This action might not be possible to undo. Are you sure you want to continue?
by Joel Topf and Sarah Faubel Reviewed by Ogan Gurel
for Little, Brown & Company
14 March 1994
It has been a pleasure to be of service in reviewing The Microbiology Companion. It is clearly an ambitious work by these two medical students, Joel Topf and Sarah Faubel who, as they put it: “… processed the class into a logical and convenient format … while [their] peers were off skittering around the globe.” They are to be commended for their effort. In general, the book serves a definite purpose and thus should sell quite well. However, I have some serious practical and philosophical reservations that potentially limit its usefulness. This review comes in two parts. Based on my experience I will first discuss the nature of medical school microbiology and how medical students typically study it. In this context, I will address the book’s strengths and weaknesses, along with the reservations I alluded to. In the second part of the review, I will try to answer the specific questions that came with your letter so that my comments may directly meet the concerns of your review committee.
How is microbiology taught in medical school? The challenge is to cover both the basic as well as the clinical (infectious disease) aspects of the subject. Towards this end, three different curricular schemes have been used, incorporating one, two or three separate courses respectively. These “pathways” are outlined below.
A B C
Number of courses
1 2 3
1st year (basic science)
2nd year (clinical science)
Microbiology (both basic & infectious disease)
Microbiology (basic) Microbiology (basic)
Pathophysiology (infectious disease) Pathophysiology (infectious disease) Pathology (infectious disease)
The Columbia course, for example, followed scheme “C” where microbiology was taught as part of three different courses. Most of the clinicallyoriented material was
presented during the 2ndyear pathology and pathophysiology sequence. In many other traditional programs, there is a single monolithic microbiology course with a heavy emphasis on clinical details. The content consists of moreorless random laundry lists of facts organized along the lines of microbial systematics (e.g. Cocci, DNAcontaining viruses, etc.). The Microbiology Companion and thus the course at Wayne State appears to follow this pattern. The book is clearly aimed at clinically oriented microbiology courses and thus would not be useful to 1st year students or for those in graduatelevel courses. “Complaining and medical school go together” as Topf and Faubel note in their preface. Among these complaints, exasperation at the capricious and arbitrary nature of microbiology leads the list. So how do medical students typically study for this class? A significant minority do exactly what Topf and Faubel have done. Namely, they systematically compile voluminous charts of data about each microbe along with its various biological and clinical properties. The compulsive and laborious preparation of such charts is nearly as much a part of medical student culture as is dissecting the cadaver. The majority of students, however, do not have the time, energy or stamina to prepare such tables and make do with attending lectures and reading the textbook. This “unwilling” majority of Topf and Faubel’s classmates are those who apparently buy their book. Therefore, it is in this context that The Microbiology Companion finds a ready market. If the book is attractively laidout, lowpriced and aggressively marketed, I suspect that a great many of this “unwilling” majority would purchase the book — even capturing those students who would have ordinarily prepared such charts on their own. For the book to be successful some major practical problems need to be resolved. The book needs more illustrations; at the very least in the form of “flagposts” that facilitate the organization. For example, a picture of some representative organisms (placed near the margin perhaps) should accompany each introductory page. Without a regular and systematic succession of such illustrations, the mass of tables in this book will look just like those dogeared sheets made by the students themselves. The book contains some diagrams but most of these are extremely confusing; see for example, page 132 which is reproduced below. Eliminating some of the detail and cleaning up the computergenerated drawings should clear up the confusion.
