Journal of the Royal Society of Medicine Volume 83 June 1990
Otolaryngology in the curriculum-10
Valerie J Lund MS FRCS London WC1X 8EE
years on:
discussion
377
paper
Professorial Unit, Institute of Laryngology and Otology, Gray's Inn Road,
Keywords: otolaryngology; teaching; medical school curriculum
JF Neil's Presidential Address' to the Section of Laryngology for the 1978/79 session concerning the position of otolaryngology in the medical curriculum concluded that 'an inadequate allocation of time in the undergraduate period, coupled with a failure to give otolaryngology proper representation in the postgraduate training programme, can only result in overloading clinics with patients whose treatment should be well within the competence of a properlytrained practitioner'. Do these remarks have relevance a decade later? Medical curriculum committees are besieged with requests for extra and longer courses, with every specialist regarding their own area of interest as deserving greater importance and time allocation. A medical course offinite size renders this an impossible task resulting in the 'Jack of all trades' approach. In 1978 one of Pickering's conclusions was that students are exposed to too many subjects and do not have sufflcient time to absorb the intellectual as opposed to practical aspects of medicine2. However, in the practical discipline of surgery, it would seem that the allocation of time to the 'minor' specialties may be historically determined rather than reflect future career requirements. The Report of the GMC Survey of Basic Medical Education in the British Isles, 1975/63 identified a number of problems and areas of proposed development in ENT. Notably it drew attention to the paucity of academics which resulted in the majority of undergraduate teaching devolving on NHS staff, already over-burdened with their clinical commitments. It recommended that basic medical education and an understanding of general principles was the fundamental requirement of the undergraduate curriculum, with the icing on the educational cake occurring at postgraduate level. A number of papers have emphasized the importance of the subject in relation to general practice so it would seem an appropriate moment to reassess the present situation in the United Kingdom4'5. Information was gathered from the 27 medical schools, and in most cases from the clinicians responsible for medical student teaching. Detailed information was obtained from 24 schools and was compared with the findings of the 1975/6 GMC
report3. Teaching arrangements Otolaryngology is still considered as a separate subject with independent curricular status though there is considerable variation in individual teaching arrangements. In only seven schools is the subject taught as a full-time single specialty, of two weeks duration in all cases except one (of one week). The majority of courses include it as a part-time subject
combined with a number of others, of which ophthalmology, dermatology and neurosciences are the most common. The combination may be with between one and six other subjects, with the allocated time for such firms being proportionally longer (2-8 weeks). This situation has been subject to some individual variation since 19753 but remains essentially unchanged in at least 50% of courses. Position in the course In integrated system-based courses such as that at Newcastle, ENT features at the earliest stages of the medical curriculum and attempts to demonstrate clinical relevance to normal anatomy and physiology. In three schools, ENT features in the first clinical year, in 15 it appears in the second year and in six during the final year. Proportionally this situation is unchanged. from 1975 and in general ENT comprises a single course occurring after completion of early clinical experience. However, four schools now offer a final year elective of between two and five weeks in otolaryngology.
Teaching methods Students are divided into groups of up to 18 individuals but for the purposes of ENT they are generally subdivided into much smaller groups of between 2 and 4. Formal courses of lectures seem to have assumed more prominence featuring in 75% of courses and a significant proportion include additional lectures on introductory and fmal revision courses. A further 42% organize tutorials or seminars instead of or in addition to lectures. As in the past the majority of teaching is done in the outpatients and featured prominently in all courses. Students are expected to attend theatre in two-thirds of courses though some departments do not feel it worthwhile in keeping with previous reports6'7. Teaching ward rounds are, also popular and in some schools students are specifically encouraged to clerk patients. In a few departments audio-visual equipment, video presentation and demonstrations are available but the expansion in this area has not fulfilled the expectations of the GMC report3. Whilst the following aims would be endorsed by most departments, a number emphasized particular aspects such as the presentation of the clinical relevance of the subject, tailoring it to the potential needs of general practice. Consequently many concentrated on the recognition and treatment of common conditions and the differentiation of potentially' serious ones which is reflected in the lecture topics. Five departments actually issue a- list of objectives to students. Several courses include visits to speech therapy departments, paediatric audiology and students may be sent to an associated district general hospital.
