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Book Clubs in Residentsʼ Education

2000; Lippincott Williams & Wilkins; Volume: 75; Issue: 1 Linguagem: Inglês

10.1097/00001888-200001000-00003

1938-808X

Anuj Gupta, Janine Cory, Michael J. Goldberg,

Health and Medical Research Impacts

During the last few decades, the education of orthopedic residents has consisted primarily of establishing clinical diagnoses and acquiring surgical technical skills. Operative technology has vastly increased (e.g., arthroscopic surgery; joint replacements; fracture fixation), and surgical equipment has become more complex (e.g., fixators and implants); with these changes has come a concomitant increase in the manual skills that orthopedic residents must master during the four-year residency training period. As a result, attention to the humanities in this area (as well as in other medical and surgical specialties) is often neglected. Two years ago, the Orthopaedic Residency Program of the Tufts Affiliated Hospitals added a new form of resident education: a book club. Although scientific journal clubs have long been an integral part of graduate medical education, and book clubs have long been popular among the reading public, to the best of our knowledge, book clubs have not been used to supplement orthopedic residents' education. To accommodate the residents' schedules, one morning conference every three months is dedicated to the discussion of one or more books. The department chair is the facilitator and, with resident input, he selects the book to be read for that quarter. In addition to the residents, faculty, medical students, spouses, and support staff are encouraged to participate. To minimize barriers to participation, the department provides the book at no cost to all participants. Although the book club is entertaining and diverting, it also serves to increase the residents' awareness of ethical issues that may relate directly to medicine. The discussions improve understanding of the human condition and provide better insight into patients' values. The discussions also broaden the staff's understanding of the values and beliefs of the residents. Most ACGME-Resident Review Committees require education around issues of medical ethics, gender bias, and harassment, and the book club format is far more thought-provoking and interactive than traditional lectures on these topics. The club also helps to keep the residents from becoming unidimensional, limited people without any perspective on life beyond the musculoskeletal system. Although there is no formal curriculum for the book club, the books are chosen to provide a well-balanced mix of fiction and nonfiction on a variety of topics. The book club's lively discussions have challenged residents and staff to think beyond traditional medical topics. Participants have explored the similarities between the atrocities of the Third Reich (Ursula Hegi's Stones from the River) and the ethnic wars in Bosnia (Peter Maass's Love Thy Neighbor). Frances Conley's probing, personal look at sexism in medicine (Walking Out on the Boys) forced participants to examine their own attitudes and behaviors. Christopher Buckley's satirical look at the tobacco industry (Thank You for Not Smoking) provoked discussion of the effect of politics on medicine and life. Two books on the same tragic events (Jon Krakauer's Into Thin Air and Anatoll Boukreev's The Climb) stimulated conversation about the biases inherent in personal accounts, and discussion of Alfred Lansing's Endurance: Shackelton's Incredible Voyage covered leadership and motivation issues. Other books read by the club include The Reader (Bernhard Schlink), which questions living life as an uncaring observer, and Simon Mawer's Mendel's Dwarf, a mix of old genetics, new genetics, and ethics. Not surprising, the residents' major objection to the book club is that it takes up too much of their nonassigned time—time that could potentially be used for studying orthopedics. In fact, though, the time required to prepare for book club meetings is modest—almost everyone can read one book in a three-month period without sacrificing other responsibilities. Orthopedic residencies have earned the reputation for being regimented, overly technical, and narrowly focused. By helping to create more well-rounded individuals and compassionate physicians, book clubs can be an excellent supplement to resident education.