A minimalist reading regimen in residency

[NewmansOwn]

I'm a PGY1 in an EM program where I fit in very well, but I have a question to which my senior residents' answers have been less than satisfying. I'm struggling to come up with a reading plan for the next year. Everyone in my program tells me I must read Rosen, Tintinalli or Adams as an intern - simply no substitution, they say, for the massive brick-and-mortar texts.

I'm skeptical because I've found the more I minimize my resources, the better I do academically; I started to succeed in med school when I stripped my studying down to a bare-bones approach of nothing but lecture notes. Also, while I was consistently told First Aid was not enough for Step I, I did quite well using only that resource. I don't think I've had the discipline to sit down an read an actual textbook once in my life.

My question is this: If supplemented by some podcasts, UptoDate readings on patients and journal review, would something like First Aid for the EM Boards or the Rivers review books be satisfactory for the in-service and my fund of knowledge? If you guys don't like those particular books, could you recommend another streamlined resource?

Many thanks, folks. As a token of my gratitude, I offer you this tidbit: On this day in 1990, the largest T. Rex skeleton ever discovered was unearthed outside of Faith, South Dakota. You are welcome.

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[deuist]

My question is this: If supplemented by some podcasts, UptoDate readings on patients and journal review, would something like First Aid for the EM Boards or the Rivers review books be satisfactory for the in-service and my fund of knowledge?

Nope, sure won't. You're supposed to be an expert in EM when you graduate residency and that means that you need to know everything there is to know. The textbook authors have tried to provide you with everything you need. I'm surprised that your administration hasn't given you a reading schedule. Try this week-by-week schedule from Tintinalli. It will take 18 months to get through the whole book. I will say that EM:Rap, EMCrit, and the journals are certainly great resources to gain valuable information, but your job as an intern is to learn the basics. Oh, and read Garcia's The Art of Interpretation to learn ECG's.

1 to 5 Prehospital Care
6 to 11 Disaster Prep
12 to 15 Resuscitation
16 to 21 Resuscitation
22 to 24 Resuscitation
25 to 27 Resuscitation
28 to 32 Resuscitation Procedures
33 to 37 Resuscitation Procedures
38 to 42 Analgesia/Sedation
43 to 47 Wound mgmt
48 to 51 Wound mgmt
52 to 54 Cardiovasc
55 to 59 Cardiovasc
60 to 64 Cardiovasc
65 to 68 Pulmonary
69 to 73 Pulmonary
74 to 78 GI
79 to 86 GI
87 to 90 GI
91 to 94 Renal/GU
95 to 98 Renal/GU
99 to 102 OB/GYN
103 to 109 OB/GYN
110 to 114 Peds
115 to 119 Peds
120 to 122A Peds
122B to 126 Peds
127 to 131 Peds
132 to 135 Peds
136 to 139 Peds
140 to 143 Peds
144 to 147 ID
148 to 152 ID
153 to 155 ID
156 to 158 ID
159 to 161 Neuro
162 to 165 Neuro
166 to 169 Neuro
170 to 176 Tox
177 to 182 Tox
183 to 188 Tox
190 to 194 Tox
195 to 201 Tox
202 to 206 Environmental
207 to 211 Environmental
212 to 217 Environmental
218 to 222 Endocrine
223 to 225 Endocrine
226 to 231 Heme-Onc
232 to 235 Heme-Onc
236 ENT
237 to 239 ENT
240 to 242 ENT
243 to 245 Derm
246 to 247 Derm
248 to 249 Derm
250 to 253 Trauma
254 to 255 Trauma
256 to 258 Trauma
259 to 263 Trauma
264 to 265 Bones and Joints
266 to 267 Bones and Joints
268 to 270 Bones and Joints
271 to 275 Bones and Joints
276 to 279 Musc-skeletal
280 to 282 Musc-skeletal
283 to 289 Psychosocial
290 to 293 Abuse/Assault
294 to 298 Special Situations
e299 Imaging

 

[pseudoknot]

Please watch this lecture from Scott Weingart:

https://vimeo.com/71874193

My favorite part:
"The only path to expertise…is to read…You're not an auditory learner, you're not a visual learner, you're not a haptic learner…it's all garbage. Everyone is capable of reading, and if you claim you're not, it's because you're lazy."