0141-0768/90/ 060377-03402.00/0 © 1990 The Royal Society of Medicine
378
Journal of the Royal Society of Medicine Volume 83 June 1990
Student assessment All courses now utilize a university-based curriculum and whilst ENT is not specifically excluded from the final qualifying examinations, its appearance is variable. Three schools noted that it rarely appeared in any form at final MB, three described it as a possible option and five as being frequently or usually present. In the past ENT made little or no contribution to in-course assessment whereas now multiple choice questionnaires feature at the end of at least half of the courses, three include vivas, and in one students answer short written questions and perform a clinical examination. In the majority, these results contribute to the final assessment and in two instances must be repeated if failed. Problems and developments Few major changes have occurred in the teaching of otolaryngology to undergraduates since 1975 though there does appear to have been an increase in formal lectures and in the relative importance of the subject to in-course assessment. Some of the changes reflect an increasing use of modules in a number of schools, attempting to integrate pre-clinical and clinical teaching in areas such as respiratory disease or neurosciences and it is worth noting that there was little if any interest in such 'vertical integration' in 19753. The GMC report emphasized that the majority of teaching was done by full-time NHS consultants dealing with large numbers of patients in generally poor facilities which an increase in the number of academic departments and staff would help to alleviate3. Certainly this situation still pertains. Indeed the number of full-time academic otolaryngologists is amongst the lowest of any specialty (surgical) and with a total reduction in universityfunded academic medical posts of 25% in the last seven years, is unlikely to improve in the foreseeable future8. Rationalization of medical schools within London in response to the Flowers report9 has led to considerable changes in undergraduate curricula but the number of medical students in the United Kingdom has doubled since 1968 and increased by 9.7% since 1976/7710 in line with Todd recommendations". Due to cuts in funding of both NHS and universities the burden of teaching students continues to be unequally divided between NHS-employed consultants and clinical academics. NHS consultants at present receive no payment for teaching and there does not seem to be any immediate prospect of an increase in their numbers or facilities despite the intentions of 'Achieving a Balance'2. Is there any need for concern at this apparent stagnation? If one accepts that 45% of recently qualified doctors wish to enter general practice'3 and that between 10 and 20% of all general practice consultations concern the upper respiratory tract4 5, with 9% of hospital referral being to ENT departments14, it is clearly important that the subject is taught as well as possible. The suggestion that postgraduate training rounds off one's otolaryngological education is not supported by available data. Nre-registration house jobs in otolaryngology are not recognized by the GMC as providing adequate surgical experience alone. Under 3% of surgical house jobs include otolaryngology, 79% of which are combined with general surgery'5. Of 280 vocational training schemes in England and Wales in 1989,
16% include ENT in any form of which 11% represent a full-time 3-month SHO appointment and the remainder offer the possibility of occasional sessions'6. Indeed otolaryngology is not mentioned in the recommendations of the Joint Committee on Postgraduate Training for General Practice requirements for vocational training'7 though it should be noted that the subject is recognized and it would be theoretically possible to complete up to 12 months in an educationally approved post in this discipline. Nevertheless, few trainee GPs gain the postgraduate experience envisaged in the GMC recommendations'8. It is of interest that the Todd report actually included otolaryngology in two out of three examples of proposed training schemes for general practice". In the light of recent government recommendations for the NHS as a whole and the endorsement by the Association of Professors in Surgery of a 'core curriculum' are there any useful recommendations which can be made or realistically implemented? Few would question the importance of concentrating on basic skills and the recognition of both the commonplace and the potentially life-threatening. ENT has been particularly at a disadvantage in the demonstration of physical signs which require expertise in examination techniques but recent advances in fibreoptic equipment and television linkage with operating microscopes can transform this situation. The importance of postgraduate courses aimed specifically at GPs should not be underestimated and underlines the possibilities of a two-stage approach to undergraduate and postgraduate education which has been suggested for other specialties'9 but this is not feasible