially covered, then read a few articles and find a more specific, unanswered question similar to your original one.

For example, if your question was “How effective is heparin in preventing DVT?” then refine your question to “How effective is low molecular weigh heparin in preventing DVT in male patients aged between 80 and 81 with a past history of smoking 22 cigarettes a day who have just undergone a knee replacement and whose favourite colour is light blue, when compared to Aspirin?” and believe you me, it is unlikely anyone else has researched that topic! Also, if someone has attempted to answer your question, it is worthwhile reading their article. If you find that their methodology is lacking, then you may decide to investigate that topic regardless, albeit with more watertight…

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Feature Articles

A very good iDEA: The inaugural gathering of the student division of Doctors for the Environment Australia

The result of one attendee’s bright iDEA.

In early December 2009, just prior to the much-hyped COP15 round of United Nations climate negotiations in Copenhagen, 40 medical students, representing six states and eleven medical schools, descended upon Melbourne for iDEA, the inaugural gathering for the student division of Doctors for the Environment (DEA). Attendees were encouraged to be mindful of their carbon footprints whilst travelling to the conference, with many students opting for train or coach rather than air travel. Most impressively, three Tasmanians cycled for three days from Hobart to Melbourne University (with the assistance of the Bass Strait ferry).

Education and networking were the focus of this three day gathering at Newman College within the University of Melbourne, where a plethora of distinguished speakers presented talks and interactive workshops to enlighten the receptive minds in attendance: academics, environmental activists, clinicians and all combinations of the three.

All present agreed that it was long overdue that medical students gathered to discuss environmental issues relevant to health; issues that for various reasons have been sidelined by the medical fraternity. These issues often traverse traditional subject boundaries, implying a perceived or real lack of academic expertise. Additionally, the lack of confidence in using one’s ‘authority’ as a medical professional plays a part. Climate change, for instance, is often seen as a political or economic concern rather than a threat to health. Being too busy, self-preservation, fear over allegations of hypocrisy, ignorance, inertia and ‘donor fatigue’ all contribute to the reluctance of doctors to speak up.

According to Costello et al., climate change “is the biggest global health threat of the 21st century” and the repercussions to health will be global in reach, but with a disproportionately large impact falling on the developing world. [1] Matthew Wright, co-founder of Beyond Zero Emissions, a Melbourne-based organisation promoting the rapid transition to a zero carbon future, raised the interesting point that planning for a zero-carbon future is different to planning for a low emissions future, which, in turn, is different to planning for a doubtful emission reduction trading scheme in which concessions are made to big polluters. Although it seems paradoxical, government inaction in the short term could thus be preferable to legislating a hurried, binding scheme, that is in fact ineffectual in preventing an unsafe average global warming of two or more degrees.

Richard Di Natale, a former GP and Public Health physician, provided insight into how one might make the transition from clinician to environmental activist and politician. His non-linear career trajectory has seen him transition through positions in primary care, HIV programme development, Government Health Department bureaucracy and community-building. Most recently, he is persuading Victorian voters to give him the job of a Greens Senator at the next Federal election…

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Feature Articles

Applying the retrospectoscope to an elective: Reflecting on six weeks in Timor-Leste

Timorese girls from the Gleno Orphanage, located about 40km or a two hour drive from Dili in the Emera Mountains. The mobile clinic from Bairo Pite Medical Clinic visited the orphanage monthly.

The medical elective is notorious for being an excuse for taking a holiday in an exotic corner of the world. Like many of my colleagues, I also travelled to one such corner, Bairo Pite Clinic in Timor-Leste (the official name of East Timor), in search of an adventure with some medical experience thrown in. In retrospect, those six weeks were without doubt the steepest learning curve of my medical training. However, there are a number of things I wish I had known and a great number I would have done differently. Therefore please let me share some insights I have gained with use of the retrospectoscope – the device in medicine which enables the viewer to judge past events or actions with the aid of knowledge obtained since they occurred. This is in the hope of equipping you with some knowledge to make your elective experience the time of your life.