 

[Birdstrike]

Read for 10 minutes per day on your most interesting patient, or the patient whose diagnosis and treatment you knew the least about. You'll retain this information and you'll accumulate a lot of knowledge about common things you see. Then for in-service and boards you can focus on the rare and uncommon. Don't expect to have the time to read, or retain and entire textbook.

 

[NewmansOwn]

Thanks for the responses, guys. Much appreciated. I've taken a look at all the major textbooks and, despite being lengthy, they don't seem to go into much detail, which I would have assumed is the point of a comprehensive volume. But everyone seems to vouch for them, so I'll give one a try.

Please watch this lecture from Scott Weingart:

https://vimeo.com/71874193

My favorite part:
"The only path to expertise…is to read…You're not an auditory learner, you're not a visual learner, you're not a haptic learner…it's all garbage. Everyone is capable of reading, and if you claim you're not, it's because you're lazy."

I'm a big fan of EmCrit. I Try to catch every podcast I can, even the ones that are well above my level. I've heard this one before and totally agree. Most research supporting "learning styles" is poorly designed, it seems like.

I'm not exactly sure why you quoted this particular passage to me, though. I didn't claim to be any specific type of learner, nor that I was incapable of reading; just that I tend prefer the most concise distillation of available information. And I'm certain you wouldn't be ill-mannered enough to suggest I'm lazy. Thank you just the same for taking the time to read my question.

 

[pinipig523]

I read a lot the latter half of my residency and I'm glad I did because it has paid off well. I just wish I started reading heavy as an intern. More reading always does a brain good.

 

[NERDY]

You may find the Adams book to be less dense than Rosens and Tintinalli.

 

[pseudoknot]

And I'm certain you wouldn't be ill-mannered enough to suggest I'm lazy. Thank you just the same for taking the time to read my question.

Oh no, I'm pretty rude, but thanks for giving me the benefit of the doubt. I quoted that part mainly because it was the most provocative and entertaining part of the talk, not necessarily because it was directly relevant to you. However, as you noted above, the major textbooks aren't even that detailed and are really just a starting point for your EM knowledge, so I guess I do think it could be a little lazy to say you don't even want to read that much. But I obviously don't know you and don't mean anything personal by it.

 

[iish]

At a minimum the general consensus I gather is that you should finish tintinalli during intern year then graduate to rosen's,which you should finish over the next 18-24 mos. All this of course is peppered in with the seminal primary literature that guides our day to clinical decision making, which we should be fluent in by the time we finish residency. From that point on, it is also our job to stay on top of current literature for the rest of our practice. I consider myself lazy when it comes to reading, but even I realize that its imperative for our own practice that we read throughout our careers

 

[RustedFox]

Okay, here comes time for me to be iconoclastic, again.

My program bought me both Rosen and Tintinalli.

I rarely if ever opened either. I freaking SOLD my "ROSENS" on half.com sometime thru my intern year. I passed my written boards by more than a comfortable margin. Oral boards coming up in October.

Been living in "Electricattendingland" for one year. Just like every 'new' attending, I've had those days where I've said to myself - "Oh, I wish I knew more about .... "

So, I'm no different than any other doc who is fresh-out of residency.

Here we go. I'm going to say it.

Tintinalli and Rosens are dead.

Dead.

Rosencrantz and Guildenstern are dead.

Dead.

Deader than disco. Deader than those shoes that you got on.

Nobody wants to read thru three pages of glittering generalities when the obvious is already in their mouth. In the words of Sweet Brown: "Ain't nobody got time fo' dat."

The 'paperback tintinalli' and the 'First Aid for the EM Boards' are putting the pressure on the old, silverhaired tomes of yesteryear. I want to be an author in the new ones.

Come mothers and fathers throughout the land..
and don't criticize what you can't understand
your sons and your daughters are beyond your command.

Your old road is rapidly changin'....
Please get out of the new one if you can't lend a hand...

Oh, the Times, they Are a-Changing....

 

[NewmansOwn]

Thank you again, guys. These responses are perfect. Thanks especially to Nerdy for the tip on Adams, vs the other two.

RustedFox, we sound similar. But it sure looks like we're outnumbered, which probably isn't a bad thing. I'll probably give both Adams and First Aid/Little Tintinalli's a look, and see which one sticks better.