unless there is a marked expansion in the number of clinical academics. However, whilst the contribution of a subject to Final MB may sadly determine its importance for the majority of medical students, communication of the personal enthusiasm of the individual teacher for their subject is likely ultimately to remain the most successful inducement of all. Acknowledgments: I would like to thank the Deans of the respective medical schools and consultant otolaryngologists who kindly supplied information for this study and Professor R M Greenhalgh, Professor D F N Harrison and Mr D J Howard for their invaluable advice. References 1 Neil JF. Otolaryngology in the curriculum. JR Soc Med 1979;72:551-2 2 Pickering G. Quest for excellence in medical education. A personal survey. Oxford: Oxford University Press, 1978 3 General Medical Council. Basic Medical Education in the British Isles, 1975-6. Nuffield Provincial Hospitals Trust, 1977 4 Griffiths E. Incidence of ENT problems in general practice. J R Soc Med 1979;72:740-2 5 Morris PD, Pracy R. Training for ENT problems in general practice. Practitioner 1983;227:995-9 6 Rivron RP, Clayton MI. ENT teaching. Clin Otolaryngol
1988;13:133-7 7 Mackenzie IJ, Hardcastle PF. Undergraduate ENT teaching - is it relevant? Med Teach 1986;8:289-92 8 The Academic Medicine Group. Academic medicine: problems and solutions. Br Med J 1989;298:573-9 9 Report of the Working Party on Medical and Dental Teaching Resources. London Medical Education. A New Framework (Flowers Report). University of London, 1980 10 Hansard 30 January 1989
Journal of the Royal Society of Medicine Volume 83 June 1990 11 Report of the Royal Commission on Medical Education (Todd Report) 1967-8: Cmnd. 3569. London: HMSO, 1968 12 Department of Health and Joint Consultants Committee. Hospital Medical Staffing: achieving a balance. London: HMSO, 1986 13 Morbidity Statistics from General Practice, 1981-2. 3rd national study. London: HMSO, 1986 14 Department of Health and Social Security. Internal publication on outpatient and ward attenders statistics. Form KHO9, year ending March 1988 15 List of Hospitals and House Officer posts in the United Kingdom which are approved or recognised for
Some recent books Neurology A Colour Atlas of Brain Disorders in the Newborn. L S de Vries, L M S Dubowitz, V Dubowitz and J M Pennock, eds. (pp 200, £50) ISBN 07234-15129, London: Wolfe Medical 1990 Assessment of the Behavioral Consequences ofHead Trauma. (Frontiers of Clinical Neuroscience, Vol 7). Muriel D Lezak, ed. (pp 600, $79.50) ISBN 0-471-51623/6, New York: Alan R Liss 1989 Caring for the Parkinson Patient: A Practical Guide. J Thomas Hutton and Raye Lynne, eds. (pp 198) ISBN 0-87975-562-8, New York: Prometheus Books 1989 Fourth International Symposium on Sodium Valproate and Epilepsy. (International Congress and Symposium Series 152). David Chadwick, ed. (pp 292, £20) ISBN 1-85315-110-6, London: Royal Society of Medicine 1989 Magnetic Stimulation in Clinical Neurophysiology. Sudhansu Chokroverty, ed. (pp 328) ISBN 0409-90151-2, London: Butterworths 1990 Neurophysiology. (2nd edition, Physiological Principles of Medicine Series). R H S Carpenter. (pp 204, £17.95) ISBN 0-340-50634-2, Kent: Edward Arnold 1990 The Assembly of the Nervous System (47th Symposium of the Society for Developmental Biology). Lynn T Landmesser, ed. (pp 330, $96) ISBN 0471-56232-7, New York: Alan R Liss 1989 The Burden: Fifty Years of Clinical and Experimental Neuroscience at The Burden Neurological Institute. Ray Cooper and Jonathan Bird. (pp 108, £5.95) ISBN 0-948265-44-2, Bristol: White Tree Books 1989
Obstetrics and gynaecology A Pocketbook of Obstetrics & Gynecology. N-O Sjoberg and B Akstedt, eds. (pp 216) ISBN 0-940813-67-X, New Jersey: Parthenon 1989 Current Concepts in Endometriosis. (Progress in Clinical and Biological Research, Vol 323). Dev R Chadha and
16 17 18
19
pre-registration service. General Medical Council, 1989 Hawkins R, ed. Directory of vocational training schemes for general practice. Hawker Publications, 1989 Joint Committee on Postgraduate Training for General Practice. Training for general practice. Chameleon Press, 1984 Wright V, Hopkins R, Burton KE. What shall we teach undergraduates. Br Med J 1979;1:805-7 Norris SH. Undergraduate teaching of orthopaedic surgery. Med Educ 1982;16:166-9
(Accepted 17 October 1989)