Review of The Microbiology Companion
The most serious weakness is the lack of the “overall picture” which Topf and Faubel had ironically promised in their preface. To follow their analogy (see page x of their book), I would say that the “Christmas tree” is missing. The Microbiology Companion is more like a huge variety of ornaments packed in piles of boxes labeled balls, bells, stars, candles, etc. The book can be used to find the ornaments but not necessarily to guide us in decorating the Christmas tree in such a way that is understandable and hence pleasing to the eye. The missing “bigpicture” leads to my philosophical concerns with the book. Again, it is important to note that in their preface, Topf and Faubel emphasize giving the reader “a broad overview so that the details will be learnable [sic].” However, without a coherent storyline and with the overwhelming crush of random detail this book is impossible to learn from. This has, indeed, been a general problem in medical education. For example, most microbiology students do not learn, in any longterm sense, much of the material in this detailbloated format. The students regard the subject as an onerous hurdle to be quickly jumped and just as quickly forgotten; the faculty, good intentions and all, recognize that the little that is remembered comes by accident and at best by “osmosis.” Recent curricular reform has focused on making medical education more conceptual and integrated, encouraging the development of criticalthinking and the ability to apply fundamental concepts to new situations. These goals are rarely served by traditional preclinical medical school pedagogy. Two books that are representative of this conceptual, thoughtbased approach are The Pathogenesis of Infectious Disease by C.A. Mims, published by Academic Press (1987) and Bacteria, Plasmids, and Phages by E.C.C. Lin, R. Goldstein, and M. Syvanen, published by Harvard University Press (1984). The first book is slanted towards the clinical side of microbiology and discusses the general principles and processes of infectious disease. The 3
material is closely integrated with immunology because most infectious processes cannot be understood without understanding what the body is doing in response. The overall table of contents (reproduced here with details included for chapter 8) gives a sense of the scope of this book. As you can see, general themes of microbial pathogenesis are described in the context of a logical progression of concepts.
Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 General Principles Entry of Microorganisms into the Body Events Occurring Immediately After the Entry of the Microorganism The Encounter of the Microbe with the Phagocytic Cell The Spread of Microbes through the Body The Immune Response to Infection Microbial Strategies in Relation to the Immune Response Mechanisms of Cell and Tissue Damage Infection with no cell or tissue damage Direct damage by microorganisms Microbial toxins Indirect damage via inflammation Indirect damage via immune response Other indirect mechanisms of damage Diarrhea Recovery from Infection Failure to Eliminate Microbe Host and Microbial Factors Influencing Susceptibility
Chapter 9 Chapter 10 Chapter 11
Review of The Microbiology Companion
The second book, Bacteria, Plasmids, and Phages is a published version of the basic microbiology syllabus at Harvard Medical School. Again, the emphasis is on fundamental concepts and on an understanding of how things work rather than what they are. The questions at the end of the chapter supplement this approach and are designed to provoke thought rather than quiz rote memorization. It is interesting to consider that this book is a product of the old Harvard Medical School curriculum; its success, nevertheless, served as a strong stimulus and example to the reforms that are now more widespread in the HMS curriculum and indeed around the nation. These reform efforts have also been extended to standardized medical examinations. From the MCAT all the way through to the USMLE National Boards these exams are becoming significantly more conceptual and integrated. All this is reflective of a cultural shift in our society in grappling with the explosion in medical knowledge and knowledge in general. In response, new technologies as well as changes in educational philosophy are being developed to meet these challenges. Concepts are in; facts are out. Thinking is in; memorizing is out. The form of medical education represented by The Microbiology Companion is quickly going out of style. In the longterm, then, I believe that this book will become an anachronism. At the same time, there will be an increased demand for a new generation of conceptbased, integrated and interactive books that address the formidable information challenges of modern medicine. What are some of these new approaches to assimilating and presenting knowledge? First, is the emphasis on concepts. It is the concepts that we commit to longterm knowledge and it is concepts that are applied to the varied and complicated situations faced in real practice. Second, is the importance of integrating knowledge. Cognitive studies have shown that it is easier to remember knowledge that is integrated (interrelated to use another word) as compared to remembering independent, random bits of knowledge. To memorize random knowledge requires a linear increase in memory “units” — brain cells, if you will; memorizing integrated knowledge demands only a logarithmic increase in memory “units.” In short, those who remember integratively retain more. These relationships are depicted in the graph below.
Third, is a shift in our view from what is being to what is becoming. Back in the 19th century the challenge of microbiology was in classifying what there was. “Here we have a round bacteria, call it a member of the cocci; here’s a spirallooking bacteria, call it a spirochete.” Now, our whole perspective on microorganisms is completely different. We know more that just the existence of things and phenomena; we also understand to some degree the processes underlying the biology. Likewise, we should teach how things become, rather than simply what they are — not only as a more effective way to learn but also as a stimulus to the development of critical thinking. Fourth, is the importance of interactive learning. Much of the excitement and challenge behind multimedia technologies is the promise and possibility of implementing this interactivity. The use of interactive technology — the modern correlate of the Socratic method — will facilitate active, rather than passive, learning on a largescale basis. Finally, there is a heightened appreciation of the effectiveness of visual learning. The proverb — “A picture is worth a thousand words,” is even more true today. There will be a continued and increasing demand for meaningful illustration in the textbooks and multimedia packages of the future. In summary, then, The Microbiology Companion stands a good chance of meeting the needs of the present market and with some of these practical suggestions it should sell well. The book is limited, however, in that it runs the risk of eventually becoming obsolete — joining, as it were, other dinosaurs of medical education.
