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Textbooks & Resources in Medical School

textbooksThe world of medical textbooks is vast, expensive and largely unchartered in terms of useful reviews. In an attempt to deal with this, the following is a comprehensive guide to textbooks for preclinical, clinical & post-graduate settings. The information in this post has been gathered from personal experience over my last 6 years of medical school & from scouring college websites for their recommended textbook lists. I will happily post other detailed reviews made in the comments within this article so if you have a textbook to recommend that I haven’t mentioned please post below!

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In providing recommendations and reviews here I’ll try to both cover the commonly prescribed text or (in situations where I used something else) explain why I chose differently. Beyond the books in the picture above I actually don’t own many physical copies and instead use online libraries to get my texts.

Physiology

Marieb & Hohnmarieb
Marieb formed the basis of my initial physiology knowledge and was used extensively throughout my 1st and 2nd year of medicine. The book has simple explanations, a depth appropriate to pre-clinical students trying to get a grasp of the basics and images that are helpful. This book was essentially my introduction to physiology but wasn’t touched beyond my 2nd year.

There are a few other options to using Marieb as a basis for human physiology study but unfortunately I can’t comment on them in detail as I didn’t find the need to search outside of this text in my first 2 years.

Guyton & Hallguyton
Guyton supercedes Marieb in a lot of ways but also takes a degree of patience to work through. It offers a far greater detail than Marieb does but really requires at least a base level of understanding in order to work through the content. The chapter on renal physiology is essentially nonsense to anyone who hasn’t paid attention to lectures or didn’t quite understand it the first time around – there are still things in the renal chapter that I don’t know what Guyton is trying to explain.

While this textbook essentially becomes your bible of physiology it does a poor job of emphasising the key information and instead presents everything at what appears to be an equivalent level. Thankfully most of the physiology that is crucial to understanding diseases is later covered in more detail in pathology textbooks.

Boron

I have never used Boron and would love some feedback about the textbook in the comments that I can add in here.

Anatomy

Gray’s Anatomygrays
This textbook is used by most as an introduction to anatomy. Most people like it and feel it does its job well – it has good images, the explanations are simple & it covers everything in a reasonable detail.

I personally think this textbook doesn’t add a great deal once you know some anatomy. Despite the fact that it’s considered by many to be the bible for medical students and doctors alike it really doesn’t offer a lot beyond images and a reference text. I feel it is essentially an index of anatomy and even in that sense is vastly inferior to other reference textbooks.

Regardless, as an initial starting textbook for anatomy it does the job of introducing you to musculoskeletal anatomy, organ systems and how they’re organised. My criticisms are that there is almost no incorporation of functional/histological anatomy (i.e. explaining how different sections of the colon have different functions because of their histological features) and very little relevant surgical or clinical anatomy.

Last’s Surgical Anatomy (12e)lasts
This book is quite frankly the bible for surgical anatomy and is endorsed by every surgical college as their textbook of choice (as the 9th edition which is out of print). It covers surgically relevant anatomy in excruciating detail – the anterior abdominal wall alone gets 12 pages. Memorising and understanding anatomy to the level presented in this textbook will carry you through most surgical fellowship examinations and it should be read with that level in mind; this is a textbook that you cannot breeze through, reading it is a struggle & each sentence almost requires you to visualize the anatomical system in question in order to fully figure out what it’s trying to say. The abdomen chapter (~120 pages) took me around 20 hours to read through and understand properly, and several more to be able to accurately recall critical information. Last’s takes this much effort to read because it assumes a great deal of prior knowledge and visualization ability, but it is because of this assumption that it can quickly delve into detailed descriptions that are all written with a surgical context in mind.

Each anatomical structure in the book is essentially broken down into: general explanation + anatomical description relative to nearby organs, blood supply, lymph drainage, nerve supply, important clinical aspects & structure (histology/function).

My main criticisms of this book are that for a surgically oriented anatomy textbook it offers almost no pictures of actual surgical images and that images in the text are often pages away from their reference. There are select x-rays/CT scans etc. scattered throughout the book but there are absolutely no sections that help with orienting yourself during laparoscopy/bronchoscopy/colonoscopy or even during open surgery. I feel that for some people the transition from a neat, colour-coded and clearly labelled artistic rendering of surgical anatomy to real life situations is one of the main struggles in learning surgical anatomy. For that reason I have always complimented this textbook with Rohen’s clinical atlas & youtube videos of specific surgical procedures. I have also found this textbook to be a good adjunct to my radiological anatomy texts which are discussed below.

