Linda Costanzo, Ph.D., and her trio of books inspire decades of students across the globe

The year was 1995. A flurry of technological advances hit the scene: Windows 95, the Palm Pilot, Internet Explorer and a few fledgling endeavors that would later all become behemoths:  Match.com, Craigslist, eBay and, yes, even Amazon.

This same year a book debuted that would withstand and even flourish in the changing times.

Physiology’s Linda Costanzo, Ph.D., published “Board Review Series Physiology”, the start of a legacy that would include seven more editions, two additional physiology textbooks, more than 1 million books in print, 13 language translations, inspiration for medical school musical parodies and the gratitude of countless medical students testifying to their impact.

In June 2022, “BRS Physiology” marked a milestone with the release of its eighth edition.

According to Elizabeth Nieginski, the book’s original editor, the majority of publications never see a revision — let alone eight editions. Nieginski, a publisher in the health sciences since 1981, calls “BRS Physiology” her favorite publishing project of all time.

And to think her partnership with Costanzo came about by chance.

Not the first pick, but the right pick

A different author was responsible for writing “BRS Physiology” when Nieginski tapped Costanzo to review the manuscript. Nieginski, now vice president/publisher at Springer Publishing, was immediately impressed with her input. When the original author left, Costanzo was the obvious replacement author.

“Linda is the perfect author,” Nieginski says. “A publication is great if it fulfills its mission. For Linda, that was taking really complex material that medical students needed to learn and simplifying it. The sales, accolades, awards and multiple editions are all a testament to the book realizing its mission. And for a first-time author’s book to catapult to the top of the charts – and stay there ever since – is amazing. About 1 to 2% of professional health care publications fall into that category.”

For Costanzo, a longtime professor in the VCU Department of Physiology and Biophysics, the book’s true testament to success lies with the students who use it. “Because physiology is the normal function of the body, it underpins all of medicine. I’m delighted to know that I’ve reached students in the way that I intended.”

Longtime physiology professor and author Linda Costanzo, Ph.D. Says one former colleague, "When a student is struggling in physiology, it's usually because they aren't using her books."

To students, for students

Known for using props like rubber bands to teach lung elasticity, Costanzo approached writing in the same way: stripping down concepts systematically, logically and in steps. She says she always kept in mind that her books were written to students, for students.

After “BRS Physiology” published, Costanzo heard that students were using it as a textbook, not as the review it was meant to be. This gave her the idea for writing a didactic, student-friendly textbook, “Costanzo Physiology” (Seventh Edition, November 2021). Then on a beach vacation, she imagined a book that would present fictitious cases and questions for students to consider. This became “Physiology Cases and Problems” (Fourth Edition, 2012).

“Being in the classroom and staying connected to students, hearing their questions and knowing what concepts they found difficult, were helpful in my writing,” says Costanzo, who says each new edition takes two years to update.

Take the story of Alexandra Racanelli, MD-PHD’11, now an instructor in medicine at Weill Cornell Medical College.

As a second-year medical student on the MCV Campus, Racanelli remembers being in Costanzo’s office when she was working on a new edition of “Costanzo Physiology.” Costanzo asked her if shading the loop of Henle gradient would add clarity to a diagram that explains how urine is concentrated. “I was speechless and shocked that she would ask, but realized she really wanted my opinion,” Racanelli says. “As always, she was seeking to better her approach, the message and the process for the student. Her books are tangible reflections of her devotion to her work – impeccable, reliable and crystal clear.”

A former colleague of Costanzo’s at VCU, Dean Parmelee, M.D., is now emeritus professor of medical education, psychiatry and pediatrics at Wright State University. After joining Wright State, he recommended Costanzo’s books, and now they are required texts.

His recommendations didn’t stop there.

Parmelee has traveled to the United Arab Emirates to conduct medical school accreditation visits and was instrumental in founding the first medical school in Saudi Arabia. Wherever he goes, Parmelee says he recommends Costanzo’s books.

“There is no other textbook of physiology that sticks to the principles and asks questions to make students think. When a student is struggling in physiology, it’s usually because they aren’t using her books,” Parmelee says. “Costanzo’s books are clear and convincing. She doesn’t go off track. Her skillset is extraordinary, and you usually don’t find that in textbooks.”

However, Costanzo is quick to point out that her books may not be for everyone.

“When your book is published, it’s out there to be scrutinized. My books aren’t for everyone,” says Costanzo, who has stacks of letters from students thanking her and a few from those who are more critical. “Some wish they included more research, while others wish they were even simpler. I have great respect for the larger physiology texts with a different mission. That’s not what mine are intended to do, and I’m comfortable in that.”

‘Physiology goddess’

A longstanding tradition among medical students is creating musical parodies and skits to let off steam and celebrate the days leading up to graduation. Known as Take Offs on the MCV Campus, students across the country have their own versions — that have frequently featured Costanzo and her books. Some groups even took road trips to Richmond for Costanzo to make cameo appearances in their videos.

On one such occasion, three Yale School of Medicine students drove to Richmond, filming and documenting landmarks along the way to prove the video’s authenticity to their classmates. Their skit portrayed a Yale student so hopeless in physiology that his classmates brought him to Costanzo, their textbook author, to see if she could teach him. The Yale students came to Costanzo’s M1 class, sat with the MCV Campus students and filmed her teaching the fledgling student. Everyone was in on the fun.

“I always knew I’d love teaching,” says Costanzo, who’s taught at the School of Medicine for more than 40 years. “My post doc mentor at Cornell thought I should only do research. He didn’t initially approve of me teaching or especially of writing the books. But after they were published, he reached out to say how proud he was of the books’ impact on future doctors. That meant a lot and reinforced that you have to follow your own path.”

All it takes is a few scrolls through Amazon reviews, medical student forums and websites, searching for the “best physiology books” to begin to understand the impact of Costanzo and her work. In fact, one reviewer named her the “physiology goddess.”

“Dr. Costanzo's books are like an old friend,” says fourth-year medical student Rhea Sharma. “When you feel lost and need advice, you go to a reliable, trusted friend. That's how Dr. Costanzo’s books feel.

“It makes me incredibly proud to be a student at VCU School of Medicine. I know students at other medical schools across the country who use Dr. Costanzo’s books, and they often say, ‘THE Dr. Costanzo is one of your professors? I’m so jealous!’ I swell with pride and gratitude knowing that we’re fortunate to have such a strong leader in physiology right on our campus, paving the way for so many students.”

Alumna Racanelli agrees.

“Learning physiology from Dr. Costanzo is one of my most cherished and proud memories from my time at VCU. It was too good to be true. She sets the standard of quality education at VCU. Generations of VCU medical students have learned physiology under her guidance and this is a strength that VCU has over every other medical school in the country.”