Professional Documents
Culture Documents
by Joel Topf and Sarah Faubel
Reviewed by Ogan Gurel
for Little, Brown & Company
14 March 1994
It has been a pleasure to be of service in reviewing The Microbiology Companion. It is
clearly an ambitious work by these two medical students, Joel Topf and Sarah Faubel who, as
they put it: “… processed the class into a logical and convenient format … while [their] peers
were off skittering around the globe.” They are to be commended for their effort. In general,
the book serves a definite purpose and thus should sell quite well. However, I have some
serious practical and philosophical reservations that potentially limit its usefulness.
This review comes in two parts. Based on my experience I will first discuss the nature
of medical school microbiology and how medical students typically study it. In this context,
I will address the book’s strengths and weaknesses, along with the reservations I alluded to.
In the second part of the review, I will try to answer the specific questions that came with
your letter so that my comments may directly meet the concerns of your review committee.
Part One
How is microbiology taught in medical school? The challenge is to cover both the basic
as well as the clinical (infectious disease) aspects of the subject. Towards this end, three
different curricular schemes have been used, incorporating one, two or three separate
courses respectively. These “pathways” are outlined below.
A 1 Microbiology
(both basic & infectious disease)
B 2 Microbiology (basic) Pathophysiology
(infectious disease)
C 3 Microbiology (basic) Pathophysiology
(infectious disease)
Pathology
(infectious disease)
The Columbia course, for example, followed scheme “C” where microbiology was
taught as part of three different courses. Most of the clinicallyoriented material was
presented during the 2ndyear pathology and pathophysiology sequence. In many other
traditional programs, there is a single monolithic microbiology course with a heavy
emphasis on clinical details. The content consists of moreorless random laundry lists of
facts organized along the lines of microbial systematics (e.g. Cocci, DNAcontaining viruses,
etc.). The Microbiology Companion and thus the course at Wayne State appears to follow this
pattern. The book is clearly aimed at clinically oriented microbiology courses and thus
would not be useful to 1st year students or for those in graduatelevel courses.
“Complaining and medical school go together” as Topf and Faubel note in their
preface. Among these complaints, exasperation at the capricious and arbitrary nature of
microbiology leads the list. So how do medical students typically study for this class? A
significant minority do exactly what Topf and Faubel have done. Namely, they
systematically compile voluminous charts of data about each microbe along with its various
biological and clinical properties. The compulsive and laborious preparation of such charts
is nearly as much a part of medical student culture as is dissecting the cadaver. The majority
of students, however, do not have the time, energy or stamina to prepare such tables and
make do with attending lectures and reading the textbook. This “unwilling” majority of
Topf and Faubel’s classmates are those who apparently buy their book.
Therefore, it is in this context that The Microbiology Companion finds a ready market. If
the book is attractively laidout, lowpriced and aggressively marketed, I suspect that a great
many of this “unwilling” majority would purchase the book — even capturing those
students who would have ordinarily prepared such charts on their own.
For the book to be successful some major practical problems need to be resolved. The
book needs more illustrations; at the very least in the form of “flagposts” that facilitate the
organization. For example, a picture of some representative organisms (placed near the
margin perhaps) should accompany each introductory page. Without a regular and
systematic succession of such illustrations, the mass of tables in this book will look just like
those dogeared sheets made by the students themselves. The book contains some diagrams
but most of these are extremely confusing; see for example, page 132 which is reproduced
below. Eliminating some of the detail and cleaning up the computergenerated drawings
should clear up the confusion.
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Review of The Microbiology Companion Ogan Gurel
The most serious weakness is the lack of the “overall picture” which Topf and Faubel
had ironically promised in their preface. To follow their analogy (see page x of their book), I
would say that the “Christmas tree” is missing. The Microbiology Companion is more like a
huge variety of ornaments packed in piles of boxes labeled balls, bells, stars, candles, etc. The
book can be used to find the ornaments but not necessarily to guide us in decorating the
Christmas tree in such a way that is understandable and hence pleasing to the eye.
