It is well known that doctors’ professional roles change throughout their career. A junior doctor is expected to be mainly committed to clinical duties, while the head of department may be mainly dedicated to management duties, with a minor or even no clinical workload. GP trainees usually start off their vocational training program by spending most of their time in a hospital environment and doing emergency medicine, which weans off in the last stages of training, when most of their time is spent in a primary care environment.
Similarly, our medical reading habits change substantially throughout the years. Most of my reading during medical school was from textbooks, and very seldomly involved reading medical journals. When I did have to read journal articles, it was usually because my lecturers told me to, rather than personal initiative. My awareness at the time of medical journals was quite limited. I thought they were the realm of clinicians and leading scientists.
I spent six years in medical school, and left medical school six years ago. I believe I have bought fewer textbooks in the last six years than in my six years at medical school. But my use of medical journals, which grew progressively throughout medical school, has sky-rocketed since graduation. This differing pattern of consumption of medical information has to do not only with my greater awareness of the role and importance of medical journals, but also with my differing information needs. Books had, and still have the advantage of condensing core information, as well as providing a more systematic and “static” approach for major subjects, which is more manageable and handy for students. Journals are more suitable for users who already have a more solid grasp of pre-clinical and clinical subjects (medical students in their final years, trainees, and specialists) and for those with sporadic, to the point needs, which goes more hand-in-hand with the needs of physicians, who need to answer random, daily questions that spring up from continuous interactions with patients.
Because of current limited contact with medical students, I actually don’t know if textbooks are still as invaluable to the current generation of medical students as they were to my generation. I was a medical student not so long ago, but at the time, the internet was still years away from what it has become today. Dial up connections were still the norm, iPhones, iPads and all those mobile gadgets were still science fiction, medical journals did not have a continuous publishing policy like they do today, open access was still in its infancy, and information hubs such as Up to Date either did not exist yet or were not yet widespread.
So my own perception is that textbooks may still bring a lot of added value to medical students, but may have become less influential. And I’ve actually heard of fellow doctors who’ve replaced classic sources of studying like Harrisson’s with resources such as Up to Date.
Just a few weeks ago, I received an invitation to write a book chapter for an upcoming book about Primary Health Care. It is an open access book. I had never heard of open access books before, but after clarifying things with the publisher, I realised the concept is similar to open access journals. The author(s) cover the publication costs, and the book is made electronically available to everyone for free. In this case, the paper hard copy can also be made available upon request, but not for free.
So, even if the classic textbook faces much tougher competitions these days from other publication types, open access books may put textbooks in the spotlight again, with medical students being one of the main target audiences. From what I learned from the open access publisher, an open access book can be launched within a turn around time of around eight months, which may allay the usual criticisms that the content of books is already out of date by the time it is published. Moreover, I remember straining my parents’ finances when I was a medical student, since each year of medical school meant having to invest thousands of Euros in books. Open access books could potentially make a huge difference in medical education, as they could in theory significantly lower the cost of training doctors. So, will open access books become the next big player in the publishing game? Only time will tell, but it’s surely something to watch out for.
Tiago Villanueva is a general practitioner based in Lisbon, Portugal, and a former BMJ Clegg Scholar and editor, studentBMJ