Review of The Microbiology Companion
The following are answers to the specific questions you suggested would be helpful in your evaluation. Some of these issues have been addressed in the above discussion and have been replicated below. Your questions are in red; my answers are in blue.
1. What is your assessment of the market potential? Please be as specific as possible about: A. Courses to which this book would apply The traditional microbiology course has usually involved a single monolithic microbiology course, with a heavy emphasis on clinical details. The content consists of moreorless random laundry lists of facts superficially organized along the lines of microbial systematics (e.g. Cocci, DNAcontaining viruses, etc.). The Microbiology Companion and thus the course at Wayne State appears to follow this pattern. The book would be much less applicable to microbiology courses that have a more basic science emphasis such as 1styear medical courses or graduatelevel courses. B. Who would buy it A significant minority of microbiology medical students systematically compile voluminous charts of data about each microorganism along with their various biological and clinical properties. One could say that the laborious preparation of such charts is as much a part of medical student culture as is dissecting the cadaver. The majority of students, however, do not have the time, energy or stamina to prepare such tables and make do with attending lectures and reading the textbook. This “unwilling” majority of Topf and Faubel’s classmates are those who apparently buy their book. Therefore, it is in this context that The Microbiology Companion finds a ready market. If the book is attractively laidout, lowpriced and aggressively marketed, I suspect that a great many of this “unwilling” majority would purchase the book. The book could even capture those students who would have ordinarily prepared such charts as they may surely prefer to save their time for other things. It should be emphasized that demand for the book will come from the students themselves rather than from the explicit course requirement. C. Applicability to what level and type of program
The book is applicable to traditional, detailladen clinicallyoriented medical school microbiology courses. The book would not apply to less clinically oriented courses such as firstyear medical school microbiology or graduate level courses. D. Application to continuing education and practicing health professionals Virtually none.
Review of The Microbiology Companion
2. Do you feel there is a definite need for a book such as the one proposed? Please substantiate your opinion. Will this book fill such a need? Why or why not? There is a need for this book in the context of the traditional medical microbiology course. With some improvements, the book should fill that need quite well. However, if current trends in medical education reform continue, this need may quickly evaporate.
1. What book(s) are you currently using to teach the topic covered in this manuscript? There are, of course the standard, heavyduty microbiology textbooks which contain much of the detail covered in The Microbiology Companion. In an ideal sense, I would prefer to use more conceptually oriented books as “companions” to the microbiology course. Two books that are representative of this conceptual, thoughtbased approach are The Pathogenesis of Infectious Disease by C.A. Mims and published by Academic Press (1987) and Bacteria, Plasmids, and Phages by E.C.C. Lin, R. Goldstein, and M. Syvanen, published by Harvard University Press (1984). The first book is slanted towards the clinical side of microbiology and discusses the general principles and processes of infectious disease. The material is closely integrated with immunology because most infectious processes cannot be understood without understanding what the body is doing in response. The second book is taken from the Harvard Medical School’s basic science microbiology syllabus. Again, the emphasis is on basic concepts and on an understanding of how things work rather than what they are. The chapter end questions are designed to provoke thought rather than test brute memorization. It is interesting to note that this book came out of the old Harvard Medical School curriculum; its success served as a strong stimulus and example to the reforms that are now more widespread in the HMS curriculum and indeed all around the nation. 2. What are the key strengths of this material It meets a defined need, namely the desire of medical students for a concise presentation of facts in chart form. Along these lines, it is organized in traditional format and relatively comprehensive. I think the crossreference tables near the back of the book have potential, but they too are over burdened with the same excessive depth of random detail. 3. What are the key weaknesses?