Language

I arrived in Dili, the hot, dusty capital of Timor-Leste after an almost sleepless night in Darwin airport and with a four-word vocabulary of Tetun, the local language. Nevertheless, I was almost immediately loaded onto the clinic’s four-wheel drive ambulance to embark on my first of many mobile clinics into the mountains. For such clinics the four-wheel drive is loaded up with a box of very basic medications, and a driver, a doctor or medical student and a medications dispenser drive up to six hours on a road resembling a goat track to a remote village. There, they see a queue of patients – some waiting, some materialising from the surrounding forest- and drive back, often with acutely ill patients. And thus was the experience from which stems my first insight – learn some of the language.

Despite having an ‘interpreter’ – she spoke as much English as I spoke Tetun – I was luckily armed with the Lonely Planet Tetun phrasebook, which I think saved more lives than I did that morning. Daily Tetun lessons, jotting phrases on the back of my hand and the phrasebook ensured I quickly picked up enough language to hold a reasonable medical consultation. Despite this, I wished countless times I knew some Tetun before I arrived in-country. If you are planning on travelling to a non-English speaking country, do try and learn some local language before you depart. Being able to communicate with your patients makes a world of difference.

Pre-Read

After my mobile clinic baptism of fire, I returned to the Bairo Pite clinic in Dili to be confronted with the afternoon ward round, and a lady in the final stages of labour. Prior to my elective I had seen one patient with tuberculosis (TB) and delivered five babies. Score at the end of the first ward round: 67 TB patients and eight babies delivered. I vividly recall returning to my room that night acutely aware of how much I did not know. I sincerely wished then that I had taken the time to read up on the common problems experienced in Timor: tuberculosis, malaria, labour and its common complications and gastroenteritis. A basic understanding of how to identify and manage these conditions in resource poor countries is essential to getting the most out of your elective. The World Health Organisation (WHO) has some great articles on managing these and other health issues specific to the developing world. [1-4] I thoroughly recommend utilising these prior to and during your elective. Along with the Lonely Planet phrasebook these articles saved a number of lives.

Change the World

Before travelling to Timor-Leste, a number of people warned me against thinking I could change the world in six short weeks. And, yes, I completely agree with them, it is not possible. However, do not allow anyone to convince you of the disillusion that you cannot make a difference, but, like chocolate cake, there is a delicate balance between too much and too little. During my time in Timor-Leste, I fluctuated between strategising how to revolutionise their health system and becoming exasperated with the staff, the patients and the system itself.

I only found this happy medium after many discussions with long-serving expatriates, my supervisor, the famous Dr Dan Murphy and a 24 hour flight using the almighty retrospectoscope. Be aware that revolutionising the local health care system includes ensuring nurses actually take observations rather than just filling in normal results; it is amazing how your patient can be saturating at 99% when the clinic does not have a working saturation probe! The work ethic in Timor is much more relaxed than the Australian system, and it is worth remembering that the way you are used to is not necessarily superior and you are the visitor, so embrace and work along with their system. And remember, change on a big scale, if you want it to last, takes time, dedication and education. So if you are planning a revolution, be prepared for your elective to go for six years rather than six weeks.

However, it is also worth noting that you can make a difference for…

Addendum

The arrow head was lodged in the young man’s right atrium. In order to remove it we did a transverse thoracotomy and made a pericardial window. After placing a purse-string around the arrow shaft we removed it, although we had to extend the entry site a small amount in order to remove the barb. Then, we pulled the purse sting taught and oversowed the pericardium (i.e. when repairing the pericardial window you overlap the edges to prevent tamponade in the event of leakage). He made a remarkable post-operative recovery. He was demanding food in an hour and asking when he could go home in two hours! Thankfully he didn’t develop any infections, and because we didn’t open the pleura at all, he didn’t require a post-operative chest-tube. All of this meant he was discharged home after three days. I saw him again about four weeks later and you never would have guessed he had been in hospital, let alone had an arrow pierce his chest!

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Feature Articles

What’s wrong with the Nobel Prize?