Colour Atlas of Anatomy: A Photographic Study of the Human Bodyrohen

This is my anatomical image reference text. It comprises anatomical dissection photos that have been meticulously prepared and labelled in a variety of different ways to present relevant information. I have never needed another textbook than this for finding an image of actual human anatomy. It combines physical dissections with diagrams & select CT/MRI/X-ray imaging to constitute what I feel is arguably the best anatomical atlas available.

Pathophysiology

Robbins and Cotran: Pathologic Basis of Diseaserobbins
Robbin’s does a fantastic job of covering the basic pathophysiological processes of disease states, tissue injury & repair, and neoplasms. It is the textbook recommended by most surgical colleges for preparing for the SET exam and carries most people through medical school. The book itself has a great array of histological slides & diagrams that accompany clear, concise explanations of pathological processes.

My criticisms are a little bit unfair of the text – I feel it falls down in areas where our understanding or classification systems are rapidly changing, i.e. certain cancers, auto-immune/immunological disease etc. This is a harsh criticism because the book does a fantastic job of building the foundation for understanding pathology but – as is the way with textbooks – will always be inferior/out of date compared to a recently published & peer-reviewed journal article on a specific topic. I used this textbook extensively throughout my initial pathology learning but now tend to use online resources/peer-reviewed journal articles when I’m chasing information about a specific disease.

Pharmacology

Rang & Dale’s rang-and-dale
Rang and Dale’s is a good introductory textbook to pharmacology and covers the majority of relevant principles in a clear, concise & brief manner. It manages to make pharmacodynamics, pharmacokinetics & drug metabolism easily understandable to someone with no previous pharmacology background which is a feat on its own.

The text runs through the majority of drug classes with an explanation of the physiology that they function through and then how they’re modified with each drug. The place I feel that it falls down is that the drugs it refers to are not Australian based & are not necessarily the ones used in up-to-date clinical practice. If you only studied Rang & Dales before heading to the wards you would end up with a fairly skewed idea of what drugs are really used in clinical practice. In addition to that the textbook doesn’t have a great deal of good summary images/diagrams and relies heavily on textual descriptions which sometimes makes understanding how drugs within the same class act differently harder than it needs to be. I used this textbook in my preclinical pharmacology semester but basically didn’t touch it after that.

To deal with the issue of lacking simple diagrams I used the Rang & Dale Flash Cards. An example of the way the flash cards for cholinergic pharmacology is depicted is below:

flashcard-ach

 

Goodman & Gillman’s (13e)goodman
This textbook is an overwhelming tome of information that makes it the bible for pharmacology in most fields. It is the only textbook I consider worth reading that I have also failed to study from – I can only use it as a reference text, I honestly could not read through the chapters as a learning exercise.

My current pharmacology knowledge has its foundations in this textbook. My method of building this has been to create Anki flashcards on common medications with the information gathered both from Goodman & Gillman’s + MIM’s product information. I review these semi-regularly or whenever I need information about a drug on the wards.

Clinical Examinations

Talley & O’Connortalley
I shouldn’t need to talk much about the value of Talley & O’Connor – it is widely considered the bible of clinical examination and is essential reading all the way upto fellowship examinations in most specialties.

Talley & O’Connor separates each clinical system into History, Examination, Correlation of Signs & Symptoms with Disease, and a summary. In my opinion the text is most valuable for the Correlation chapters which with careful reading allow you actually get an idea of how valuable/how much weight to place on a physical sign or symptom with respect to major disease processes.

One particular issue I will bring up here is that the neurological examination section is poorly presented. As a speciality of medicine that tends to be the one that students and doctors alike struggle with more than others it really deserves a straightforward explanation and a framework that can be referred to when out of your depth – Talley & O’Connor instead approaches this like an encyclopaedia of neurological signs which invariably confuses a first time reader. The reality is that in medical school (and even as a junior doctor!) making a definite neurological diagnosis is not as important as identifying the presence or absence signs and symptoms so that you can effectively communicate the issue. Talley unfortunately does (in my opinion) a poor job of establishing a system for this.

A far better neurological examination & history text is Clinical Neurology: A Primer which is covered in depth below.