At a minimum the general consensus I gather is that you should finish tintinalli during intern year then graduate to rosen's,which you should finish over the next 18-24 mos. All this of course is peppered in with the seminal primary literature that guides our day to clinical decision making, which we should be fluent in by the time we finish residency. From that point on, it is also our job to stay on top of current literature for the rest of our practice. I consider myself lazy when it comes to reading, but even I realize that its imperative for our own practice that we read throughout our careers

Haha thanks man. You're an intern too, right? Could you please tell me more about the seminal primary literature that had guided your day to day practice over the past 1.5 months?

 

[NewmansOwn]

Oh no, I'm pretty rude, but thanks for giving me the benefit of the doubt. I quoted that part mainly because it was the most provocative and entertaining part of the talk, not necessarily because it was directly relevant to you. However, as you noted above, the major textbooks aren't even that detailed and are really just a starting point for your EM knowledge, so I guess I do think it could be a little lazy to say you don't even want to read that much. But I obviously don't know you and don't mean anything personal by it.

Fair enough, good sir. And decent point.

 

[RustedFox]

Thanks, amigo.

I remember reading one of the first "resuscitation" sections of Tintin. 15 or so pages long. I had it down to 18 sentences, with some 'lists' off of each sentence.

Resuscitation is good. Make sure that the airway is doubleplusgood.

Here are some ways to make sure that your airway is doing it right.

(A...B...C...D...D1....D2... whatev.)

If its not doing it right. Do it over again, changing one of the above factors.

If you notice something else wrong, maybe step back and think about other things. These other things will be described in other chapters ad nauseum. It will take eleveteen chapters to instruct you as to "common fuucking sense".

I am the great cornholio. Come out with your pants down.

NOTE: the author uses long sentences that seem to run in circles because they want to feel important. Isn't that grand?

My version: Nevermind that; here's what is really important. Build off of that. Kthxbye.

 

[Kal EI]

Thanks, amigo.

I remember reading one of the first "resuscitation" sections of Tintin. 15 or so pages long. I had it down to 18 sentences, with some 'lists' off of each sentence.

Resuscitation is good. Make sure that the airway is doubleplusgood.

Here are some ways to make sure that your airway is doing it right.

(A...B...C...D...D1....D2... whatev.)

If its not doing it right. Do it over again, changing one of the above factors.

If you notice something else wrong, maybe step back and think about other things. These other things will be described in other chapters ad nauseum. It will take eleveteen chapters to instruct you as to "common fuucking sense".

I am the great cornholio. Come out with your pants down.

NOTE: the author uses long sentences that seem to run in circles because they want to feel important. Isn't that grand?

My version: Nevermind that; here's what is really important. Build off of that. Kthxbye.

Not commenting on these books - but I've found a lot of medical writing to be overly dense and to say very little in many words. Sometimes it feels like the writing could be 1/3rd the length and retain the essentials.

 

[Birdstrike]

Not commenting on these books - but I've found a lot of medical writing to be overly dense and to say very little in many words. Sometimes it feels like the writing could be 1/3rd the length and retain the essentials.

Yes! Don't waste your time on a "sprain" chapter.

10 minutes per day, people, on your most interesting case.

 

[primadonna22274]

Read for 10 minutes per day on your most interesting patient, or the patient whose diagnosis and treatment you knew the least about. You'll retain this information and you'll accumulate a lot of knowledge about common things you see. Then for in-service and boards you can focus on the rare and uncommon. Don't expect to have the time to read, or retain and entire textbook.

Still a student but I love this advice. Thank you.

 

[Arcan57]

Go for the disease review articles in NEJM, they tend to be well-written and mostly succinct. Ideally a lot of what Rosen's tries to impart (the philosophy of EM) is something you're learning by being in an EM residency. I have no idea why anyone would read Tintanelli's cover to cover, although it can be useful if your internet is down and you have a low-level question regarding a specific disease process. Do all the PEER questions you can get your hands on for the in-service and read up on specific disease that you saw and didn't really understand or that crossed your mind but didn't end up being the actual diagnosis. The problem with Rosen's is that it's written in a way that pays lip service to how we think in EM (probability based, worst-first) but then still gives a Harrison's style overview that projects a lot more certainty into the history and physical than is actually present. The problem with pathophys is that once have the diagnosis it tells a really neat story, but actually using pathophys to make the diagnosis is significantly trickier.

 

[Hamhock]

I am easily board certified in EM and I have not read more than a third of Rosen's or Tint's.

I think it is wrong for attendings to imply or explicitly state that to become an expert in EM one needs to read one of these texts.

HH

 

[Tiger26]

I am easily board certified in EM and I have not read more than a third of Rosen's or Tint's.