The missing “bigpicture” leads to my philosophical concerns with the book. Again, it
is important to note that in their preface, Topf and Faubel emphasize giving the reader “a
broad overview so that the details will be learnable [sic].” However, without a coherent
storyline and with the overwhelming crush of random detail this book is impossible to learn
from. This has, indeed, been a general problem in medical education. For example, most
microbiology students do not learn, in any longterm sense, much of the material in this
detailbloated format. The students regard the subject as an onerous hurdle to be quickly
jumped and just as quickly forgotten; the faculty, good intentions and all, recognize that the
little that is remembered comes by accident and at best by “osmosis.” Recent curricular
reform has focused on making medical education more conceptual and integrated,
encouraging the development of criticalthinking and the ability to apply fundamental
concepts to new situations. These goals are rarely served by traditional preclinical medical
school pedagogy.
Two books that are representative of this conceptual, thoughtbased approach are The
Pathogenesis of Infectious Disease by C.A. Mims, published by Academic Press (1987) and
Bacteria, Plasmids, and Phages by E.C.C. Lin, R. Goldstein, and M. Syvanen, published by
Harvard University Press (1984). The first book is slanted towards the clinical side of
microbiology and discusses the general principles and processes of infectious disease. The
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material is closely integrated with immunology because most infectious processes cannot be
understood without understanding what the body is doing in response. The overall table of
contents (reproduced here with details included for chapter 8) gives a sense of the scope of
this book. As you can see, general themes of microbial pathogenesis are described in the
context of a logical progression of concepts.
Chapter 1 General Principles
Chapter 2 Entry of Microorganisms into the Body
Chapter 3 Events Occurring Immediately After the Entry of the Microorganism
Chapter 4 The Encounter of the Microbe with the Phagocytic Cell
Chapter 5 The Spread of Microbes through the Body
Chapter 6 The Immune Response to Infection
Chapter 7 Microbial Strategies in Relation to the Immune Response
Chapter 8 Mechanisms of Cell and Tissue Damage
Infection with no cell or tissue damage
Direct damage by microorganisms
Microbial toxins
Indirect damage via inflammation
Indirect damage via immune response
Other indirect mechanisms of damage
Diarrhea
Chapter 9 Recovery from Infection
Chapter 10 Failure to Eliminate Microbe
Chapter 11 Host and Microbial Factors Influencing Susceptibility
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Review of The Microbiology Companion Ogan Gurel
The second book, Bacteria, Plasmids, and Phages is a published version of the basic
microbiology syllabus at Harvard Medical School. Again, the emphasis is on fundamental
concepts and on an understanding of how things work rather than what they are. The
questions at the end of the chapter supplement this approach and are designed to provoke
thought rather than quiz rote memorization. It is interesting to consider that this book is a
product of the old Harvard Medical School curriculum; its success, nevertheless, served as a
strong stimulus and example to the reforms that are now more widespread in the HMS
curriculum and indeed around the nation.
These reform efforts have also been extended to standardized medical examinations.
From the MCAT all the way through to the USMLE National Boards these exams are
becoming significantly more conceptual and integrated. All this is reflective of a cultural
shift in our society in grappling with the explosion in medical knowledge and knowledge in
general. In response, new technologies as well as changes in educational philosophy are
being developed to meet these challenges. Concepts are in; facts are out. Thinking is in;
memorizing is out. The form of medical education represented by The Microbiology
Companion is quickly going out of style.
In the longterm, then, I believe that this book will become an anachronism. At the
same time, there will be an increased demand for a new generation of conceptbased,
integrated and interactive books that address the formidable information challenges of
modern medicine.
What are some of these new approaches to assimilating and presenting knowledge?
First, is the emphasis on concepts. It is the concepts that we commit to longterm knowledge
and it is concepts that are applied to the varied and complicated situations faced in real
practice. Second, is the importance of integrating knowledge. Cognitive studies have shown
that it is easier to remember knowledge that is integrated (interrelated to use another word)
as compared to remembering independent, random bits of knowledge. To memorize
random knowledge requires a linear increase in memory “units” — brain cells, if you will;
memorizing integrated knowledge demands only a logarithmic increase in memory “units.”
In short, those who remember integratively retain more. These relationships are depicted in
the graph below.
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Third, is a shift in our view from what is being to what is becoming. Back in the 19th
century the challenge of microbiology was in classifying what there was. “Here we have a
round bacteria, call it a member of the cocci; here’s a spirallooking bacteria, call it a
spirochete.” Now, our whole perspective on microorganisms is completely different. We
know more that just the existence of things and phenomena; we also understand to some
degree the processes underlying the biology. Likewise, we should teach how things become,
rather than simply what they are — not only as a more effective way to learn but also as a
stimulus to the development of critical thinking.