Introduction

The Nobel Prize is the single greatest honour that can be bestowed upon a scientist, and yet it has received its fair share of criticism. Even Nobel Laureate, Max Dulbrück, has criticised the Prize stating “by some random selection procedure, you pick out a person and make them the object of a personality cult. After all, what does it amount to?” [1] Recently, there have been calls to reform the Nobel Prizes with ten scientists writing an open letter to the executive director of the Nobel Foundation. [2] This article presents a critical analysis of the Nobel Prize and its role in science, showing that whilst flawed the Prize is still valuable.

The origin of the Nobel Prize

The Nobel Prize is named after Alfred Nobel, who made a fortune in the munitions industry after inventing dynamite. When he died in 1896, Nobel’s estate was worth more than 33 million kronor with one year’s interest from the fortune equal to the annual budget of Sweden’s greatest university. [1] Nobel’s will, written in 1895, dedicated the majority of this estate to prizes for those who had “conferred the greatest benefit on mankind” by making “the most important discovery or invention” in the fields of physics, chemistry and physiology or medicine. In just one short paragraph, Nobel directed how the Prizes should be awarded: the Swedish Academy of Sciences was appointed to award the Physics and Chemistry Prizes and the Karolinska Institute was given responsibility for the Prize for Physiology or Medicine. [3] Nobel also included Prizes in Literature and Peace, but these will not be discussed in detail in this article. For various reasons, Nobel’s will remained in legal peril until 1898 when the Nobel Foundation was finally established as the legal legatee. [4] In 1901, five years after Nobel’s death, the first Nobel Prizes were awarded.

The role of the Nobel Prize in recognising and rewarding great discoveries

The purpose which Alfred Nobel intended his Prizes to serve remains their primary role: to recognise and reward great scientific discoveries. [5] Indeed, one of the reasons that the Nobel Science Prizes now demand so much respect is that their histories give testimony to many of science’s most significant discoveries. Only on a few occasions has a Nobel Prize in Science been awarded for an undeserving discovery. Most notably, Johannes Fibiger won the 1926 Nobel Prize for Medicine for discovering that parasites caused cancer, a discovery which later turned out to be completely unfounded. [1,6] There have also been instances in which outstanding advances in scientific thinking have gone unrecognised by the Nobel Prize. Albert Einstein, although awarded a Nobel Prize for the discovery of the photoelectric effect, received no recognition for his most important achievement, the theory of special relativity. On the whole however, the Nobel Prizes for Science have been awarded for great scientific discoveries. The prizes have found their value in the calibre of their recipients. [5]

The Nobel Prizes for Peace, and in particular Literature, have not fared as well. [1,4] In the early years the Nobel Committee for Literature favoured conventional authors and failed to recognise greats such as Tolstoy. Consequently, the reputation of the Literature Prize was damaged and still suffers. Some suggest that the Science Prizes have enjoyed more success because science is objective, and the selection of Prize winners is less arbitrary than in the subjective fields of literature and peace. This is not the case. The selection process for the science awards is also subjective and may be influenced by the bias of the decision-makers.

Is the decision-making process arbitrary?

The statutes of the Nobel Foundation dictate rules for selecting Prize winners, adding several criteria to those stipulated by Nobel. These can be summarised as follows: [7]

  • Prizes may only be awarded for work that “by expert scrutiny has been found to be of … outstanding importance” and of great benefit to mankind.
  • “The awards shall be made for the most recent achievements in the fields of culture referred to in the will and only for older works if their significance has not become apparent until recently.”
  • “To be eligible to be considered for a Prize, a written work shall have been issued in print or have been published in another form.”
  • Prizes may not be awarded posthumously but a Prize may still be presented if the Prize winner dies before the presentation ceremony.
  • Prizes may be shared between two or three co-workers or between two discoveries but not between more than three people.

