Rewriting the Book on the Brain

medical-neurobiologyStudents might sometimes think that their textbook appeared out of thin air, the accumulated knowledge of a field spontaneously forming into a heavy slab of facts and figures. But textbooks are like any other type of book, with flesh-and-blood authors who labor over the words within and make a million tiny decisions to shape the final product. If you try to include everything, the book will likely be too heavy for even the most determined or muscular students to carry. Cut too much out, and your definitive textbook might be scorned as incomplete and elementary.

In writing her new textbook, professor of neurobiology Peggy Mason helped find the happy middle by starting with a very specific audience in mind: the medical students that she has spent 15 years teaching at the Pritzker School of Medicine. Her completed product, simply named “Medical Neurobiology,” is the first designed with aspiring physicians in mind, teaching med students about the broad influence of the central nervous system. Picking a specific target audience helped Mason make the hard choices about what to include and what to leave out, she said – even if the final 660 pages is heavier than she intended.

“I think it’s actually the only textbook completely aimed at the medical students,” Mason said. “I did a few things because of that that no other textbook does.”

For starters, Mason chose not to interpret “medical neurobiology” as simply “neurology.” Only a small percentage of medical students will eventually choose to train as neurologists, but the other 97 percent also need to be familiar with the central nervous system, she said. Knowing the anatomy and function of the brain, spinal cord, and nerve pathways can help everyone from future neonatologists measuring infants’ reflexes to future pulmonologists treating asthma to future geriatricians looking for the warning signs of dementia or motor deficits.

Another important decision came to Mason after a dinner with four medical students who gave her insight into the overwhelming workload of an aspiring doctor.

“All of a sudden I just realized that the immensity of the knowledge base that they need to acquire in two years,” Mason said. “It made me think anew about what we were teaching them, and I decided that as entertaining as it may be for us to talk about the newest, greatest research, it’s a disservice to them. They don’t have the time; they need the body of information that they need clinically and not the extraneous stuff. So I tried to cut out as much as I could.”

Mason kept the page count down by restricting the coverage wherever possible to topics of clinical relevance, leaving out popular neuroscience textbook subjects such as the fundamentals of smell and leech swimming (a common model for the neurobiology of locomotion). Instead, she focused on the anatomical regions where patients are most likely to suffer lesions that cause symptoms, and the neurotransmitter imbalances that cause behavioral changes. Pop-out boxes describe the clinical manifestations physicians are likely to see, such as the pupil constriction and droopy eyelid of Horner syndrome, which indicates damage to a specific pathway from the brain to the eye.

But to really help important neurobiology topics take up permanent residence in the minds of medical students, Mason deployed an armory of inventive examples and metaphors to make the text both enjoyable to read and memorable.

Within the first three pages, the book discusses the locked-in syndrome of magazine editor Jean-Dominique Bauby (known best from the book and movie The Diving Bell and the Butterfly) and describes the components of the central nervous system as members of a theatrical production. Those types of plain language descriptions are helpful for both a student’s education and their responsibility later in life to come up with simple explanations for patients, Mason said.

“I think that neurobiology is all around us, I don’t think it’s anything fancy. They just need the knowledge, and I think that there are everyday examples of everything,” Mason said. “I think that metaphors are useful because it’s very important that physicians can explain things to patients, so if I can explain it to them in a way that sticks in their head, they can explain it to their patients.”

Bauby’s case returns in the last chapter as an instructive case study of the more abstract damage that a neurological condition might cause a patient – “the impact of brain dysfunction is particularly poignant when it attacks our essence, who we are to ourselves,” Mason writes. The textbook also closes with a challenge, asking its readers to bring what they have learned about the nervous system to whatever specialty they eventually inhabit. Could a geriatrician find a cure for incontinence by studying the innervation of the bladder? Does the tendency for schizophrenics to smoke suggest a clue to the disease that could change psychiatric practice? Is there a way to apply neuroanatomical knowledge to reverse the epidemic of myopia?

“In the last chapter I tried to give them a challenge – go out there and go do whatever you’re interested in, but think about the role of the brain in whatever it is that you do,” Mason said.

UPDATE – Mason’s book was also selected as one of the British Medical Association’s Highly Commended book on basic and clinical sciences for 2012.

About Rob Mitchum (526 Articles)

Rob Mitchum is communications manager at the Computation Institute, a joint initiative between The University of Chicago and Argonne National Laboratory.

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