Clinical Neurology: A Primer (1e)neurology
Until I read this textbook I was absolutely confounded by the apparent amount of knowledge needed to conduct even a basic neurological exam. Talley & O’Connor had convinced me that if I didn’t know the specific causes of specific cranial nerve abnormalities then my neurological examination was inadequate.

Without a doubt this textbook forms the basis of my neurological examination & history taking on the wards and in the emergency department as a junior doctor. 

This text instead focuses on establishing a system with which your neurological exam will be reproducible, easily interpretable & relatively simple for a non-neurologist. There are absolute ‘eureka!’ moments when the text explains how to reproducibly examine tone in the upper & lower limbs, when it actually explains in detail how to localize lesions within the nervous system, and when neurological history taking is made systematic instead of memorizing a constellation of complaints and their associations.

The examination and history sections are followed by chapters that go into similar systematic approaches to common neurological diseases faced on the wards: cerebrovascular disease, epilepsy & seizures, common arm, leg, back & neck problems, and headaches.

Examination: Medicine (7e) examination-meicine
As part of the Examination: series this textbook is focused on preparing readers for fellowship examinations & as such it goes into a fair bit more depth than is expected as a medical student. It’s written largely by Talley from Talley & O’Connor and presents similar information at a higher level & with the reasoning seen by registrars & consultants on the ward for common medical conditions.

I found this textbook to be a great add-on to reading Talley & O’Connor & it really helped me with developing a long-case assessment system & knowing what questions to ask after I’ve figured out a diagnosis. In preparation for OSCE’s the short cases at the end of the book are incredibly valuable as they represent common OSCE cases which will likely be mirrored a fair bit in your medical school curriculum.

Note: An 8e is available but I have not read it and so this review is based on the 7e.

Surgery

Bailey & Love’s Short Practice of Surgery 26Ebailey
I consider this my reference text for examination, history taking & basic management of surgical conditions. It is an incredibly thorough textbook that tries to cover the entirety of surgical management in every possible field. As a result while it has a lot of useful information it will invariably be out-of-date in terms of management & so should realistically be replaced with more recent literature when making management decisions.

Where this textbook shines is its combination of anatomy with examination & history taking, in covering important differentials & finally in also detailing post-operative & peri-operative complications. There are also descriptions of common surgeries & their methods but these are realistically not done in enough detail to call it a manual of surgery.

If you have the surgical list for the following day and see an operation you aren’t sure about, or realise you are lacking in your understanding of (specific anatomical area, e.g. thyroid) then this textbook is a great place to start.

Examination Surgery (1e)examination-surgery
As with the other books in the Examination: series this is aimed at preparing for fellowship examinations and there are sections in the text that are far beyond expected medical student knowledge (e.g. surgical anatomy is brilliant but not essential). At the same time there are parts of the textbook that I consider absolutely critical reading as I have not found the information better presented elsewhere.

This text excels at establishing organised responses to clinical questions. The answers to common clinical questions and the way clinical cases presented is organised & structured. The entire text is focused around the answers not only being correct but being structured in such a way that they are easy to follow, logical & cover most possibilities. I do not know a better way to present surgical cases than what is outlined in this text!

The key point about this text is that the questions/cases presented are essentially both the common surgical examination cases & common cases that you will see in your rotation through general surgery – the answers to these cases are presented at a fellowship level and so will serve well as a guide all the way through your years as a junior doctor. I found that in theatre the questions that I was ‘grilled’ with were almost directly covered in this text and being able to vomit out an answer at the level of this textbook got me far more praise than I deserved.

To be added: Specialty Specific Recommendations

RADIOLOGY & ULTRASOUND

INFECTIOUS DISEASES

NEURO

RENAL

INTERPRETTING ECG’s

EMERGENCY

PROCEDURAL TEXTS

Exam Preparation Books

Toronto Notes

Examination: Medicine

Examination: Surgery

Textbooks & Resources for Remote Areas

The following is a guide on books while on remote placements without internet access, specifically written in the context of a placement in the Solomon Islands.

My day-to-day time on the wards generally consists of me having constant access to Uptodate/Therapeutic Guidelines/Google to answer questions that I run into. Over the past few weeks while I’ve been in the Solomon Islands this has had to change because internet access is limited to ~3kb/s in specific areas of the village – i.e. the corner of my kitchen or standing on the edge of the wharf.