The Foundation’s statutes also provide guidelines for nominations and adjudication of the awards. Nominations are not open to the public and to be considered for an award, a written nomination must be received from “a person competent to make such a nomination.” This includes all Nobel Laureates, members of the Prize-awarding bodies (the Swedish Academy of Sciences and the Karolinska Institute) and those invited to submit nominations. [6] Each Prize-awarding body sends out thousands of invitations every year to scientists world-wide, and a rotation system is used to include as many people as possible. Nominations for an award are then considered by a subset of the Prize-awarding body, the Nobel Committee, which consists of three to five persons appointed by the Prize-awarding body. After careful deliberation, the Nobel Committee votes to determine which candidate should be recommended for the award. Although the final…

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Medical Careers

Nicholas Talley: A career of reinvention

Prof. Nicholas Talley

I finished medical school at the University of New South Wales at the end of 1978 wrapping up my course with an inspiring elective at Addenbrookes Hospital in Cambridge, England; they invited me to stay on, but I returned to Australia eager to start my internship, although I had no clear idea of how my career path would progress. I have now been a practicing clinician, researcher and educator for about 30 years; I still love it. Everyone’s personal journey is different, and will be influenced by all sorts of external as well as internal forces, some of which are not under one’s control. However, we all learn lessons from others and perhaps a few pieces of advice will prove instructive.

Plan to periodically reinvent your career

Re-invention and renewal is the course I have chosen. I spent four years as a resident and medical registrar learning how to become a competent hospital based clinician from 1979 to 1982. I then decided I wanted a break; I was offered a research position with an outstanding academic (Prof. Douglas Piper) and decided to give it a go. I spent three very happy years from 1983 to 1985 undertaking a PhD at Royal North Shore Hospital in Sydney, then a further year as the Professorial Registrar at the hospital, years when I wrote the first editions of my most popular books, as I’ll describe later.

I developed a passion for generating new knowledge and publishing it, so I next decided to move to the United States (US) to join an outstanding expatriate Australian (Prof. Sidney Phillips) for further mentorship and training. I expected to stay a year but instead spent seven years in Rochester, Minnesota, initially as a Research Fellow at Mayo Clinic for 18 months and then as a junior faculty member (first as Assistant Professor, then Associate Professor – if you are productive, you can rise very rapidly in the academic ranks in the US).

In 1993, I returned to Australia to take up a new post as Foundation Professor of Medicine at Nepean Hospital, which had just been designated a new Teaching Hospital of the University of Sydney; I was 37 years old, had virtually no administrative experience and was charged with the daunting task of developing teaching and research plus new clinical departments in a hospital that didn’t even yet have a physicians training program. I spent nine exciting years developing a fresh dynamic Division of Medicine, introducing the new graduate medical program and actively engaging in research, education and clinical practice.

At the end of 2001 I was offered an opportunity to return to Mayo Clinic in Rochester for a period to pursue a new research passion; I wanted to focus on gene hunting in the functional bowel diseases. As I really knew little about how to do this, I initially undertook a Masters degree in genetic and molecular epidemiology at the University of Newcastle online; I learnt a lot about medical education trends being a virtual student! I had planned to be away about a year, but again was enticed to stay, even though returning to Mayo Clinic in 2002 required me to re-start my research program from scratch once again. I spent four years focused on building my research team and program.

In 2006 I was tapped on the shoulder to become the Chair of the Department of Medicine at Mayo Clinic Florida. My charge was to transform the Department into a cohesive academic entity, and I have focused on building teamwork and ensuring financial success while expanding teaching and research. The administrative experience in Florida has been exhilarating; I have learnt more about the science of leading and managing than at any other time in my career. My next (but hopefully not my last) transformation will take place later in 2010; I have decided to move back to Australia to take up the post of Pro Vice Chancellor (Health) at the University of Newcastle, where I will strive to make a positive difference in terms of research and education across the health faculties and in the country.

Strengthen your written and verbal communication skills

Some have asked me how I came to write medical textbooks so early in my career. Frankly, it was the combination of falling upon a good idea, a little luck, and a good team. I saw while having the pleasure of sitting the Fellowship examination for the Royal Australasian College of Physicians (FRACP) that there was an acute need for better guidance on how to prepare for this difficult test. I also recognized many useful clinical examination techniques were poorly discussed in the available textbooks; a detailed systems based approach was largely lacking. At the party celebrating my passing the FRACP exam, I invited Simon O’Connor to join me as a co-author; I knew his wit and style would help add life to the planned manuscript, plus I felt a team would be better equipped to cover the waterfront (and having a co-author…

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Book Reviews

The iPhone: Is it an indispensable tool for medical students?

