Medicine: A Competency-Based Companion

Abstract

When this book arrived in the mail and I saw what was in the box, I thought it was just another handbook. I automatically assumed that the book was for residents, and at first thought, I might be right in my quick assessment. I realized that it was for medical students and, yes, it is basically a handbook; however, as I looked through it more thoroughly, I admit I was pleasantly surprised. It is the fourth title in the Competency-Based Series (the others are Obstetrics and Gynecology, Pediatrics, and Surgery) and part of the Student Consult online program from Elsevier. Its premise is to use brief internal medicine case studies to highlight the six core competencies of the Accreditation Council for Graduate Medical Education (ACGME) (patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice). Each competency is color coded to make it easier for the reader to find a specific competency. In addition, there are other color-coded sections with a different focus. “Intelligently Speaking” is a teal box that discusses, for instance, whether or not someone should be seen in the office or sent to the emergency department or the relationship between the Gleason score and prostate cancer. A purple box indicates differential diagnosis or a problem list. The “Zebra Zone” (a black-and-white striped box) refers to rare and/or unusual diseases that may present with the same signs and symptoms as more common diseases. “Imaging Considerations” are indicated with a solid black box. The work also includes a short foreword, preface, and preface to the series, all discussing the evolution of and reasons for the series and the individual books. The first section includes three short chapters and two appendixes. The chapters focus on use of the book, medical clerkships, and the ACGME competencies. The first appendix discusses the competencies in more detail, and the second appendix is a competency self-assessment. The rest of the book comprises sections related to each medicine subspecialty, with the first of these sections being ambulatory internal medicine. The first chapter in this section covers tips on the medicine clerkship. Two of the other three chapters in this section follow the format of most of the rest of the book, which is one case to one chapter. The other chapter in this section presents several common problems together, as do two chapters in the oncologic diseases section. The other sections include cardiovascular diseases, pulmonary diseases, renal diseases and electrolyte disorders, gastrointestinal and liver diseases, hematologic diseases, endocrine diseases, rheumatologic diseases (the shortest section of only two chapters), infectious diseases, and neurologic diseases. Four sections include “Teaching Visuals” chapters. The cardiovascular diseases section has two of these chapters: one on coronary angiography and the other on interpretation of the electrocardiogram. The pulmonary diseases section has a “Teaching Visuals” chapter on interpretation of chest radiographs, and the hematologic diseases section has one on peripheral blood smears. Each chapter includes objectives, relevant visuals, and good explanations of what is being shown. The coronary angiography chapter also has a multiple choice quiz. The book includes references and suggested readings and a fairly extensive index. One thing I thought was very useful for teaching purposes was that reimbursements are included with suggested laboratory and imaging studies. Many of the practice-based learning and improvement competencies have a reference to an evidence-based article. The main deficits are that a majority of the references, suggested readings, and evidence-based articles are from Elsevier journals and the only book referenced is Cecil Essentials. Also, the book is too heavy to fit comfortably in a white coat pocket, especially considering many people carry their phones in their pockets these days. In addition, I doubt many people who pick up this book to look at it will bother to read the preliminary and supplemental material, which would be helpful for their use of the book. However, the format is good for quick reference: It uses the case studies to highlight the competencies as it says it will do; the illustrations and images are very good; and the price is right. I would recommend this book for medical school and teaching hospital libraries with internal medicine programs as an addition to a collection that needs quick reference works for the ACGME competencies. It would also be ideal for libraries that would or could place library materials outside the library. Other medical libraries may look at this title as “nice to have.”