BOOK REVIEW

Abstract

Shahab S. Minassian & Mark B. Woodland, editors. Obstetrics and Gynecology Clerkship Guide. Philadelphia, PA: Mosby Elsevier, 2007. ISBN 0323018971. Price USD 34.95. Through my fifth year clerkship in obstetrics and gynaecology in a Danish university hospital, the Clerkship Guide for undergraduates has been in my scrub pocket. Handy-sized, it has been my fellow teacher. The book is in three easy-to-read sections. An introduction where questions on how to be a good junior doctor are raised, a symptoms section, where specific symptoms such as vaginal discharge or incontinence are described, and a section describing well-known conditions, such as leiomyoma or aspects of gynaecologic oncology. Most headlines are formed as questions, and every chapter ends with a key-point box and case-stories with answers to sum up the most important clinical and practical knowledge. In addition, the book concludes with a practice test of multiple-choice questions. In theory, this is a fine disposition: teaching basic knowledge, answering symptom-specific questions, exploring the most likely diagnoses, and checking your newly gained skills through a study of cases and by tests. However, the book is filled with editorial flaws and inconsistencies of great annoyance to the reader. A few examples: in chapter 17 there are 6 sections repeated (same headlines, same text). The index is filled with errors. When looking up ‘Pearl index’, it is registered on page 262, but is not mentioned here. ‘HELLP’ is not listed under H, but under ‘Prenatal care’. The sub-headlines are ridiculously overused; ‘PAP-smear’ has 18 sub-headlines, 15 sub-sub-headlines, 4 sub-sub-sub-headlines, and 2 sub-sub-sub-sub-headlines – too confusing to look up anything, really. In addition, to my disappointment, the multiple-choice test promoted on the book cover consisted of only 3 questions. Unfortunately, the disappointment lasted as I read the first chapter, introducing the caricatured John Doe, a clerkship medical student who is clueless regarding acceptable behaviour in a hospital. The authors subsequently lecture the reader: ‘Allow for unanticipated delays such as traffic or long lines at Starbucks by leaving 10 to 15 minutes earlier than necessary’ or ‘Your appearances should always show respect … by being neat and never sloppy or showing signs of various and sundry body fluids’. In my opinion, not to trust medical students or junior doctors to be aware of this is patronising. Surely, the very few students or junior doctors who may need this scolding would disregard the advice anyway. My guess is that few will read through the belittling, aunt-like reprimands and notice of the following section that contains useful advice on communication. This is a shame. Regarding the content of the clerkship guide, the rest of the first section is very good. Chapter 3 is a welcome introduction to ethical and moral dilemmas in obstetrics and gynaecology. It is good to have a short brush up on ethical terms, and the accurate recipe on how to approach an ethical problem is fine. In addition, Chapter 4 is extremely useful. Explanations required on practical skills and the speciality-specific manoeuvres, fetal monitor strip reading or how to approach a gynaecologic examination can be obtained here. However, I do miss drawings and schematic pictures illustrating the various skills. The few illustrations are fine, but additional pictures showing the various skills step-by-step or an ultrasound picture of the normal uterus are necessary in such a chapter. Furthermore, I need the inclusion of several missing skills: a thorough guide to the bimanual palpation (what to do when your fingers are in the vagina-the guide stops here), a description of how to evaluate the position of the descending fetus and the progression of labour, and above all a full description of Leopold's manoeuvres, which are nowhere to be found in the book. Though many of the following chapters in sections II and III are very good, short, and enlightening, the selection of material is unequally distributed. The rare reasons for amenorrhoea are described in detail in Chapter 5, but a more common illness, such as endometriosis, is only described briefly on page 92. Above this, I too often doubt that the evaluation and treatment recommended by American guidelines are similar to Scandinavian practice (coitus interruptus is not considered a contraception method in Denmark). Therefore, after 4 weeks of companionship, would I buy the clerkship guide? No, not in its present form. Even though the structure in its idea is meaningful, the great paucity of pictures, the editorial problems, and the uneven weighting of knowledge are too grave errors to be ignored.