Veasy C. Buttram Jr, eds. (pp 496, $120) ISBN 0471-56685-3, New York: Alan R Liss 1989 Experiences ofHysterectomy. Ann Webb. (pp 160, £4.99) ISBN 0-356-14141-1, London: Macdonald Optima 1989 Fluconazole and its Role in Vaginal Candidiasis. (International Congress and Symposium Series 160). R G Richardson, ed. (pp 64, £7.50) ISBN 1-85315-115-7, London: Royal Society of Medicine 1989 Motherhood and Mental Illness: Causes and Consequences. (Vol 2). R Kumar and I F Brockington, eds. (pp 302, £42.50) ISBN 0-7236-9766-4, Guildford: Butterworth Scientific 1988 Placenta as a Model and a Source. Olga Genbacev, Arnold Klopper and Rebecca Beaconsfield, eds. (pp 192, $59.40) ISBN 0-30643238-2, New York: Plenum Press 1989 Quadruplets and Higher Multiple Births. (Clinics in Developmental Medicine No. 107). Marie M Clay. (pp 200, £20) ISBN 0-632-02466-6, Oxford: Blackwell Scientific 1990 Safety Requirements for Contraceptive Steroids. Scientific Basis ofFertility Regulation. F Michal, ed. (pp 484, £65) ISBN 0-521-35459-5, Cambridge: Cambridge University Press 1989 The Causation and Clinical Management ofPelvic Radiation Disease. P E Schofield and E W Lipton, eds. (pp 172) ISBN 3-540-19561-0, London: Springer-Verlag 1989 Transplacental Disorders. Perinatal Detection, Treatment, and Management (including Pediatric Aids). Ronald Bellisario and Gerald J Mizejewski, eds. (pp 287, $70) ISBN 0471-56677-2, New York: Alan R Liss 1990 Medicine Menopause: Evaluation, Treatment, and Health Concerns. Charles B Hammond, Florence P Haseltine and Isaac Schiff, eds. (pp 339, $96) ISBN 0471-56223-8, New York: Alan R Liss 1989 Nutritional Sciences for Human Health. S Berger, A Gronowska-Senger and S Ziemlanski et al., eds. (pp 234, £18) ISBN 1-85463-003-2, London: Smith Gordon & Co 1989 Occupational Health Practice. H A Waldron. (pp 529, £35) ISBN 0-407-337024, London: Butterworths 1989 Year Book of Medicine 1989. Rogers et aL (pp 818, £42) ISBN 0-8151-7262-1, Chicago: Year Book Medical Publishers
379
Otolaryngology in the curriculum-10
Valerie J Lund MS FRCS London WC1X 8EE
years on:
discussion
377
paper
Professorial Unit, Institute of Laryngology and Otology, Gray's Inn Road,
Keywords: otolaryngology; teaching; medical school curriculum
JF Neil's Presidential Address' to the Section of Laryngology for the 1978/79 session concerning the position of otolaryngology in the medical curriculum concluded that 'an inadequate allocation of time in the undergraduate period, coupled with a failure to give otolaryngology proper representation in the postgraduate training programme, can only result in overloading clinics with patients whose treatment should be well within the competence of a properlytrained practitioner'. Do these remarks have relevance a decade later? Medical curriculum committees are besieged with requests for extra and longer courses, with every specialist regarding their own area of interest as deserving greater importance and time allocation. A medical course offinite size renders this an impossible task resulting in the 'Jack of all trades' approach. In 1978 one of Pickering's conclusions was that students are exposed to too many subjects and do not have sufflcient time to absorb the intellectual as opposed to practical aspects of medicine2. However, in the practical discipline of surgery, it would seem that the allocation of time to the 'minor' specialties may be historically determined rather than reflect future career requirements. The Report of the GMC Survey of Basic Medical Education in the British Isles, 1975/63 identified a number of problems and areas of proposed development in ENT. Notably it drew attention to the paucity of academics which resulted in the majority of undergraduate teaching devolving on NHS staff, already over-burdened with their clinical commitments. It recommended that basic medical education and an understanding of general principles was the fundamental requirement of the undergraduate curriculum, with the icing on the educational cake occurring at postgraduate level. A number of papers have emphasized the importance of the subject in relation to general practice so it would seem an appropriate moment to reassess the present situation in the United Kingdom4'5. Information was gathered from the 27 medical schools, and in most cases from the clinicians responsible for medical student teaching. Detailed information was obtained from 24 schools and was compared with the findings of the 1975/6 GMC
report3. Teaching arrangements Otolaryngology is still considered as a separate subject with independent curricular status though there is considerable variation in individual teaching arrangements. In only seven schools is the subject taught as a full-time single specialty, of two weeks duration in all cases except one (of one week). The majority of courses include it as a part-time subject
combined with a number of others, of which ophthalmology, dermatology and neurosciences are the most common. The combination may be with between one and six other subjects, with the allocated time for such firms being proportionally longer (2-8 weeks). This situation has been subject to some individual variation since 19753 but remains essentially unchanged in at least 50% of courses. Position in the course In integrated system-based courses such as that at Newcastle, ENT features at the earliest stages of the medical curriculum and attempts to demonstrate clinical relevance to normal anatomy and physiology. In three schools, ENT features in the first clinical year, in 15 it appears in the second year and in six during the final year. Proportionally this situation is unchanged. from 1975 and in general ENT comprises a single course occurring after completion of early clinical experience. However, four schools now offer a final year elective of between two and five weeks in otolaryngology.
