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Core Paediatrics and Child Health
  1. M D C Donaldson

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Another textbook of paediatrics finds its way to market, to take its place alongside those already in print. In their introduction, Haddad et al write that they have written this for undergraduates and junior doctors undertaking their first paediatric post. The underlying concepts arise from prior collaborative work undertaken by departments of Child Health in Scottish Universities in response to the GMC guidelines contained in “Tomorrow's Doctor”. This work, reported in Medical Education,1 provides a structure that gives uniformity of approach for each organ system and indeed the textbook is clearly and consistently laid out.

As with many other authors of textbooks, the authors start with an assumption that the layout of texts will influence learning. It is difficult to find any supportive evidence in educational literature and any research suggests that it is assessment rather than course material that drives acquisition of knowledge and reasoning skills.2 Nevertheless it seems reasonable to assume that those learning paediatrics should be able to choose from a selection of texts written and laid out differently. As such, it could be commended to students if they are considering the purchase of a textbook to support their learning, and I feel sure it will take its place in the “top five” of UK paediatric textbooks.

Although system based, the authors claim they have adopted a “problem orientated approach”. This does not match other books that start with clinical signs and symptoms; such a true problem orientated approach can be seen in Field et al's book.3 This difference highlights the difficulty of writing a text for both students and practising doctors. Anecdotally, students, who seem to prefer topic based teaching while SHOs, may find a true problem based approach more suited to their needs. They do, nevertheless, include “Key problems”, and have useful sections that review underpinning science, such as “Essential background”. For the enthusiastic student who wishes to pursue any topic further, they have included “Beyond core” material and sections entitled “Highlights and hypotheses”.

At over 300 pages, it probably contains more than is needed at undergraduate level but could be seen as core and a suitable text for reference. SHOs might find its system based layout less helpful in their learning how to practice paediatrics, but it would be a useful starting point for revision for postgraduate exams.

Teachers need to look at evaluation from a different perspective. How should they evaluate material for students undertaking their course? Fundamentally, any text should support and NOT divert student effort from the learning objectives of the course. It should help the teachers by providing them an agreed core curriculum. As a collaboration between Scottish departments of paediatrics, this should not present a problem north of the border, but others will need to analyse it mindful of their own course objectives. As a tutor at Imperial College School of Medicine this would raise problems. Our main course objectives are that:

1. Students should acquire understanding of families, their structure and how children are supported within this.

2. Students should acquire the skills of history taking and examination of children along with the necessary communication skills.

3. Students should acquire a basic knowledge of common and important childhood diseases.

This textbook clearly supports the last objective but neither 1 nor 2, although it is only fair to say that this criticism could be levelled against other similar textbooks. This could be seen as an argument for radical redesign of all undergraduate texts to match more fundamental course aims rather than a “topic based” core curriculum, but such discussion is outside the remit of a book review such as this.

My one major criticism is that it divides up history taking and examination according to body systems. Development of these clinical skills must be the cornerstone of undergraduate education, and dissection of history taking and examination makes it a difficult text from which to teach these essential practical skills.

Having said that, this book offers a fresh, clearly structured text for early professional education, and it will be interesting to see how it is received by the consumer, the medical student or doctor undertaking general professional training.


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    BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health