I think it is wrong for attendings to imply or explicitly state that to become an expert in EM one needs to read one of these texts.

HH

Agree with Hamhock.

In fact, I'll take the devil's advocate role to a greater extent.

Other that reading Amal Mattu's "Avoiding Common Errors in the Emergency Department" and Vicki Nobel's book on ultrasound, I didn't read a medical textbook in residency besides the first 10 pages of Harwood Nuss.

With that said, I still study all the time, but I'm kind of an unconventional learner (I also only went to 2 weeks of class my first year of med school and 2 hours of class the second year . . . and saw my grades drastically improve with self study)

I've watched every USC essentials lecture online (many a few times) and used to follow emcorecontent.com before that dissolved.

Otherwise, I listen to every EMRAP, EMCRIT, ERCAST, PEMED podcast and regularly listen to the ones from Joe Lex's "Free Emergency Medicine Talks" website.

In addition to that, I read the EB medicine series and regularly read journal articles.

Mostly, though, I read or study something every day and mentally file away something on each shift to read about later.

Not to take away from what others have said, but you have to do what works for you. We'll see how boards go this fall, but I always got the "You're 99% likely to pass" result on the inservice.

At this point, you're an adult learner, so the biggest thing is finding something that is sustainable and enjoyable enough for you to continue improving

 

[Kal EI]

Okay, here comes time for me to be iconoclastic, again.

My program bought me both Rosen and Tintinalli.

I rarely if ever opened either. I freaking SOLD my "ROSENS" on half.com sometime thru my intern year. I passed my written boards by more than a comfortable margin. Oral boards coming up in October.

Been living in "Electricattendingland" for one year. Just like every 'new' attending, I've had those days where I've said to myself - "Oh, I wish I knew more about .... "

So, I'm no different than any other doc who is fresh-out of residency.

Here we go. I'm going to say it.

Tintinalli and Rosens are dead.

Dead.

Rosencrantz and Guildenstern are dead.

Dead.

Deader than disco. Deader than those shoes that you got on.

Nobody wants to read thru three pages of glittering generalities when the obvious is already in their mouth. In the words of Sweet Brown: "Ain't nobody got time fo' dat."

The 'paperback tintinalli' and the 'First Aid for the EM Boards' are putting the pressure on the old, silverhaired tomes of yesteryear. I want to be an author in the new ones.

Come mothers and fathers throughout the land..
and don't criticize what you can't understand
your sons and your daughters are beyond your command.

Your old road is rapidly changin'....
Please get out of the new one if you can't lend a hand...

Oh, the Times, they Are a-Changing....

Just curious, are these the books you are talking about?

Tintinalli's Emergency Medicine: Just the Facts, Third Edition [Paperback]
http://www.amazon.com/Tintinallis-Emergency-Medicine-Facts-Edition/dp/007174441X/ref=pd_sim_b_4

First Aid for the Emergency Medicine Boards 2/E (First Aid Series) [Paperback]
http://www.amazon.com/First-Aid-Eme...4&sr=1-2&keywords=First+Aid+for+the+EM+Boards

Is that Tintinalli book good for 4th year clerkship?

 

[deleted547339]

I literally just fell asleep trying to read Tintinalli's......and I love to read.

 

[RustedFox]

Just curious, are these the books you are talking about?

Tintinalli's Emergency Medicine: Just the Facts, Third Edition [Paperback]
http://www.amazon.com/Tintinallis-Emergency-Medicine-Facts-Edition/dp/007174441X/ref=pd_sim_b_4

First Aid for the Emergency Medicine Boards 2/E (First Aid Series) [Paperback]
http://www.amazon.com/First-Aid-Eme...4&sr=1-2&keywords=First+Aid+for+the+EM+Boards

Is that Tintinalli book good for 4th year clerkship?

Those are the ones. I love em both.

And 2.) Yes.

 

[Old_Mil]

The best way to minimize what you need to read is to read something that is well written and well edited - by that I mean don't use a reference that repeats itself and contradicts itself. Tintinalli fails this test. I would recommend Rosen's or Emergency Medicine: Clinical Essentials (Expert Consult - Online and Print), 2e [Hardcover]. Hardwood-Nuss is thinner, but not as complete.

If you're an auditory learner, I would recommend getting MP3s of NEMBR's excellent EM board review course and putting them on a phone or MP3 player and listening to them as you drive back and forth to work in your car.