Technology is always presenting us with new ways of going about our daily lives, and our inability to be separated from our mobile phone, internet or online social networking is growing. Some technology has become obsolete and fallen into obscurity, while some has never caught on. One that definitely has, though, is Apple’s iPhone. As medical students, smartphones have the potential to revolutionise our education and training, and one heavy contributor to this is Apple’s growing library of medical ‘apps’ (applications made specifically for iPhones).

‘Medical’ is a headline category on the iPhone App Store, right next to Utilities, Lifestyle and Games. It is even separate from Healthcare and Fitness – something a good chain bookstore is yet to figure out. Entering this category brings up a multitude of free and paid apps that will be of interest to practicing physicians, medical students or other health care professionals. Finding an app to suit one’s needs is made even easier by using one of several online app directories. Apps can do everything from looking up reference values, differentiating between types of arrhythmias to performing useful calculations. While this article cannot hope to delve very far into the thousands of medical apps available, what follows is an overview of some of the most popular ones, which may prove useful for the uninitiated.

The app ABG, or Arterial Blood Gas, can help in the sometimes complicated world of blood gases; simply type in lab values to determine if an acidosis is respiratory or metabolic in nature. Instant ECG (electrocardiogram) displays rhythm strips of many common arrhythmias to study and then provides a quiz to consolidate learning. General Medical History categorically runs through all the questions one should ask to take a medical history. It is very comprehensive, and could be particularly useful for junior medical students who are still becoming familiar with the basics of history-taking. However, pulling out an iPhone in front of a patient, let alone a clinical supervisor, will no doubt fail to convey the best impression.

Some of the big names in textbooks have already made their way to the iPhone platform. The Netter’s series of texts is available, including very handy anatomy flashcards. These are an ideal way to brush up on anatomical identification skills while commuting or waiting around. However, some may find that the size of the screen does not do justice to Netter’s famous illustrations. The Merck Manual of Diagnosis and Therapy is a guide on the essentials of diagnosis and treatment. Taber’s Medical Dictionary is perfect for a mental block on what Klippel-Trenaunay-Weber Syndrome actually is. The original Gray’s Anatomy is right amongst the lineup in all its pencil-rendered beauty. However, while it does have a search function, it does not have a table of contents, which is a major oversight. Medscape, Epocrates and Skyscape are bundled apps which include medical calculators and continually updated drug and clinical references – a veritable all-in-one reference for clinicians on the go. Epocrates even has a drug identification tool to allow you to identify a patient’s pills.

The Australian-specific content is also increasing. Frank Shann’s Drug Doses promises to end the suffering of those who need a little reminder just how many mg/kg of fentanyl to give a child. Likewise, MIMS Australia now has their product available for the platform, allowing healthcare professionals to look up entire product information. Most of the calculator programs such as MedCalc have the ability to change units, allowing the user to easily modify the program to suit the needs of an Australian medico.

One of the drawbacks is that some apps are just not in an affordable price range for many students (Table 1). Netter’s Anatomy Flashcards is priced at $47.99, MIMS is an explosive $170, and some, such as Frank Shann’s Drug Doses at $23.99, are over double the price of the hardcopy version. However, some of the helpful ones are free, such as Medscape and Skyscape, and there are always useful medical apps on sale. Epocrates has several tiers of its product. The basic version is free, and includes features such as a drug interaction checker and pill identifier. However, to obtain features such as disease images and a medical dictionary, a subscription is required, ranging from US$99 to US$199 depending on the features required.

Another major drawback to some of these apps is that they consume considerable amounts of storage space, such as Gray’s Anatomy at 402…

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Book Reviews

Oxford Handbook of Clinical Specialities

As medical students progress through their clinical years, they are exposed to the varied streams of medicine, which not only functions as a key component in their broader medical training, but serves as a degustation for potential specialities they may choose to pursue after medical school. Students often find themselves starting a specialty term without knowing what they need to know, let alone which is the best student-friendly textbook.

