Fundamentals of Obstetrics and Gynaecology [antikvár]

THE CONTENT OF OBSTETRICS AND GYNAECOLOGY The expansion of medical knowledge over the past 20 years and its increasing complexity makes it difficult for medical students and interns to know what they need to know to be competent doctors and to pass the examinations set at the end of their assignments in various medical discipUnes. This has led in the words of the General Medical Council to a situation in which 'it is distressing to see the progressive disenchantment [of many students] as they work their way through the course. Imagination and curiosity are soon dulled'. This opinion is echoed by the Dean of St. Bartholomew's Hospital Medical School who was horrified at the transformation of eager, bright school leavers into dull, demoralized doctors in the space of five years. The question is: 'What has occurred to change the best and brightest into unhappy, disillusioned doctors, particularly in the intern year?'. In part, the change is due to the enormous collection of facts that students and interns appear to have to learn: in other words there is too much rote learning and too little encouragement of curiosity and of inquiry. In part it is because teachers in a discipline appear to believe that it is essential for students and interns to learn a great deal about that discipline and resent having to curtail the information they provide in the interests of the medical curriculum as a whole. If teachers insist that students remember facts and gear their teaching sessions to encompass this, if teachers fail to inspire students to seek further, the situation will not change. If teachers 'put down' students in tutorials and fail to respect the patient's dignity during bedside teaching, the situation will not change. Students are realists and if they know that they will be examined on matters they have memorized they wiU continue to rote learn facts and to forget most of the material as soon as they have passed the examinations. During the pre-registration year interns learn that to progress it is best to adopt the attitudes of their consultants towards patients, particularly when interns' working conditions often are appalling and not conducive to continued learning. The difficulty in each of the medical disciplines is to determine what is the essential knowledge medical students and interns should acquire (and, equally importantly, what they do not need to know), and how to encourage them to retain their curiosity as well as to memorize facts. This leads to the further question; 'Should women's health issues, that is, obstetrics and gynaecology (or, as I prefer, 'gyniatry') be a core subject or an optional subject?'. The General Medical Council considers that understanding of the human reproductive cycle and the understanding of human relationships are essential aspects of the undergraduate medical curriculum, which suggests that women's health issues should remain a core subject. Fundamentals of Obstetrics and Gynaecology was first published over 25 years ago in two volumes. The contraction of the assignment in obstetrics and gynaecology in the undergraduate curriculum to 10 weeks or less means that the size of a text book should also be reduced. It is for this reason that the books, which have sold over 100,000 copies, have been completely rewritten as a single volume. In undertaking this task I have discussed the content with some of my colleagues and although we have not always agreed, there has been sufficient consensus for the book to be written. I am particularly grateful to Professor Malcolm Coppleson for reviewing Chapter 40; to Professor Ian Eraser for reviewing Chapter 30; to Professor David Henderson-Smart for reviewing the sections and chapters relating to the newborn infant; and to Dr Bernard Haylen for reviewing Chapter 41. However, the published opinions are mine and are based on the literature and on the discussions. If teachers do not agree with some of them I hope that students wiU be encouraged to find out why there is disagreement and to evaluate the information critically and creatively. In the evolution of new medical curricula I believe that there will be a mix of teacher-centred information transfer and self-directed problem-based learning. I hope that this textbook wiU serve as a source book for both approaches, supplemented by literature searches and evaluation of chosen topics. This is the reason why I have limited the bibUography mainly to reference books. Readers will note that some of the material may seem to be irrelevant for many students. Does a student need to know, for example, the steps required to perform a forceps delivery or a caesarean section?. These topics have been included, largely as illustrations with captions, as the book is used in several developing countries where this information has a practical value. I have tried to describe the effect of a chosen procedure on the woman (and in many cases on her partner) as it appears that some teachers are brilliant diagnosticians and skilled surgeons, but are poor communicators. Modern medicine increasingly