Finally, get Intraining Prep's Excellent Board Review Book as a source for review for your annual intraining exam or written boards.

In my opinion, these resources are the best that are out there. Of course, supplement with EMCrit and so on.

 

[Cerberus]

I'm gonna have to disagree with all the posts I've read so far. I do not think Tintinelli's or Rosen's is a useful allocation of resources. I opened up Tintinellis a few times during residency and was one of the high scorers on the intraining exams. The key is to know HOW you learn. I am more of an audio learner (this is something I'll just have to disagree with Weingart on). I'm also more a fan of a bullet point - then in depth review system. I took a board prep book and would go through it and then do internet searches for subjects I didn't have a solid understanding of. I would also frequently look things up on or after shift (but never in the unwieldly monster textbooks). There are so many FOAMED resources now that I really don't see the point of investing in the archaic, outdated, textbook style that used to be only way to learn. Another thing I find useful is looking up review articles in lit search. It's usually more up to date and pertinent than what you find in the texts.

 

[Kal EI]

I'm gonna have to disagree with all the posts I've read so far. I do not think Tintinelli's or Rosen's is a useful allocation of resources. I opened up Tintinellis a few times during residency and was one of the high scorers on the intraining exams. The key is to know HOW you learn. I am more of an audio learner (this is something I'll just have to disagree with Weingart on). I'm also more a fan of a bullet point - then in depth review system. I took a board prep book and would go through it and then do internet searches for subjects I didn't have a solid understanding of. I would also frequently look things up on or after shift (but never in the unwieldly monster textbooks). There are so many FOAMED resources now that I really don't see the point of investing in the archaic, outdated, textbook style that used to be only way to learn. Another thing I find useful is looking up review articles in lit search. It's usually more up to date and pertinent than what you find in the texts.

Yeah, I saw that Weingert quote that learning styles are BS. It's difficult to make that argument. It's not like people are choosing between listening to an audio of Tintinellis compared to reading it. The dissemination of information is a completely different style on audios than textbook style delivery of info.

Since everything is evidenced based now, no one can believe something unless a study backs it. I also remember things better if I can visualize or draw a picture of the concept. Learning is very individual, regardless of what any study shows.

 

[deuist]

What Weingart was talking about in keeping current with the literature through journals. He was not referencing textbooks.

 

[pseudoknot]

What Weingart was talking about in keeping current with the literature through journals. He was not referencing textbooks.

He's stated repeatedly that everyone should read one of the standard textbooks during residency. I agree. FOAMed is wonderful and I am a great advocate for it but there are many gaps, especially unsexy topics not related to airway or resuscitation. You can tell the difference between people who read and people who don't. I'm sure you can pass the boards either way but that is a minimum standard and I know some spectacularly crappy EPs who are board certified.

 

[Cerberus]

He's stated repeatedly that everyone should read one of the standard textbooks during residency. I agree. FOAMed is wonderful and I am a great advocate for it but there are many gaps, especially unsexy topics not related to airway or resuscitation. You can tell the difference between people who read and people who don't. I'm sure you can pass the boards either way but that is a minimum standard and I know some spectacularly crappy EPs who are board certified.

The worst attendings I've known were great at reading the textbooks. They knew all about what the last iteration of Rosen's said - they just didn't know about much outside of that. Those are the guy's pimping you about stone heart and lido w/ epi for a facial lac. If you want to learn something well, read one of the reviews articles in the academic EM journals. The EBMedicine also has pretty great topic oriented reviews as well.

As for the unsexy stuff, I'd say that you are about as likely to remember it from reading through Tintinellis once as not. It takes more than reading a subject once to truly know it.

 

[WilcoWorld]

Here's why I think it's a good idea to read the basic texts: because knowing basic science is what makes medicine fun.

Understanding how high dose insulin treats beta blocker OD or why intralipid works for lipophillic OD's is what makes tox cool. Why do I give clinda for necrotizing fasciitis? Is it because the surgeon says to, or because of its antiribosomal mechanism? Why is a poorly reduced both bone forearm fracture no big deal, but a supracondylar fracture potentially disabling?

Thinking and talking about this stuff is what keeps me liking my job. If you don't find the minutiae of EM interesting, that's too bad.

Do you need to get it from a 20lb textbook? Not anymore, but it's a good way to be confident you're covering it all (even though you'll still have to look things up on the reg). If you're going to pick another route, just make sure that you're being comprehensive.