The Oxford Handbook of Clinical Specialties (OHCS) is divided into twelve chapters, covering streams such as obstetrics and gynaecology, paediatrics, primary care, psychiatry and accident and emergency, which are part of the core teaching in most medical schools. It also covers a number of other important specialities, such as otolaryngology, dermatology, ophthalmology and anaesthetics.

Made as a companion to the Oxford Handbook of Clinical Medicine – often referred to as the ‘medical student’s bible’ – this book is another in the Oxford Handbook series which provides a solid summary of many clinical streams that will be encountered by medical students as part of general medicine, as well as during speciality rotations.

Like most books in the series, this book is extremely user-friendly. It is divided into different sections based upon fields, with coloured tabs used to help identify each section. Most chapters in the OHCS begin with summary pages which deal with the fundamentals of each stream, allowing students to familiarise themselves with the essentials and identify important learning areas. Following this, most chapters spend one or two pages discussing important clinical entities, covering the common, the classical and the critical conditions that medical students should be aware of. Students who have used other Oxford handbooks will be familiar with the structure used to discuss each condition. Where relevant, the book covers the basics – signs and symptoms, investigations, treatment and management, and complications.

Where this book may fail students is in its lack of detail. While the succinct nature of the OHCS is useful in the first few clinical years, its brevity also means that the level of knowledge expected of more senior students is lacking. For example, the psychiatry section is an area where this textbook fails to compete with a more comprehensive text. Since psychiatry is a stream that is quite removed from the rest of medicine, the brief summary pages on schizophrenia and affective disorders will doubtless leave students wanting. The dermatology section is also underdone, with not enough space in this pocket-sized textbook to include images of the myriad of integumentary conditions, which is vital for the inexperienced student.

Having said this, the OHCS certainly does not purport to be a comprehensive textbook of each of the streams it covers. Tutors will recommend their favourite textbook – the ‘must have’ for each speciality – which will serve to work biceps as much as brains. Like most Oxford handbooks, the selling point for OHCS is that it can fit in one’s pocket and is a handy guide to confirm what has already been learned. Overall this is a great textbook for junior-year students entering the clinical environment for the first time, and a useful reference text for senior students.

Collier J, Longmore M, Turmezei T, Mafi A. Oxford Handbook of Clinical Specialties. 8th ed. Oxford (UK): Oxford University Press; 2009.

RRP $97.95

Conflict of Interest

None declared.

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Book Reviews

‘Moore’ than just a doorstop: Clinically Oriented Anatomy vs. Gray’s Anatomy for Students

The study of anatomy is often a challenging endeavour for many medical students. Central to the learning process is the use of a good textbook. Two of the most often recommended texts for medical students are Gray’s Anatomy for Students (GAS), descended from the iconic text by Henry Gray, and Clinically Oriented Anatomy (COA), by Moore, Dalley and Agur.

Both texts employ a regional approach to the study of anatomy. GAS separates each chapter into four sections: Conceptual Overview, Regional Anatomy, Surface Anatomy and Clinical Cases. The conceptual overview aims to provide the very basic concepts of each region in a concise summary before moving on to an increasingly detailed description. While this approach may be useful for the beginner or reviewer, the inevitable repetition creates a degree of redundancy. COA presents information in a ‘bones up’ format, progressively adding surrounding structures before detailing the arthrology of each region. Each chapter concludes with a series of radiographic images to complement integration and understanding.

Certain striking distinctions are evident in the textual quality of each book. GAS aims to strip away irrelevant information into an easy-to-read summation while leaving intricate details for other texts. While this provides an excellent introduction for the neophyte, COA includes more rigorous explanations concerning the finer points and the complex interaction with surrounding structures. An enlightening example of the differing styles can be observed through the treatment attributed to the sternocleidomastoid (SCM) muscle. A concise, tabular description of muscular attachments, innervations and basic function is provided in GAS in association with a stylised diagram indicating its position in the neck. Conversely, COA devotes an entire four page sub-section to a detailed discussion of the manner in which body position and the use of synergist muscle groups can alter function of the SCM beyond an isolated view of the muscle acting independently in the anatomical position. Thus, while simplified to enhance the initial integration of basic concepts, GAS may simultaneously perpetuate certain erroneous notions concerning the nature of anatomical function. On the other hand, the text in COA may reduce its effectiveness for the uninitiated, while GAS may prove to be too simplistic for the interested student.