Fourth, is the importance of interactive learning. Much of the excitement and challenge
behind multimedia technologies is the promise and possibility of implementing this
interactivity. The use of interactive technology — the modern correlate of the Socratic
method — will facilitate active, rather than passive, learning on a largescale basis. Finally,
there is a heightened appreciation of the effectiveness of visual learning. The proverb — “A
picture is worth a thousand words,” is even more true today. There will be a continued and
increasing demand for meaningful illustration in the textbooks and multimedia packages of
the future.
In summary, then, The Microbiology Companion stands a good chance of meeting the
needs of the present market and with some of these practical suggestions it should sell well.
The book is limited, however, in that it runs the risk of eventually becoming obsolete —
joining, as it were, other dinosaurs of medical education.
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Review of The Microbiology Companion Ogan Gurel
Part Two
The following are answers to the specific questions you suggested would be helpful in
your evaluation. Some of these issues have been addressed in the above discussion and have
been replicated below. Your questions are in red; my answers are in blue.
I. MARKET
1. What is your assessment of the market potential? Please be as specific as possible
about:
A. Courses to which this book would apply
The traditional microbiology course has usually involved a single monolithic
microbiology course, with a heavy emphasis on clinical details. The content
consists of moreorless random laundry lists of facts superficially organized
along the lines of microbial systematics (e.g. Cocci, DNAcontaining viruses,
etc.). The Microbiology Companion and thus the course at Wayne State appears
to follow this pattern. The book would be much less applicable to
microbiology courses that have a more basic science emphasis such as 1styear
medical courses or graduatelevel courses.
B. Who would buy it
A significant minority of microbiology medical students systematically
compile voluminous charts of data about each microorganism along with
their various biological and clinical properties. One could say that the
laborious preparation of such charts is as much a part of medical student
culture as is dissecting the cadaver. The majority of students, however, do not
have the time, energy or stamina to prepare such tables and make do with
attending lectures and reading the textbook. This “unwilling” majority of
Topf and Faubel’s classmates are those who apparently buy their book.
Therefore, it is in this context that The Microbiology Companion finds a ready
market. If the book is attractively laidout, lowpriced and aggressively
marketed, I suspect that a great many of this “unwilling” majority would
purchase the book. The book could even capture those students who would
have ordinarily prepared such charts as they may surely prefer to save their
time for other things. It should be emphasized that demand for the book will
come from the students themselves rather than from the explicit course
requirement.
C. Applicability to what level and type of program
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The book is applicable to traditional, detailladen clinicallyoriented medical
school microbiology courses. The book would not apply to less clinically
oriented courses such as firstyear medical school microbiology or graduate
level courses.
D. Application to continuing education and practicing health professionals
Virtually none.
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Review of The Microbiology Companion Ogan Gurel
2. Do you feel there is a definite need for a book such as the one proposed? Please
substantiate your opinion. Will this book fill such a need? Why or why not?
There is a need for this book in the context of the traditional medical
microbiology course. With some improvements, the book should fill that
need quite well. However, if current trends in medical education reform
continue, this need may quickly evaporate.
II. COMPETITION
1. What book(s) are you currently using to teach the topic covered in this manuscript?
There are, of course the standard, heavyduty microbiology textbooks which
contain much of the detail covered in The Microbiology Companion. In an ideal
sense, I would prefer to use more conceptually oriented books as
“companions” to the microbiology course. Two books that are representative
of this conceptual, thoughtbased approach are The Pathogenesis of Infectious
Disease by C.A. Mims and published by Academic Press (1987) and Bacteria,
Plasmids, and Phages by E.C.C. Lin, R. Goldstein, and M. Syvanen, published
by Harvard University Press (1984). The first book is slanted towards the
clinical side of microbiology and discusses the general principles and
processes of infectious disease. The material is closely integrated with
immunology because most infectious processes cannot be understood without
understanding what the body is doing in response.
The second book is taken from the Harvard Medical School’s basic science
microbiology syllabus. Again, the emphasis is on basic concepts and on an
understanding of how things work rather than what they are. The chapter
end questions are designed to provoke thought rather than test brute
memorization. It is interesting to note that this book came out of the old
Harvard Medical School curriculum; its success served as a strong stimulus
and example to the reforms that are now more widespread in the HMS
curriculum and indeed all around the nation.
2. What are the key strengths of this material
It meets a defined need, namely the desire of medical students for a concise
presentation of facts in chart form. Along these lines, it is organized in
traditional format and relatively comprehensive. I think the crossreference
tables near the back of the book have potential, but they too are over
burdened with the same excessive depth of random detail.
