British Journal of Medical Edricatioti, 1915, 9, 296-297
Textbooks - a new approach A. MARCUS, H. HALL', and R. M. HARDENZ Update Publications Ltd.; and Centre for Medical Education, The University, Dundee K e y words "BOOKS RHEUMATISMLEARNING EDUCAnON.
MEDICAL
INFORMATION DISPLAY
BOOKBINDINGMEDICALILLUSTRATION
While a considerable effort is being put into developing newer, more sophisticated learning experiences such as television, audio-tape and slides, and computer-assisted instruction, few attempts have been made to improve a more traditional approach - the book. The conventional textbook imposes many constraints upon the reader and the author. For example, each page is fixed and bound into an order determined solely by the author and incapable of being modified by the reader. The amount of material is also fixed; the conventional book cannot grow in accordance with the needs of the reader nor can the content be modified to suit different needs. This paper describes briefly the application of a new aproach to the production of a textbook by a team comprising publisher, educationalists, and subject specialists. The aim of the project was to minimize the limitations of the standard text and to maximize the usefulness of the book as an aid to learning. Five criteria were adopted: the book should be flexible and modular, it should adopt an interdisciplinary approach. core material should be distinguished from additional material, illustrations should play an important part, and attention should be paid to layout and design.
Flexibility and modularity Flexibility has been achieved by arranging that the binding can be opened to allow the pages to be rearranged or removed, or to allow 'Present address : Orthopaedic Department, Toronto General Hospital, Toronto, Canada. ?Requests for reprints to D r R. M. Harden, Centre for Medical Education, The University. Dundee. 296
additional material to be added. This binding also allows the book to be readily adapted to local situations or levels of study. Personal notes of articles read or patients seen, infonnation from teaching sessions or photocopied articles or reprints may be added by the student. Thus, the book can grow with the reader, and may progress from being an undergraduate textbook through all stages of his development until it reaches the library shelf of the qualified doctor. It would become in a unique sense a personal book. The book has five sections each tackling the subject from a different direction and each capable of independent use. Section one deals with background and briefly reviews the relevant general anatomy, biochemistry, pathology, and epidemiology. Section two considers how to take a history and conduct a physical examination, for example, in a patient with a suspected rheumatic disorder. Section three discusses the investigation and management of the common clinical presentations such as low back pain or acute monoarthritis and leads to a differential diagnosis. Section four considers the rheumatic disorders independently and discusses their management. Section five covers in more detail some aspects of the pharmacology and therapeutics of rheumatic disorders.
Interdisciplinary approach An interdisciplinary approach was achieved by including in the production team general physicians, specialists, surgeons, and a general practitioner along with other experts, and by arranging that the team discussed and agreed each section of the book.
Texrbooks - a new approach
Distinction between core and additional material Core material is clearly distinguished from additional material. Each page of the book has two columns. The left hand column contains material considered to be essential or core knowledge. This column provides an easy to read textbook for those who wish to study rapidly, for those who require only the basic knowledge, or for those who wish a simple revision. The right hand column serves several different functions. It provides additional information not essential to the understanding of the subject. This may be more detailed information to increase the depth of knowledge or it may be information such as historical anecdotes designed to motivate the reader and increase his interest. The right hand column provides further explanation for the student who lacks full understanding of the material in the left hand column. Terms used in the left hand column may be defined in the right hand column since definitions in the left would slow the average reader and hinder revision. Important points noted in the left hand column may be restated in the right hand column for emphasis and revision material from another section may be included where appropriate. Self-assessment exercises are also supplied in the right hand column so that the student can evaluate his own knowledge of the subject while annotated references direct the student to more detailed discussions of the topic in the literature.
Illustrations I t is frequently difficult for a student adequately
to grasp a point if he has no visual image of the condition under discussion. A large number of full colour illustrations and x-rays have, therefore, been included in the textbook. They are printed on separate, detachable pages that are constantly available so that when a reference is made to an illustration or x-ray it can be examined alongside the relevant page of text. Each picture or x-ray may be referred to at a number of different places in the book and can be used wherever the reader feels the need. Words and pictures, therefore, are integrated
297
and reinforce one another. The illustrations and x-rays with their legends can be used as a summary or as an additional self-assessment exercise.
Layout and design Attention has been paid to the layout and design of the book so that the book appears attractive to the student while at the same time facilitating learning. The indexing structure and layout have been designed to allow rapid reference and facilitate revision while not hampering the reader who is using the book for the first time. The important two-column layout with core material in one column and additional material in the other has been discussed. The columns have been so arranged that related material is juxtaposed on the page. Headings in the left hand core column are printed in a second colour to allow the student to scan the pages and rapidly locate information he requires. While full evaluation must await publication, preliminary assessment suggests that it is possible to design a medical textbook which fulfils the criteria listed and that such a book offers many advantages over conventional textbooks.
Summary A new approach to medical textbooks has been applied by a team comprising a publisher, educationalist, and subject specialist. The binding of the book can be opened so that additional material can be added and the pages rearranged. Illustrations are printed on separate sheets so as to be available for study at any point in the text. An interdisciplinary approach has been adopted throughout and each section of the book examines the subject from a different viewpoint, for example, a disease, a clinical presentation, or an approach to therapy. An important feature is the separation of core material from additional material. Layout and design have been used to facilitate learning and to make possible the use of the book for reference and revision. The work described in this paper was carried out with the aid of a grant from Update Publications Ltd.
