David L. Felten, M.D., Ph.D., UMHS Associate Dean of Clinical Sciences and Professor of Neurosciences, has written and published, along with his wife and colleague Mary Summo Maida, Ph.D., Netter’s Neuroscience Coloring Book. Dr. Felten recently spoke to the UMHS Endeavour about working on the book.
The UMHS Endeavour talked to Dr. Felten about the inspiration for the book; how med students can benefit from using a “coloring book” about neuroscience; advice for using the clinical notes, what people learning about the nervous system for the first time can expect, and some common study challenges. In addition, Dr. Felten explained why the book is reasonably priced. Finally, he discussed what it was like working with his wife and colleague, Mary Summo Maida, Ph.D., and why work on the Netter projects has been so rewarding.
Editors at Elsevier first approached Dr. Felten about doing a neuroscience coloring book. “They had experienced outstanding success with John Hansen’s Netter’s Anatomy Coloring Book, with accolades and positive feedback from students,” he said.
Although Dr. Felten was not enthusiastic about the idea at first, with the help of the editors, he realized such a book could be “a wonderful tool for students for more hands-on learning,” and it “also gave me an opportunity to produce tight summaries for neuroscience topics from Netter’s Atlas of Neurosciences, 3rd Edition, without sacrificing either the organization (overview, regional neurosciences, systemic neurosciences) or the scientific and clinical accuracy.”
Dr. Felten noted that the book is well organized, using the same framework as Netter’s Atlas of Neuroscience, 3rd Edition.
“It is based on an overview, regional neurosciences, and systemic neurosciences,” he said. “Second, we selected 139 illustrations or collections of plates, and the superb Elsevier artists converted them to black and white to facilitate coloring. Third, our written information was kept very succinct, and was divided into three components: (1) what is the structure(s) and what does it do; (2) recommendations for approximately 12 structures that we think are important, selected for coloring; (3) a clinical note that discussed the clinical applications of knowledge gained from the basic anatomy and physiology related to the illustration(s). Fourth, we provided as scholarly a discussion as possible without delving into minutia or obscure points. And fifth, we tried to keep the topics interesting and related to clinical applications of basic neurosciences. To our thinking, there is a conspicuous tie-in between basic neurosciences and clinical usefulness for diagnosing and treating patients.”
Helpful Clinical Notes
Netter’s Neuroscience Coloring Book also has helpful clinical notes.
“There are two useful aspects that were intended as we wrote the clinical notes,” Dr. Felten said. “First and foremost is the answer to the question ‘so why should we focus on learning the anatomy and physiology related to these neurosciences illustrations, when there is a mountain of information across all medical sciences disciplines competing for medical students’ attention?’ If a student can see a clear application of the neurosciences information related to a patient diagnosis, problem, or treatment, it is quite a compelling reason to look closely at it. And a second benefit is that we tried to cover a majority of neurosciences topics that will show up in the form of questions and/or cases on the USMLEs.”
Why a coloring book? Dr. Felten explained that coloring key structures offers a hands-on way to “look more closely at structures that we thought were important to understanding the illustration(s) at hand. Or, as Mary Maida stated, ‘Who doesn’t like to color?’”
Although the coloring book was initially intended for medical students and health-care professionals with some experience with medical sciences or patient care, Dr. Felten said the book could be beneficial for users experiencing an introduction to the nervous system.
“The Elsevier editors told us that John Hansen’s Netter’s Anatomy Coloring Book was being purchased by advanced high school students, college biology/premed students, and many other students, as well as lay audiences that wanted to learn about how the human body works,” Dr. Felten said. “For the truly first-time user, the terminology may be a bit daunting, but we tried to define many terms; and with the availability of medical definitions on the Internet, a first-time user can get some insight without having to delve into a medical school library. It is our hope that the first-time user will see the beauty and marvelous intricacies of the nervous system, and see that a basic outline and organization is helpful to appreciating this last great frontier of science.”
Learning neurosciences presents numerous common challenges for medical students, but understanding the information is not impossible.
“Perhaps the greatest initial challenge for anyone learning the breadth (and hopefully the depth) of neurosciences is the overwhelming terminology and the sheer number of structures, pathways, cell groups, interconnections, and physiological functioning of hundreds if not thousands of components,” Dr. Felten said.
Memorizing everything can be overwhelming, but fortunately the book is well organized and features succinct summaries.
“We have organized Netter’s Neuroscience Coloring Book, 1st Edition, Netter’s Atlas of Neuroscience, 3rd Edition, and Netter’s Neuroscience Flash Cards, 3rd Edition, according to an organization that includes an Overview, Regional Neurosciences (peripheral nervous system, spinal cord, brain stem, and forebrain), and Systemic Neuroscience (sensory systems, motor systems, limbic-hypothalamic-autonomic systems, including higher cortical functions),” Dr. Felten said. With this organization, there are structural and functional summaries to hang your hat on, not just isolated structures. We try to provide a framework for ‘what do you find in a peripheral nervous system, a spinal cord, a brain stem, and a forebrain,’ organized by functional categories that follow the outline of how one carries out a neurological exam, which is by systems. We also believe that if a student sees the organizational framework for illustrations, and then colors in key structures, and reviews the clinical importance of them, it will solidify their knowledge and understanding.”