For the book to be successfully marketed some major practical problems need to be resolved. The book needs more illustrations; at the very least in the form of “flagposts” that facilitate the organization. For example, a picture of some representative organisms (placed near the margin perhaps) should accompany each introductory page. Without a regular and systematic succession of such illustrations, the mass of tables in this book will look just like those dogeared sheets made by the students themselves. For those diagrams that are in the book, most are extremely confusing; see for example, page 132. Eliminating some of the detail and cleaning up the computer generated drawings should clear up the confusion. The most serious weakness is the lack of an “overall picture” which Topf and Faubel had promised in the preface. To follow their analogy (see page x), I would say ironically that there is no “Christmas tree” in this book. Rather The Microbiology Companion is more like a huge variety of ornaments packed in piles of boxes labeled “balls,” “bells,” “stars,” “candles,” etc. Using this book, we can find the ornaments but we aren’t guided in decorating the Christmas tree in such a way that is understandable and thus pleasing to the eye. 4. What have you chosen the text(s) you are using? (Please discuss considerations such as content, size, depth of presentation, price, etc.) Again, I chose the Mims as well as the Harvard book because I wanted to learn things on a fundamental, conceptual level. During medical school, I might have also bought The Microbiology Companion although it would not have been with pleasure but rather because I was compelled by the demands of the course. 5. What advantages, if any, would the proposed project have over the competition? I am not aware of any direct competition.
1. What elements do you feel are essential in a text such as the one proposed here? Clear and attractive layout of charts. Completeness. 2. Based on the information provided herein, how does this proposed book compare to the competition? There is really no competition that I am aware of. 3. Please discuss the following areas: A. Accuracy of content
Review of The Microbiology Companion
Appears to be accurate; all of the material has been pulled from course syllabi or standard microbiology texts. Some typos are scattered about: “The disease often relapses months later and may take a chronic coarse [sic] of years.” B. Depth and scope of coverage (should any areas be deleted? added?) I would suggest massively cutting out much of the detail. However, the book would then no longer serve its purpose. D. Writing style clear? logical? concise? Essentially there is no writing style to comment on. Apart from the preface and some introductory passages, the grammar consists of sort, “soundbite” like phrases. The individual phrases themselves are generally clear and concise although the listing of facts in each chart cell is nearly completely random. Medical education has often been likened to drinking from a fire hose; with this book, I would say it’s more like catching bullets from a machine gun. This is not a book that can be easily read. Here’s a typical cell:
Legionnaires’ disease is an atypical pneumonia named after the outbreak which occurred at the 1976 American Legion convention in Philadelphia. Transmission is through contaminated water sources. Air conditioners are the cause of most outbreaks. No person to person transmission occurs. The organism may be found in lakes, ponds and tap water. The disease can be fatal. Risk factors for infection include: smoking, alcohol consumption and immunosuppression. Pontiac fever is a milder form of infection named after an outbreak in Michigan in 1968. Selflimiting within 34 days.
E. Pedagogical devices? The book makes extensive use of charts which closely the ones that some medical students typically prepare for themselves. This is the book’s strongest selling point. F. Illustrative aids (if applicable) More illustrations (even simple ones) would benefit the book greatly. Most of the diagrams that are included are quite confusing and need to be cleared up to be more effective. 4. Do you have any additional ideas and suggestions that may assist the author developing this project? in
In addition to the points mentioned above, I would urge the author to make individual chart entries more logical and systematic rather than a mere listing
of facts culled from other sources. A renewed commitment to providing an “overall picture” would also help although it is unclear how this would fit in a book whose primary purpose is to convey facts. 5. Based on the information provided, would you require this book for your students’ use? Recommend it? Why or why not? I would not recommend or require this book for a microbiology course. My own courses and review sessions strongly emphasize conceptual understanding. Any facts to be memorized, per se would be within the context of these concepts rather than in the traditional format that is presented in The Microbiology Companion. 6. In your opinion, should Little, Brown pursue publication of this project? Why or why not? From what I understand of Little, Brown’s book portfolio, I do not see a major place for The Microbiology Companion. Your company seem to focus on two major areas: highend, physicianoriented texts in specialized areas along with student/residentoriented handbooks and manuals. This book does not fit neatly in either of these categories. One could propose a Companion series devoted to chartlike compendiums of medical school minutia. However, this doesn’t seem to be your company’s style; moreover, as I have argued, the longterm demand for detailoriented learning material is limited. Of course, the book can always be published as an isolated offering in your portfolio with shortterm revenue generating potential.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue listening from where you left off, or restart the preview.