Do Medical School Textbooks Accurately Represent Public Health Concerns? Addressing Discrepancies between References in Textbooks and the Actual Prevalence of Five Congenital Disorders

Abstract

The pre‐clinical years of medical school are designed to give future physicians the foundational knowledge essential to practicing medicine. Characteristically, the curriculum explores vital topics such as anatomy, physiology, biochemistry, pharmacology, immunology, and other basic sciences. In addition to learning about the “typical” function in a healthy patient, medical students are also taught “pathological” conditions they may see in their clinical settings to discuss treatment, prevention, and prognosis. Due to lecture hour time restraints, it is not possible to speak in depth about every relevant condition; therefore, courses usually assign textbooks to provide additional information to students outside the classroom. We sought to explore the relationship between the frequency with which certain congenital differences were identified in textbooks used in medical school courses, and the prevalence of those conditions within patient populations in the United States. A sample of allopathic and osteopathic schools were surveyed to compile a list of 121 textbooks used in years one and two of medical school. These books were examined to evaluate the references to five congenital conditions with teratogenic and/or genetic origins: congenital cytomegalovirus (cCMV), Zika virus, fetal alcohol syndrome, spina bifida, and Down syndrome. Frequency of mentions was defined as the presence or absence of the name of each condition determined by both automated and manual searches of the texts. Prevalence rates were taken from the Centers for Disease Control and Prevention (CDC). Our results indicate that the frequency of mentions of the selected conditions do not accurately reflect the prevalence of these conditions in the United States as identified by the CDC. Most surprisingly, congenital cytomegalovirus was one of the least mentioned conditions in the texts, despite cCMV having the highest relative prevalence. Our results indicate that the foundational education that first and second year medical students receive through textbooks may not accurately represent their future patient populations. It is important to increase the representation of common, preventable teratogens in the basic science years of medical education in order to augment general physician awareness, which may translate to better patient education of common prevention techniques and health outcomes.