Textbooks - a new approach A. MARCUS, H. HALL', and R. M. HARDENZ Update Publications Ltd.; and Centre for Medical Education, The University, Dundee K e y words "BOOKS RHEUMATISMLEARNING EDUCAnON.
MEDICAL
INFORMATION DISPLAY
BOOKBINDINGMEDICALILLUSTRATION
While a considerable effort is being put into developing newer, more sophisticated learning experiences such as television, audio-tape and slides, and computer-assisted instruction, few attempts have been made to improve a more traditional approach - the book. The conventional textbook imposes many constraints upon the reader and the author. For example, each page is fixed and bound into an order determined solely by the author and incapable of being modified by the reader. The amount of material is also fixed; the conventional book cannot grow in accordance with the needs of the reader nor can the content be modified to suit different needs. This paper describes briefly the application of a new aproach to the production of a textbook by a team comprising publisher, educationalists, and subject specialists. The aim of the project was to minimize the limitations of the standard text and to maximize the usefulness of the book as an aid to learning. Five criteria were adopted: the book should be flexible and modular, it should adopt an interdisciplinary approach. core material should be distinguished from additional material, illustrations should play an important part, and attention should be paid to layout and design.
Flexibility and modularity Flexibility has been achieved by arranging that the binding can be opened to allow the pages to be rearranged or removed, or to allow 'Present address : Orthopaedic Department, Toronto General Hospital, Toronto, Canada. ?Requests for reprints to D r R. M. Harden, Centre for Medical Education, The University. Dundee. 296
additional material to be added. This binding also allows the book to be readily adapted to local situations or levels of study. Personal notes of articles read or patients seen, infonnation from teaching sessions or photocopied articles or reprints may be added by the student. Thus, the book can grow with the reader, and may progress from being an undergraduate textbook through all stages of his development until it reaches the library shelf of the qualified doctor. It would become in a unique sense a personal book. The book has five sections each tackling the subject from a different direction and each capable of independent use. Section one deals with background and briefly reviews the relevant general anatomy, biochemistry, pathology, and epidemiology. Section two considers how to take a history and conduct a physical examination, for example, in a patient with a suspected rheumatic disorder. Section three discusses the investigation and management of the common clinical presentations such as low back pain or acute monoarthritis and leads to a differential diagnosis. Section four considers the rheumatic disorders independently and discusses their management. Section five covers in more detail some aspects of the pharmacology and therapeutics of rheumatic disorders.
Interdisciplinary approach An interdisciplinary approach was achieved by including in the production team general physicians, specialists, surgeons, and a general practitioner along with other experts, and by arranging that the team discussed and agreed each section of the book.
Texrbooks - a new approach
Distinction between core and additional material Core material is clearly distinguished from additional material. Each page of the book has two columns. The left hand column contains material considered to be essential or core knowledge. This column provides an easy to read textbook for those who wish to study rapidly, for those who require only the basic knowledge, or for those who wish a simple revision. The right hand column serves several different functions. It provides additional information not essential to the understanding of the subject. This may be more detailed information to increase the depth of knowledge or it may be information such as historical anecdotes designed to motivate the reader and increase his interest. The right hand column provides further explanation for the student who lacks full understanding of the material in the left hand column. Terms used in the left hand column may be defined in the right hand column since definitions in the left would slow the average reader and hinder revision. Important points noted in the left hand column may be restated in the right hand column for emphasis and revision material from another section may be included where appropriate. Self-assessment exercises are also supplied in the right hand column so that the student can evaluate his own knowledge of the subject while annotated references direct the student to more detailed discussions of the topic in the literature.
Illustrations I t is frequently difficult for a student adequately
to grasp a point if he has no visual image of the condition under discussion. A large number of full colour illustrations and x-rays have, therefore, been included in the textbook. They are printed on separate, detachable pages that are constantly available so that when a reference is made to an illustration or x-ray it can be examined alongside the relevant page of text. Each picture or x-ray may be referred to at a number of different places in the book and can be used wherever the reader feels the need. Words and pictures, therefore, are integrated
297
and reinforce one another. The illustrations and x-rays with their legends can be used as a summary or as an additional self-assessment exercise.
Layout and design Attention has been paid to the layout and design of the book so that the book appears attractive to the student while at the same time facilitating learning. The indexing structure and layout have been designed to allow rapid reference and facilitate revision while not hampering the reader who is using the book for the first time. The important two-column layout with core material in one column and additional material in the other has been discussed. The columns have been so arranged that related material is juxtaposed on the page. Headings in the left hand core column are printed in a second colour to allow the student to scan the pages and rapidly locate information he requires. While full evaluation must await publication, preliminary assessment suggests that it is possible to design a medical textbook which fulfils the criteria listed and that such a book offers many advantages over conventional textbooks.
Summary A new approach to medical textbooks has been applied by a team comprising a publisher, educationalist, and subject specialist. The binding of the book can be opened so that additional material can be added and the pages rearranged. Illustrations are printed on separate sheets so as to be available for study at any point in the text. An interdisciplinary approach has been adopted throughout and each section of the book examines the subject from a different viewpoint, for example, a disease, a clinical presentation, or an approach to therapy. An important feature is the separation of core material from additional material. Layout and design have been used to facilitate learning and to make possible the use of the book for reference and revision. The work described in this paper was carried out with the aid of a grant from Update Publications Ltd.