As a result here are the books and phone apps that I have found to be absolutely invaluable as reference texts while I’m here:

Emergency Medicine Procedures by Reichman 2e
On rural/remote placements where there is only one other Doctor you ARE going to have to do things you haven’t done or seen before. Whether that’s putting in a paediatric intraosseous needle with an 18 gauge cannula (instead of an IO), doing wrist blocks, procedural sedation, joint reductions or anything in the spectrum of trauma/emergency management then this book has it covered with brilliant diagrams and explanations. Supplement it with a good anatomy text (Last’s Anatomy + Rohen’s Colour Atlas of Anatomy) incase you’re a little bit unsure of the anatomy and you can work your way through most things.

WikiEM App & Tintinalli’s Emergency Medicine Manual
When I need quick guidelines on management of conditions that I’ve heard about but have never had to actually write up drugs for this is where I turn. The app covers most of the standard ED presentations in enough detail to get management started or help clinch a diagnosis, and Tintinalli’s extends on that.

Emergency Ultrasound by O. John Ma (2007)
In a setting without many lab investigations being able to actually see pathology on an ultrasound is invaluable. This book takes you through what a basic emergency ultrasound can be expected to assess, how to assess it with anatomical diagrams, ultrasound images and probe placement protocols. I found this book was one of my most used for everything from gallstones, basic assessments of heart failure/LV&RV function/basic valve images, confirming placement of NG tubes, assessing hydronephrosis/kidney stones, diagnosing ectopic pregnancies, differentiating between masses and abscesses (surprisingly difficult without USS sometimes!) etc. None of these things would have been possible without this book and my inexperience was metered by me not trying to exclude anything – i.e. if I couldn’t find it that didn’t mean it wasn’t there, whereas if it was present and both myself and the doctor saw it then we acted on that information.

Pocket Book of Hospital Care for Children by WHO 2e & Royal Childrens Hospital Guidelines App
The RCH app guidelines are available offline and give you a firm basis on how to assess and manage the myriad of paediatric presentations that you invariably have little experience dealing with. Unfortunately, a lot of the time the RCH guidelines call for management based on investigations that aren’t available or medications that similarly don’t exist where you are. The WHO pocket book helps guide decisions in that context and fills some of the gaps that the RCH guidelines have – i.e. having a clear neonatal/paediatric resus algorithm on the second page whereas the RCH guidelines require you to download it every time! Similarly the WHO book deals a lot more with malnutrition than RCH does and since this is likely to be a feature of your rotation it’s important to have a reference guide.

I also brought copies of the Harriet Lane Paeds handbook but didn’t find it to be useful as it is more focused on tertiary care of paediatric conditions.

Infectious Diseases: A clinical approach by Yung, Spleman et al. 3e
This textbook is the Australian bible of infectious diseases, written by Directors of Infectious Disease from hospitals all across the country. Its section on antibiotics regimens is a must-read when your only options antibiotic options are chloramphenicol, cloxacillin, gentamicin, metronidazole, azithromycin and ceftriaxone (in EMERGENCIES). The first three chapters cover what should be your general approach to assessing febrile and infectious patients, while the rest of the book serves as a reference for guiding your management.

Essentials of Obstetrics & Gynaecology by O’Reilly, 2e
Covers everything from standard history and examinations through to managing postpartum haemorrhage, shoulder dystocia, breech delivery, C-Sections, normal births, post-partum assessments etc.

Books I wish I had:
An anaesthetics manual – Miller’s anaesthesia would have been a great addition to have so that the Ketofolol sedations and epidurals/spinals that inevitably crop up had some more basis than “I’ve seen this done a few times”.

A surgical manual – I had Bailey & Love’s Short Practice of Surgery but it does not go into any significant detail about the actual procedures of surgery, i.e. HOW to perform an open appendicectomy etc. In saying that I don’t actually know of a book that would have covered everything I wanted – the majority of our surgeries were trauma or emergent presentations ranging from ruptured appendixes & ectopics through to bowel obstructions and tendon repairs/limb trauma. I think a number of books would be needed here to have covered what I wanted to know – a good ortho textbook and a good trauma book would have been very useful.

An obstetrics manual with ultrasound information – While my Essentials of O&G book covered me for the most part I desperately needed more information. A book with clear images showing how to estimate gestational age, exclude or include placenta previa, estimate fetal weight etc. would have been brilliant at the start of my placement.

Ben is currently working as a junior registrar in Intensive Care.