 

[Kal EI]

He's stated repeatedly that everyone should read one of the standard textbooks during residency. I agree. FOAMed is wonderful and I am a great advocate for it but there are many gaps, especially unsexy topics not related to airway or resuscitation. You can tell the difference between people who read and people who don't. I'm sure you can pass the boards either way but that is a minimum standard and I know some spectacularly crappy EPs who are board certified.

Is this to say that those who haven't read a standard textbook in full are crappy? And if board certification is not the standard, how do you measure the competence of an EP? How would anyone know if the person reading the standard textbooks is more competent than those using other methods described in this thread (or vice versa)?

Weingart also mentioned he has an obsession with reading every single journal article in his area. I.e. it sounds like he definitely reads as much as anyone in his field - and I'm not sure if that's the person to ask what's an adequate amount of reading.

I'm sure there are excellent EP that use different methods.

 

[deleted109597]

A surgeon once told me something groundbreaking.

I used to think I was bad a test taking. I knew the material, but the test wouldn't represent my knowledge base. Then I actually started reading. The more I read, the better I got at test taking. Truthfully, I think test taking is really now what you know, but what you know cold. And if you read, you know more cold.

 

[Kal EI]

A surgeon once told me something groundbreaking.

I always here people say medicine isn't where you go to earn $. I'm beginning to understand why.

Surgery ~60-70 hrs week, paperwork 5-10 hrs, reading time 10 hrs a week, family time minimal, free time 0 hrs, exercise time 0 hrs wk.

 

[Venko]

For my path to becoming an, "expert," in emergency medicine I have not read more than 20 pages of a hard textbook on emergency medicine.

My method was throughout residency to do the following:
1. Use First Aid for EM Boards for framework
2. Read on the topic that I feel the least comfortable with from the day's patient load
3. Create and maintain a, "killer foils," list unique to my weaknesses and study that weekly
4. Ask questions on shift when I did not know why, what, how, when, etc
5. Seek out engaging and challenging colleagues and teachers to keep learning with and from.
6. Keep current with two journals (Annals of EM, and NEJM)

This worked for me and certainly will not work for everyone, but no solution will. I could be wrong in this belief since I have not read the textbooks, but I would suspect that much of what is written there with regards to diagnosis and management is likely outdated and would lead me away from the "expertise," I seek to obtain.

Good luck with your reading schedule, please feel free to take, modify, trash, or do whatever with my strategy.

TL

 

[NewmansOwn]

Thank you, to all, for all the thoughtful replies. This has turned into a great discussion.

I looked through Adams and found it to be as RustedFox suggested. Tiresome, weirdly circular restatements of already-too-lengthy expressions of EM fact. I picked up a copy of Tintinalli - Just the Facts and have found it to have the same information, just without the burdensome prose-like form.

I've also found I really like ACEP's Critical Decisions summary articles. And as ThymeLess suggested, asking questions of attendings until I'm being borderline annoying has proven very high-yield as well.

 

[RustedFox]

Thank you, to all, for all the thoughtful replies. This has turned into a great discussion.

I looked through Adams and found it to be as RustedFox suggested. Tiresome, weirdly circular restatements of already-too-lengthy expressions of EM fact. I picked up a copy of Tintinalli - Just the Facts and have found it to have the same information, just without the burdensome prose-like form.

I've also found I really like ACEP's Critical Decisions summary articles. And as ThymeLess suggested, asking questions of attendings until I'm being borderline annoying has proven very high-yield as well.

Thank you.

Rosen's and Tintinalli's are dead.

The song remains the same. The data and the knowledge are there. It doesn't require three pages of epidemiology and self-congratulatory posturing to figure out that "Hundreds of tons of people suffer COPD exacerbations all the time. Here are the management nuances; if you dont' understand the pathophys... please go back and read Robbins' Pathology until you get it."

 

[RustedFox]

Sorry for the double post, but this just hit me:

I remember opening up (Rosen/Tint) one day and reading on a topic, three paragraphs in, I remember reading: "In a recent study, eleventeen percent of schwiffty-fife percent of patients in a study reported various feelings regardi-...."

Done. Byeeeee.

It was seriously that quick. 3 paragraphs. Less than 2 minutes.

If you don't hook me within three paragraphs.... you're doing it wrong. l'm already frustrated, and will go somewhere else to learn without listening to the author wank-off about how much research was done about it. If you're the author, then its your job to read the research and make it concise for me. I trust you.