Using Workbook Review Questions
The book also contains workbook review questions to help reinforce comprehension and retention for medical students.
“We were asked to produce questions that involved illustrations, fill-ins, and multiple choice responses, mainly as a tool to help the reader see if they picked up some of the key points,” Dr. Felten said. “Questions also can give students an idea of the type of questions they might encounter on exams. For many years, I wrote questions for item-writing committees at the National Board of Medical Examiners, intended and tested for use on U.S. Medical Licensure Exams, so producing questions, sometimes hundreds of them, is a good exercise for the authors as well, as it keeps us focused on what is important for students to know.”
The book is an affordable $19.95, a price that is almost unheard of for any type of medical textbook. Dr. Felten said editors and authors had many discussions about pricing of the Netter neuroscience products. Netter’s Atlas of Neuroscience, 3rd Edition is also reasonably priced at approximately under $60.
“Elsevier arranged the pricing based on getting students to feel comfortable affording a neurosciences text that can provide amazing amounts of organized information, with hands-on opportunities, for a cost that would not break a piggy bank,” Dr. Felten said. “[Co-author] Mary and I do not get royalties for numbers of books sold; we want to see this book used and enjoyed. We hope a few of our readers will come to appreciate the beauty of the nervous system and its organization as much as we do.”
Artists & Illustrators
Much of the book is visual, and Dr. Felten was fortunate to work with a great team of artists and illustrators.
“The original artists for many of the illustrations is the incomparable Frank Netter, M.D.,” Dr. Felten said. “He was able to bring to life illustrations of the human body in general, and the nervous system in specific. He passed away several decades ago, and no one wanted to see his beautiful illustrations, recognized by medical doctors and other practitioners around the world, lost to posterity. So selected authors and writers were asked to work on new editions using the Netter illustrations.”
“For the Netter’s Atlas of Neuroscience, I totally rewrote all of the figure legends, went over all of the labeled structures and leader lines, and created a host of clinical note and discussions, as well as organizational points. It was clear that we needed to add many more plates.”
Dr. Felten explained that Elsevier has in-house artists, including John Craig. Dr. Craig created “axial and coronal sections through the brain, and cross sectional illustrations through the brain stem.”
“We added well over 100 new illustrations, often incorporating sophisticated molecular and cellular neurosciences information, with the help of a skilled and highly knowledgeable artist, James A. Perkins, a Professor of Medical Illustrations at Rochester Institute of Technology. He also helped us to start with a basic template from Netter’s illustrations, and add new pathways and information that was not known at the time Dr. Netter created the original illustrations. For the black and white images used for this coloring book, Rob Duckwell converted the color images to crisp black and white images suitable for coloring. The authors have been privileged to work with highly talented artists and editors throughout our activities on Netter products for Elsevier.”
Working with Wife & Colleague, Mary Summo Maida, Ph.D.
Dr. Felten also had many good things to say about working with his wife and colleague, Mary Summo Maida, Ph.D. Her editing skills and background were particularly useful.
“She has a background in molecular neurosciences (Ph.D.), a broad knowledge of basic neurosciences, an understanding of clinical applications, a business background with teaching experience in medical entrepreneurship, successful biotech leadership as the CEO of a biotech company, as well as many other talents,” he said. “We would often discuss the organizational points as well as details of what I was trying to do with the atlas, flash cards, and then the coloring book. She was an author on the atlas, and helped to provide valuable insights and contributions for the coloring book. I sometimes want to write a more comprehensive discussion on the sections for an illustration on what is it and what does it do, and what is the clinical implication. Mary would sometimes read over something I wrote and say, ‘Great discussion, but probably only a half a dozen of your neurosciences colleagues will understand what you just wrote.’ She would then have the knack of editing, making additions, achieving deletions of confusing components, and getting the descriptions to read in a far more understandable fashion. So the coloring book turned out to be a true collaboration. I wrote what I wanted to express, and Mary made sure that it was understandable, and added a lot from a potential reader’s point of view.”
‘One of the Most Rewarding Experiences’
Dr. Felten said working on the various Netter projects has been one of the most rewarding experiences of his life.
“I never cease to marvel at the beauty and complexity of the nervous system, and am grateful for the privilege of spending more than 50 years benefiting from the teaching excellence and research advances of a half a century of dedicated instructors, investigators, and clinicians,” he said. “ And I continue to be appreciative of the wonderful editors at Elsevier who let me express my organizational understanding and basic/clinical integration for the benefit of our students. Trying to put one’s total knowledge together for an integrative picture of the nervous system is an endless task that will still be ongoing 500 years from now.”
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