Teaching methods Students are divided into groups of up to 18 individuals but for the purposes of ENT they are generally subdivided into much smaller groups of between 2 and 4. Formal courses of lectures seem to have assumed more prominence featuring in 75% of courses and a significant proportion include additional lectures on introductory and fmal revision courses. A further 42% organize tutorials or seminars instead of or in addition to lectures. As in the past the majority of teaching is done in the outpatients and featured prominently in all courses. Students are expected to attend theatre in two-thirds of courses though some departments do not feel it worthwhile in keeping with previous reports6'7. Teaching ward rounds are, also popular and in some schools students are specifically encouraged to clerk patients. In a few departments audio-visual equipment, video presentation and demonstrations are available but the expansion in this area has not fulfilled the expectations of the GMC report3. Whilst the following aims would be endorsed by most departments, a number emphasized particular aspects such as the presentation of the clinical relevance of the subject, tailoring it to the potential needs of general practice. Consequently many concentrated on the recognition and treatment of common conditions and the differentiation of potentially' serious ones which is reflected in the lecture topics. Five departments actually issue a- list of objectives to students. Several courses include visits to speech therapy departments, paediatric audiology and students may be sent to an associated district general hospital.
0141-0768/90/ 060377-03402.00/0 © 1990 The Royal Society of Medicine
378
Journal of the Royal Society of Medicine Volume 83 June 1990
Student assessment All courses now utilize a university-based curriculum and whilst ENT is not specifically excluded from the final qualifying examinations, its appearance is variable. Three schools noted that it rarely appeared in any form at final MB, three described it as a possible option and five as being frequently or usually present. In the past ENT made little or no contribution to in-course assessment whereas now multiple choice questionnaires feature at the end of at least half of the courses, three include vivas, and in one students answer short written questions and perform a clinical examination. In the majority, these results contribute to the final assessment and in two instances must be repeated if failed. Problems and developments Few major changes have occurred in the teaching of otolaryngology to undergraduates since 1975 though there does appear to have been an increase in formal lectures and in the relative importance of the subject to in-course assessment. Some of the changes reflect an increasing use of modules in a number of schools, attempting to integrate pre-clinical and clinical teaching in areas such as respiratory disease or neurosciences and it is worth noting that there was little if any interest in such 'vertical integration' in 19753. The GMC report emphasized that the majority of teaching was done by full-time NHS consultants dealing with large numbers of patients in generally poor facilities which an increase in the number of academic departments and staff would help to alleviate3. Certainly this situation still pertains. Indeed the number of full-time academic otolaryngologists is amongst the lowest of any specialty (surgical) and with a total reduction in universityfunded academic medical posts of 25% in the last seven years, is unlikely to improve in the foreseeable future8. Rationalization of medical schools within London in response to the Flowers report9 has led to considerable changes in undergraduate curricula but the number of medical students in the United Kingdom has doubled since 1968 and increased by 9.7% since 1976/7710 in line with Todd recommendations". Due to cuts in funding of both NHS and universities the burden of teaching students continues to be unequally divided between NHS-employed consultants and clinical academics. NHS consultants at present receive no payment for teaching and there does not seem to be any immediate prospect of an increase in their numbers or facilities despite the intentions of 'Achieving a Balance'2. Is there any need for concern at this apparent stagnation? If one accepts that 45% of