The Textbook is Dead

29 Jul




So this is some more ICEM 2012 gold, again, from the trainees session. The same session that the Greg Henry talk was recorded at.

On the “for” side is Mike Cadogan – author on Life in the Fast Lane and ironically a number of great textbooks.

On the “against” side is Paul Dhillon, an EP/FP and author of a couple of novels (how many EPs can say that).

It’s well worth a watch and it’s certainly entertaining. As a quick disclaimer, this is done for fun and with tongue firmly in cheek and the views expressed are not necessarily those of the two speakers.

The whiskey concerned is Yellow Spot and is a fine little Irish number that can be found here. [Of note I have no ties with any whiskey companies despite my best efforts…]

Be sure and let us know your own thoughts on the issue in the comments (both on whiskey and educational material…)

For what it’s worth I’m with Mike all the way on this one. This despite the fact that I’m currently working on two chapters for two different textbooks…

10 Replies to “The Textbook is Dead

  1. Interesting debate and of course the truth is somewhere between the arguments.

    Couple of thoughts which I think need expanding…

    1. Quality – I think Paul makes this point well in that we need some form of filter in the system to try and work out what is good and what is not so good. It’s perhaps harder to do in the free publishing and somewhat chaotic world of social media. This is a real challenge and I’d love to know how we are going to achieve this in years to come.

    2. Longevity. Longevity in the book world is easy to see, define and feel. It’s a real thing that can be found, held, stored and referred to. The medical internet is perhaps not yet there to allow us to catalogue data in social media. Libraries have developed systems and whole courses/professions to help us in the cataloguing of information. The web has SO much information then we are faced with a real challenge of how we organise that data in something we can find, refer to, store and use to build future knowledge.

    So, I agree with many of the points made and although the book is dead it is right not to mix this up with publishing, editing and presenting medical information.

    Just thoughts, not sure if I have the answers. Would love to hear if anyone else out there has the answers.



    • Good comments Simon

      Publishing, editing and presenting is core to both the Internet and the traditional textbook so they certainly have a lot in common – it’s difficult to draw out exactly where the differences lie.

      I know how to look something up in a textbook – go to contents or index and I’ll know how to find it. So you’re right it’s harder to know how to find such information in an efficient and reliable way.

      The last point is that examiners use textbooks to set exams – at least I suspect as much. And we are recommended to read textbooks for exams. So they’ll definitely have a place on my shelf for a while yet.

      • Sure, and to expand, say you have (for example) put together a series of super lectures online about anatomy for EM physicians. If they were journal articles I have pubmed (or alternative – no branding here unlike Olympics) to find it. How will I be able to do that in the future through the internet and websearches? OK, there is Google and other search engines, but they are based on engines which value timeliness as a significant part of the relevance.

        I just don’t know whether it will be as easy to find your work in 10 years when published online as it would be if in print.

        Hmmm, tricky and I guess we will just need to see where we get to.

        Online publishing databases (e.g. pubmed) have evolved to sort this problem for us in the print world, but what about in online meducation? Should we be thinking very hard, and very fast about how we develop an effective archive, OR, do we just leave it to the internet as it exists and hope it works out?

        No doubt Mike has a plan……?? Hope so anyway, ‘cos I’m a bit troubled by this.


        • Fair point

          There’s definitely some kind of “oral/handed down tradition” when it comes to this stuff. It only gets used because people talk about it and share links

          From memory Richard smith promoted a similar idea with post publication peer review (though that may not be him…) – the idea that the best and most useful will rise to the top and stay there. If a resource is really good then it’ll stay there

          That sounds dangerously close to Adam smith’s “invisible hand” in the wealth of nations but there is something like that at work.

          Wikipedia is a free open access resource that is a repository of info everyone uses. It’s not great for some topics but for anatomy for example it’s brilliant – it has research ahead of the newest textbooks and is much easier to navigate.

  2. Some comments:

    (1) Quality – The quality of textbooks is often over-rated- not just because they are out of date, but because the evidence blurs with the eminence due to the way they are written and (not) referenced. When this occurs on a blog you can demand clarification and expect a response, usually with links to references.

    (2) Database of FOAM resources – I think you (Simon) over-estimate the challenge of creating such a database. Consider that the databases on LITFL are made by 2 people with families and full-time jobs as physicians (e.g.,, which is morphing into GMEP). If someone was paid to do this, or a few altruistic people banded together it would be done in a flash.

    (3) Exams – Textbooks are close to useless for the FACEM exam in my opinion. The number of prescribed texts is large, and if you look at a few of them you come to see the contradictions. Some of the MCQs are farcical because it is clear that testing incorrect knowledge from an outdated textbook.

    The textbook is dead and buried.


    • Cheers Chris, I pretty much agree with everything you say to be honest. I think the concept of physical text books is pretty much dead and buried. Not sure what I’m ging to do when I’m next asked to review one!

      I’m really keen to see how we develop the archiving of material as we go forward. I am in awe of the LITFL system and will try to do the same, but that leaves us with independent databases and catalogues of posts, podcasts, data etc.

      I guess what I am interested is how we bring those together so that if I search for something on tranexamic acid in a couple of years through (whatever? Google? BlogMed – I thought of it first!) a search facility it finds yours, mine, Weingarts etc.

      Maybe I’m inventing a problem that doesn’t exist and won’t cause grief in the future, but pehaps not.

      Maybe we do need a BlogMed to supplant/mirror PubMed???


      PS. Every time I’ve questioned something you Australians have already thought of it and solved it, so fab if you have on this one as well.

      PPS. I’m not a fan of setting exams from textbooks either. Just wrong, or lazy, or both.

  3. hi guys. as an educator I believe the textbook still has a role as a repository of core knowledge. it just does not have to be paper based. for up to date practical teaching and learning, it is dead. it cannot keep pace with FOAM, subscription online content and evidence based literature. I agree quality assurance and governance are vital though. Turin wrote of a test to assess if a computer could be considered intelligent if it could trick a human into believing it was itself human. perhaps we need a similar test for FOAM. How do you know what is being blogged is genuine, credible and meets a standard? currently this is all self regulated and mainly considered as a hobby. what is needed is to publish research into how FOAM affects measurable outcomes in clinical world..even if that maybe something like exam pass rates.

    • Great points made by all. Min, perhaps we need a HONCode that is a little more basic and creates a guideline for credibility and sets standards to which we all adhere to if publishing in the name of FOAM? As we move closer and closer to the semantic web, finding the information will become easier and easier as people tag and catalog the material for themselves and each other.

      An interesting side note is the reliability of a crowd sourced resource (Wikipedia) versus a privately published behemoth (Encyclopedia Britannica). They’re equally accurate despite the open nature of Wikipedia. I remember hearing of one study where a professor intentionally added false information into multiple pages and timed how long it took to correct them. Everything was fixed in about 30 minutes!

      As for the research, it’s being done, albeit at the expected slow pace of research. Most of the literature I’ve reviewed for my lectures has looked at methods of implementation and low level satisfaction data, not the meaningful educational outcomes or patient outcomes data.

      • When I taught anatomy I specifically directed students to it as it was often more up to date. One student came to us to tell us that the innervation of long head of triceps was now actually axillary not radial nv – a reference he found on wikipedia that the newest version of Gray’s anatomy didn’t have!

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