Do We Need EM Textbooks Anymore?

April 29, 2020

Written by Nicole McCoin

Spoon Feed
One residency program went from studying a textbook (i.e. Tintanalli) to reading Evidence-Based Medicine (EBM) articles and corresponding questions in Rosh Review. Residents preferred this, and their in-service scores were non-inferior to the traditional textbook reading study plan.

Why does this matter?
If this study can be replicated on a larger scale, it would definitely make us all feel even more comfortable with adopting a non-traditional approach to studying emergency medicine.

Making the Most of Our Time
It is hard to establish a study routine both during emergency medicine residency and beyond. Many of us have already searched for more efficient ways to distill information and reinforce it in our minds. Tools such as JournalFeed (wink-wink) have been created partly due to this need, but how do we all get the core knowledge in?

This study took one residency and examined if question-based study was non-inferior to textbook-based study. Now, there were a few limitations. It was one residency and thus the sample size was quite small. Furthermore, they did a couple of comparisons. First, they compared each resident’s individual scores in year one before the change to the question-based curriculum and then in year two after the curriculum change. I wish they had used national percentile rankings instead of raw scores as I think that would have given us a more accurate picture of how these residents were doing from one year to the next. However, their second comparison of one whole residency level’s scores in year one before the curriculum change to the same residency level’s scores in year two after the curriculum change (e.g. PGY-2s pre-curriculum change to the next year’s PGY-2 class post-curriculum change) was more helpful. In this comparison as well, the question-based approach seemed to be non-inferior to the text-based approach. In addition to these findings, there was definitely greater resident satisfaction with the new curriculum, and the residents used it more often. 

From a Program Director perspective, that is purely anecdotal, I feel that those residents who use the question-based approach in our residency tend to do really well on the inservice exam. They are able to study efficiently and make good use of small increments of “free” time. There also seems to be greater repetition in their study, hammering home important facts and details. Additionally, they can contextualize their study a bit better by gearing the EBM reading that they do and the questions that they tackle based on cases that they have recently seen.

This study helps us think about what we focus on in our precious moments of study. Perhaps it is time for more of us to try these techniques and see if they work for us and our trainees. Thanks to the St. Joseph’s University Medical Center Residency Program for studying this important topic.

Source
Does the Removal of Textbook Reading from Emergency Medicine Resident Education Negatively Affect In-Service Scores? West J Emerg Med. 2020 Feb 25;21(2):434-440. doi: 10.5811/westjem.2019.11.44639.

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