recently qualified doctors wish to enter general practice'3 and that between 10 and 20% of all general practice consultations concern the upper respiratory tract4 5, with 9% of hospital referral being to ENT departments14, it is clearly important that the subject is taught as well as possible. The suggestion that postgraduate training rounds off one's otolaryngological education is not supported by available data. Nre-registration house jobs in otolaryngology are not recognized by the GMC as providing adequate surgical experience alone. Under 3% of surgical house jobs include otolaryngology, 79% of which are combined with general surgery'5. Of 280 vocational training schemes in England and Wales in 1989,
16% include ENT in any form of which 11% represent a full-time 3-month SHO appointment and the remainder offer the possibility of occasional sessions'6. Indeed otolaryngology is not mentioned in the recommendations of the Joint Committee on Postgraduate Training for General Practice requirements for vocational training'7 though it should be noted that the subject is recognized and it would be theoretically possible to complete up to 12 months in an educationally approved post in this discipline. Nevertheless, few trainee GPs gain the postgraduate experience envisaged in the GMC recommendations'8. It is of interest that the Todd report actually included otolaryngology in two out of three examples of proposed training schemes for general practice". In the light of recent government recommendations for the NHS as a whole and the endorsement by the Association of Professors in Surgery of a 'core curriculum' are there any useful recommendations which can be made or realistically implemented? Few would question the importance of concentrating on basic skills and the recognition of both the commonplace and the potentially life-threatening. ENT has been particularly at a disadvantage in the demonstration of physical signs which require expertise in examination techniques but recent advances in fibreoptic equipment and television linkage with operating microscopes can transform this situation. The importance of postgraduate courses aimed specifically at GPs should not be underestimated and underlines the possibilities of a two-stage approach to undergraduate and postgraduate education which has been suggested for other specialties'9 but this is not feasible unless there is a marked expansion in the number of clinical academics. However, whilst the contribution of a subject to Final MB may sadly determine its importance for the majority of medical students, communication of the personal enthusiasm of the individual teacher for their subject is likely ultimately to remain the most successful inducement of all. Acknowledgments: I would like to thank the Deans of the respective medical schools and consultant otolaryngologists who kindly supplied information for this study and Professor R M Greenhalgh, Professor D F N Harrison and Mr D J Howard for their invaluable advice. References 1 Neil JF. Otolaryngology in the curriculum. JR Soc Med 1979;72:551-2 2 Pickering G. Quest for excellence in medical education. A personal survey. Oxford: Oxford University Press, 1978 3 General Medical Council. Basic Medical Education in the British Isles, 1975-6. Nuffield Provincial Hospitals Trust, 1977 4 Griffiths E. Incidence of ENT problems in general practice. J R Soc Med 1979;72:740-2 5 Morris PD, Pracy R. Training for ENT problems in general practice. Practitioner 1983;227:995-9 6 Rivron RP, Clayton MI. ENT teaching. Clin Otolaryngol
1988;13:133-7 7 Mackenzie IJ, Hardcastle PF. Undergraduate ENT teaching - is it relevant? Med Teach 1986;8:289-92 8 The Academic Medicine Group. Academic medicine: problems and solutions. Br Med J 1989;298:573-9 9 Report of the Working Party on Medical and Dental Teaching Resources. London Medical Education. A New Framework (Flowers Report). University of London, 1980 10 Hansard 30 January 1989
Journal of the Royal Society of Medicine Volume 83 June 1990 11 Report of the Royal Commission on Medical Education (Todd Report) 1967-8: Cmnd. 3569. London: HMSO, 1968 12 Department of Health and Joint Consultants Committee. Hospital Medical Staffing: achieving a balance. London: HMSO, 1986 13 Morbidity Statistics from General Practice, 1981-2. 3rd national study. London: HMSO, 1986 14 Department of Health and Social Security. Internal publication on outpatient and ward attenders statistics. Form KHO9, year ending March 1988 15 List of Hospitals and House Officer posts in the United Kingdom which are approved or recognised for