3. What are the key weaknesses?
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For the book to be successfully marketed some major practical problems need
to be resolved. The book needs more illustrations; at the very least in the form
of “flagposts” that facilitate the organization. For example, a picture of some
representative organisms (placed near the margin perhaps) should
accompany each introductory page. Without a regular and systematic
succession of such illustrations, the mass of tables in this book will look just
like those dogeared sheets made by the students themselves. For those
diagrams that are in the book, most are extremely confusing; see for example,
page 132. Eliminating some of the detail and cleaning up the computer
generated drawings should clear up the confusion.
The most serious weakness is the lack of an “overall picture” which Topf and
Faubel had promised in the preface. To follow their analogy (see page x), I
would say ironically that there is no “Christmas tree” in this book. Rather The
Microbiology Companion is more like a huge variety of ornaments packed in
piles of boxes labeled “balls,” “bells,” “stars,” “candles,” etc. Using this book,
we can find the ornaments but we aren’t guided in decorating the Christmas
tree in such a way that is understandable and thus pleasing to the eye.
4. What have you chosen the text(s) you are using? (Please discuss considerations such
as content, size, depth of presentation, price, etc.)
Again, I chose the Mims as well as the Harvard book because I wanted to
learn things on a fundamental, conceptual level. During medical school, I
might have also bought The Microbiology Companion although it would not
have been with pleasure but rather because I was compelled by the demands
of the course.
5. What advantages, if any, would the proposed project have over the competition?
I am not aware of any direct competition.
III. CONTENT
1. What elements do you feel are essential in a text such as the one proposed here?
Clear and attractive layout of charts. Completeness.
2. Based on the information provided herein, how does this proposed book compare to
the competition?
There is really no competition that I am aware of.
3. Please discuss the following areas:
A. Accuracy of content
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Review of The Microbiology Companion Ogan Gurel
Appears to be accurate; all of the material has been pulled from course syllabi
or standard microbiology texts. Some typos are scattered about: “The disease
often relapses months later and may take a chronic coarse [sic] of years.”
B. Depth and scope of coverage (should any areas be deleted? added?)
I would suggest massively cutting out much of the detail. However, the book
would then no longer serve its purpose.
D. Writing style clear? logical? concise?
Essentially there is no writing style to comment on. Apart from the preface
and some introductory passages, the grammar consists of sort, “soundbite”
like phrases. The individual phrases themselves are generally clear and
concise although the listing of facts in each chart cell is nearly completely
random. Medical education has often been likened to drinking from a fire
hose; with this book, I would say it’s more like catching bullets from a
machine gun. This is not a book that can be easily read. Here’s a typical cell:
E. Pedagogical devices?
The book makes extensive use of charts which closely the ones that some
medical students typically prepare for themselves. This is the book’s
strongest selling point.
F. Illustrative aids (if applicable)
More illustrations (even simple ones) would benefit the book greatly. Most of
the diagrams that are included are quite confusing and need to be cleared up
to be more effective.
4. Do you have any additional ideas and suggestions that may assist the author in
developing this project?
In addition to the points mentioned above, I would urge the author to make
individual chart entries more logical and systematic rather than a mere listing
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of facts culled from other sources. A renewed commitment to providing an
“overall picture” would also help although it is unclear how this would fit in a
book whose primary purpose is to convey facts.
5. Based on the information provided, would you require this book for your students’
use? Recommend it? Why or why not?
I would not recommend or require this book for a microbiology course. My
own courses and review sessions strongly emphasize conceptual
understanding. Any facts to be memorized, per se would be within the
context of these concepts rather than in the traditional format that is
presented in The Microbiology Companion.
6. In your opinion, should Little, Brown pursue publication of this project? Why or why
not?
From what I understand of Little, Brown’s book portfolio, I do not see a major place for The
Microbiology Companion. Your company seem to focus on two major areas: highend,
physicianoriented texts in specialized areas along with student/residentoriented
handbooks and manuals. This book does not fit neatly in either of these categories. One
could propose a Companion series devoted to chartlike compendiums of medical school
minutia. However, this doesn’t seem to be your company’s style; moreover, as I have argued,
the longterm demand for detailoriented learning material is limited. Of course, the book
can always be published as an isolated offering in your portfolio with shortterm revenue
generating potential.
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