Both books approach diagrammatical representation through the use of computer-generated imagery, though distinct dissimilarities are visible. COA depicts each region by incorporating detailed and realistic diagrams which are thoroughly labelled. In contrast, GAS represents analogous images through a distinctly stylised fashion. Major structures are portrayed in an idealistic mode, which, in combination with relatively sparse labelling, may impede practical application, particularly in medical courses focussed on anatomical dissections. However the simplified overview, devoid of extensive detail, is potentially easier to comprehend for the less experienced anatomist. In addition to detailed, accurate labels, COA consolidates diagrammatic elements through representations in various anatomical planes. The depiction of distinct layers within each system aids the appreciation of the detailed nature of such structures. Ultimately, COA associates these illustrative characteristics through the use of numerous, detailed figures within each specified anatomical region. The use of COA may prove to be beneficial, both in dissection and in providing a broader scope of understanding.

The integration of clinical aspects throughout a text is essential to the effective understanding of anatomical information. Both books appear to have achieved a relatively streamlined integration of such information through the utilisation of clinical vignettes. Complemented with relevant diagrams, topics covered in the text of these vignettes include information relating to development, anatomical variation, radiology and pathology. For those without significant exposure to anatomy, having clinical information presented in such a fashion is an ideal mode for the consolidation of vital concepts. The use of end of chapter case studies in GAS allows the reader to evaluate their own level of understanding, a feature that is absent in COA. Radiological correlations in GAS are discussed further through an in-text approach. Alternatively, COA utilises radiological imaging juxtaposed with easily understood computer generated diagrams, allowing the student to…

Drake R, Vogl W, Mitchell A. Gray’s Anatomy for Students. London: Churchill Livingstone; 2009.

RRP: $138.00

Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy, Sixth Edition. Baltimore: Lippincott Williams & Wilkins; 2009.

RRP: $129.80

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Review Articles

What do medical students think about pharmaceutical promotion?

Abstract

Aim: The aim of this review was to produce an overview of surveys of medical students’ exposure to and attitudes towards pharmaceutical promotion. Methods: PubMed was searched for studies featuring surveys of medical students regarding their interactions with pharmaceutical promotion and tabulated the findings for survey questions relating to the main themes. Results: Students have significant exposure to promotion, and they generally view receiving gifts as acceptable, but do regard some gifts as more appropriate than others. Most students think pharmaceutical sales representative (PSR) presentations are biased but still of educational value and should not be banned. Most students do not believe promotion will affect their prescribing behaviours. A large majority of students want more education in their curricula on how to interact with PSRs. Conclusions: Many medical students think that pharmaceutical promotion is biased and feel underprepared for interactions with the pharmaceutical industry. Despite this, they accept exposure to pharmaceutical promotion believing that it will not influence them. There is scope for improved education in medical schools about this issue.

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Review Articles

Information and support needs of adolescents with Familial Adenomatous Polyposis

Familial adenomatous polyposis: the mucosal surface of the colon is carpeted by numerous polypoid adenomas. (Copyright, UNSW Department of Pathology, from the ‘Images of Disease’ collection.)

Abstract

Familial Adenomatous Polyposis (FAP) is a dominantly inherited bowel cancer predisposition syndrome presenting with hundreds of premalignant polyps in the colon. The standard form of treatment is preventative surgery which involves removal of the entire colon. The rectum and colon may also be removed. Predictive testing is usually done at ten to fourteen years of age, and surgery is recommended by the age of 20. Thus, adolescents face a wide variety of difficult decisions and situations. The aim of this review is to critically evaluate existing literature which examines the experiences of these young people and their families, including their information and support needs, psychosocial adjustments and satisfaction with current genetic services.