Some recent books Neurology A Colour Atlas of Brain Disorders in the Newborn. L S de Vries, L M S Dubowitz, V Dubowitz and J M Pennock, eds. (pp 200, £50) ISBN 07234-15129, London: Wolfe Medical 1990 Assessment of the Behavioral Consequences ofHead Trauma. (Frontiers of Clinical Neuroscience, Vol 7). Muriel D Lezak, ed. (pp 600, $79.50) ISBN 0-471-51623/6, New York: Alan R Liss 1989 Caring for the Parkinson Patient: A Practical Guide. J Thomas Hutton and Raye Lynne, eds. (pp 198) ISBN 0-87975-562-8, New York: Prometheus Books 1989 Fourth International Symposium on Sodium Valproate and Epilepsy. (International Congress and Symposium Series 152). David Chadwick, ed. (pp 292, £20) ISBN 1-85315-110-6, London: Royal Society of Medicine 1989 Magnetic Stimulation in Clinical Neurophysiology. Sudhansu Chokroverty, ed. (pp 328) ISBN 0409-90151-2, London: Butterworths 1990 Neurophysiology. (2nd edition, Physiological Principles of Medicine Series). R H S Carpenter. (pp 204, £17.95) ISBN 0-340-50634-2, Kent: Edward Arnold 1990 The Assembly of the Nervous System (47th Symposium of the Society for Developmental Biology). Lynn T Landmesser, ed. (pp 330, $96) ISBN 0471-56232-7, New York: Alan R Liss 1989 The Burden: Fifty Years of Clinical and Experimental Neuroscience at The Burden Neurological Institute. Ray Cooper and Jonathan Bird. (pp 108, £5.95) ISBN 0-948265-44-2, Bristol: White Tree Books 1989
Obstetrics and gynaecology A Pocketbook of Obstetrics & Gynecology. N-O Sjoberg and B Akstedt, eds. (pp 216) ISBN 0-940813-67-X, New Jersey: Parthenon 1989 Current Concepts in Endometriosis. (Progress in Clinical and Biological Research, Vol 323). Dev R Chadha and
16 17 18
19
pre-registration service. General Medical Council, 1989 Hawkins R, ed. Directory of vocational training schemes for general practice. Hawker Publications, 1989 Joint Committee on Postgraduate Training for General Practice. Training for general practice. Chameleon Press, 1984 Wright V, Hopkins R, Burton KE. What shall we teach undergraduates. Br Med J 1979;1:805-7 Norris SH. Undergraduate teaching of orthopaedic surgery. Med Educ 1982;16:166-9
(Accepted 17 October 1989)
Veasy C. Buttram Jr, eds. (pp 496, $120) ISBN 0471-56685-3, New York: Alan R Liss 1989 Experiences ofHysterectomy. Ann Webb. (pp 160, £4.99) ISBN 0-356-14141-1, London: Macdonald Optima 1989 Fluconazole and its Role in Vaginal Candidiasis. (International Congress and Symposium Series 160). R G Richardson, ed. (pp 64, £7.50) ISBN 1-85315-115-7, London: Royal Society of Medicine 1989 Motherhood and Mental Illness: Causes and Consequences. (Vol 2). R Kumar and I F Brockington, eds. (pp 302, £42.50) ISBN 0-7236-9766-4, Guildford: Butterworth Scientific 1988 Placenta as a Model and a Source. Olga Genbacev, Arnold Klopper and Rebecca Beaconsfield, eds. (pp 192, $59.40) ISBN 0-30643238-2, New York: Plenum Press 1989 Quadruplets and Higher Multiple Births. (Clinics in Developmental Medicine No. 107). Marie M Clay. (pp 200, £20) ISBN 0-632-02466-6, Oxford: Blackwell Scientific 1990 Safety Requirements for Contraceptive Steroids. Scientific Basis ofFertility Regulation. F Michal, ed. (pp 484, £65) ISBN 0-521-35459-5, Cambridge: Cambridge University Press 1989 The Causation and Clinical Management ofPelvic Radiation Disease. P E Schofield and E W Lipton, eds. (pp 172) ISBN 3-540-19561-0, London: Springer-Verlag 1989 Transplacental Disorders. Perinatal Detection, Treatment, and Management (including Pediatric Aids). Ronald Bellisario and Gerald J Mizejewski, eds. (pp 287, $70) ISBN 0471-56677-2, New York: Alan R Liss 1990 Medicine Menopause: Evaluation, Treatment, and Health Concerns. Charles B Hammond, Florence P Haseltine and Isaac Schiff, eds. (pp 339, $96) ISBN 0471-56223-8, New York: Alan R Liss 1989 Nutritional Sciences for Human Health. S Berger, A Gronowska-Senger and S Ziemlanski et al., eds. (pp 234, £18) ISBN 1-85463-003-2, London: Smith Gordon & Co 1989 Occupational Health Practice. H A Waldron. (pp 529, £35) ISBN 0-407-337024, London: Butterworths 1989 Year Book of Medicine 1989. Rogers et aL (pp 818, £42) ISBN 0-8151-7262-1, Chicago: Year Book Medical Publishers
379
