Book club

Kumar and Clark's Clinical Medicine¹ is one of the leading textbooks on internal medicine at the undergraduate level. Parveen Kumar, a consultant gastroenterologist and professor of clinical medical education, is one of the minds behind the genesis of the book. Joseph Ward catches up with her

How did the idea for Kumar and Clark begin?

I had been asked to write a chapter on gastroenterology for another textbook of medicine. In fact, I'd always wanted to write a textbook as the ones that I had grown up with were so awful. In a conversation with Dr Clark, he suggested that if I wanted to write a textbook, “why don't we do it ourselves?” Naively, I thought it would take us the summer, or two months, to write the book. It took us two and a half years, and was very hard work. We wrote and rewrote every evening, and on holiday with our respective families. Of course we didn't just edit it but checked up some of the original references for each chapter (as we were not experts) and then rewrote some of them to make all the chapters consistent. Our authors were terrific. I think this book changed the style of medical publishing as it makes learning more fun, using colour and diagrams.

The beauty of the textbook is that with each edition we go back to the basics and look at the recent literature to check what is new, and then we thoroughly update the book. Every time we start a new edition we re-read the chapters, work out what we want to change and include, and then ask our authors. It is very much a combined effort. Students have no idea. It takes up a huge amount of time as each edition takes three to four years, and between each publication we only get about six months off.

What frustrates you?

The gradual loss of the core values from the NHS. I hope we never lose our caring role, and just number crunch. We need to ensure absolutely that health care is always free at the point of need; I feel we may be losing this as well as our caring role, and I would hate to see them go. I am also frustrated by the fact that sometimes I seem to be unable to do the things that I want to do, but I suppose that's just life.

What excites and encourages you?

Students. I love teaching students; they are great fun. I learn so much from the students on my firm, and I only hope they learn as much from me.

What would you tell future students?

Cement your knowledge. By this I mean, if you go to a lecture or a problem based learning session, you can write down everything there, or none of it, but the only way really to remember information is to go back over it as much as possible. I always tell my students to do this for 15 minutes every day—I call it, Parveen's quarter of an hour—go over the day's learning points. I really think that if students do this regularly over their three years of clinical studies, they really shouldn't have much trouble at all with the examinations.

As a teacher, what would your perfect medical degree include?

If I had to create a perfect medical degree, I would have the first two to three years of integrated basic sciences, like the Americans, where you have to have a degree before entering a medical course. You would learn methodology, critical analysis, and how to read a paper as well as how to write one so that in the future you would understand how to learn and critically appraise data. Students should then do the clinical course, followed by the penultimate year of medical school, where students would return to integrated science before doing another year of clinical. If students did some science and research as undergraduates then they would be more likely to carry out research in the future. I always encourage my students to do an intercalated Bachelor of Science; I did one myself.

Overall, in the United Kingdom I would extend the medical degree to six years. I really believe that science is very important within the medical curriculum. The softer skills are also very important, but if you are a young senior house officer faced at 2 am with a very ill patient, who has a really complicated set of blood gases, unless you have the scientific basics, how do you recognise what is going on? At the beginning of medical degrees we are becoming too touchy feely, to the detriment of science—communication skills are extremely important but so is science.

How would you redesign the body?

Oh come on, what kind of a question is that? If I had to redesign the small bowel, I would make it shorter and more efficient. It takes up so much space.

Why did you choose gastroenterology?

There is so much variety in gastroenterology. You have so many organs, for example—the stomach, small bowel, pancreas, colon, liver, and gallbladder. There is biochemistry as well as electricity and motility. It's all there, which is great for me because I get bored easily. At the beginning of my career, however, I chose gastroenterology because a new gastroenterologist (Anthony Dawson) had come to Barts, and I thought that is what I want to be. I have never completely fully appreciated how important role models can be.

Did you always want to be a doctor?

Yes, from about the age of 12 I knew that I wanted to be a doctor. My mother inspired me. Although she wasn't a doctor, she was always a very independent person. I became a doctor because of the way that medicine could combine caring with science. What else could you want? It's great.

Joseph Ward, second year medical student, University of Birmingham
Email: josephward@btopenworld.com

Competing interests: None declared.

1. Kumar PJ, Clark MC, editors. Kumar and Clark's clinical medicine. London: Saunders, 2002.