When talking to rotating medical students and residents in emergency medicine (my specialty), one of the most common sources of angst and anxiety is: “There’s so much that I need to know, how do I learn everything?!” Particularly in a field like emergency medicine, where a patient could come in with a chief complaint that has never been uttered by anyone else in the history of the world, involving any known organ system, it’s daunting to consider that somehow, at the end of a mere three years, you’ll know how to work up that chief complaint and treat that person.
When I ask most medical students and residents how they study these days, I tend to hear the same cluster of answers – a mix of online resources for topic-focused review, commercial question banks that they can do during downtime, and podcasts for when they’re commuting or exercising. This style of learning has been mainstream for approximately the past decade across the hundreds of learners I’ve interacted with. And it’s generally working! Learners are learning, students are getting better and performing at higher levels than ever before, and there are more options out there for medical students and residents to find resources that meet their needs. It’s hard to argue against the results. But what about the humble textbook? I’ve heard residents despairingly call them “expensive doorstops,” but could this be true?
Even when I started medical school in 2007, in the pre-clinical years we were given printed course notes from the professor and were told to buy various “high yield” review books for specific topics. But rarely did the course syllabus tell us to buy a traditional textbook. During the clinical years of medical school the syllabuses and professors would mention that a given textbook might provide the “gold standard” reference for a particular topic, but rarely were we told to read them. Fast forward to residency, and again it’s rare to find a resident who learns primarily from a legacy, authoritative textbook (such as Tintinalli’s or Rosen’s in emergency medicine).
I understand that times change, didactic theories change, and the current suite of educational opportunities available to medical students and residents helps them learn more (and probably end up more satisfied with their learning) than ever before. All that being said, with the risk of showing my gray hairs and old-timey values, I don’t believe textbooks should be abandoned entirely.
There’s a lot of good information that is not “high yield”! No one would say that reading a Wikipedia summary of the “Great Gatsby” is as illuminating as reading the real thing. While reading a quick blog post or listening to a podcast can provide the “high yield” parts of the topic, nothing can replace the slow and deliberately “low yield” work of reading a comprehensive text. While a total novice may want “just the highlights”, academic progression – which most medical students and residents admirably aspire to – requires a deeper understanding of all facets and parts of a topic, like mortar between bricks to make a house. Smaller and supporting details matter more the more you learn. Understanding and appreciating nuance is a hallmark of expertise.
Popular blogs and podcasts and review sites are often biased in their content coverage. Lots of popular blogs, podcasts, and quick review websites gain notoriety, clout, and often revenue, from attracting fresh eyes, new readers, and holding on to people’s attention. Not to say that the content creators lack good intentions or that they don’t create great products; they do, and I’ve learned much from them over the years myself. But because of the need for novelty and attention, “shiny and fun” topics are overrepresented on these platforms, while mundane and more difficult topics (which are less attention-grabbing) can be ignored. I’ve consumed dozens, if not hundreds, of articles and podcasts on the slickest way to intubate someone in asthma, but I haven’t seen that much out there about antibiotic resistance, chronic abdominal pain, or ankle sprains – topics which, despite being “boring,” are very common and arguably more relevant to modern practice. Review websites and podcasts, for all their other uses, were never designed for a comprehensive education, and so we shouldn’t be surprised that they don’t provide one. For all the faults and problems with textbooks, they at least represent one deliberate attempt to think of and record all of the things that are important to know.
It’s a perennial topic for educators to question the next generation with a “what are these youngsters thinking?” sense of authority. And the younger generation constantly wants to fight against their out-of-date elders. But hey, there’s a reason why high school English teachers still have kids read the Great Gatsby in full and not just watch the movie or skim the SparkNotes version. Medical educators and learners would be wise to do the same, and to choose the right times to go “old school” and read a few chapters that didn’t make it into high-yield reviews or featured podcast episodes.