 

[WilcoWorld]

If you're the author, then its your job to read the research and make it concise for me. I trust you.

But if you don't know how the author supports the statement, then you wont recognize when the statement doesn't apply.

 

[RustedFox]

But if you don't know how the author supports the statement, then you wont recognize when the statement doesn't apply.

In a myriad of other topics/situations/volumes, yes - one should not 'trust blindly' every statement.

In a textbook of emergency medicine that's been around for (x) years and with established studies and research methods, I'm not sweating the details.

 

[edgesofsanity]

If you're looking for absolutely bare-bones reading, focus your time and readings on the things you need to know cold. That means reading your critical care concepts again and again. You are supposed to be the expert in resuscitation. No one in your hospital should know more about that topic than you. The cardiologists may be experts in their field, but your field is undifferentiated chest pain - and that includes expert EKG interpretation. Regardless of your feelings about the drug, you need to know the inclusion/exclusion criteria for tPA administration in acute ischemic stroke. And so on...

Once you have that down, read how to manage the "less important" cases that are highly litigious - meningitis, pediatric appendicitis, wound repair with foreign bodies. When you have your fund of knowledge stocked, you can then approach the patient in a systemic way and pair it up with good charting to be covered.

Everything else? Save it for reading about it around inservice/boards/Concert exams. No one is going to sue you for missing a case of pityriasis rosea. However, leave yourself enough time to employ this strategy - one week probably isn't enough to pick up all the minutiae that are tested on the boards, and they will use this to weed out those who haven't been keeping up on their reading.

 

[Kal EI]

Wow. Great thread. Thx for all the advice.

 

[deleted109597]

While not reading one of the texts isn't going to make you fail your boards (I bet less than half ever read an entire book, I sure didn't), that doesn't mean you shouldn't read. It just means you should spend your time reading better sources and learning better reading methods.
The texts may do a terrible job of explaining each topic, but they are a great template for the areas you need to read. If you only read about what you see, you'll never read about the rare stuff.

 

[WilcoWorld]

While not reading one of the texts isn't going to make you fail your boards (I bet less than half ever read an entire book, I sure didn't), that doesn't mean you shouldn't read. It just means you should spend your time reading better sources and learning better reading methods.
The texts may do a terrible job of explaining each topic, but they are a great template for the areas you need to read. If you only read about what you see, you'll never read about the rare stuff.

So when something you've never seen (and thus never read about) comes in, you wont know anything about it. Worse yet, if you don't know anything about it, you may not know that you don't know anything about it.

 

[RustedFox]

So when something you've never seen (and thus never read about) comes in, you wont know anything about it. Worse yet, if you don't know anything about it, you may not know that you don't know anything about it.

I get what you're saying; but if Tinti/Rosens can be reduced to "a list of things that you need to know about" (that can be found elsewhere as well)... and then multiple people go on to be both paper-tested and battle-tested after learning what they need to know from OTHER sources.... then ...

Tintinalli is dead. Rosen's is dead.

 

[Hamhock]

Tintinalli is dead. Rosen's is dead.

If you think you know about the rare stuff after reading Tints or Rosen you are greatly mistaken...some generalities, at best.

The best EM docs -- especially those who have never wasted time with Tints -- are so scared of the life threatening rare diseases and presentations, they have read nearly all of the primary literature, considered the interpretations of others, and visualized how they would actually handle the rare presentation.

This takes more time that reading Tints out-of-date descriptions, but its what the best EM docs I have met do.

HH

 

[namethatsmell]

If you think you know about the rare stuff after reading Tints or Rosen you are greatly mistaken...some generalities, at best.

The best EM docs -- especially those who have never wasted time with Tints -- are so scared of the life threatening rare diseases and presentations, they have read nearly all of the primary literature, considered the interpretations of others, and visualized how they would actually handle the rare presentation.

This takes more time that reading Tints out-of-date descriptions, but its what the best EM docs I have met do.

HH

Is there a running list somewhere of the EM primary literature? I've seen specific "key articles" listed on here before, but is there any more expansive list of key articles spanning across different areas of EM?

 

[TooMuchResearch]

Is there a running list somewhere of the EM primary literature? I've seen specific "key articles" listed on here before, but is there any more expansive list of key articles spanning across different areas of EM?

Google Colorado Compendium.

 

[WilcoWorld]

Ah ha! So, we've found the new Tint /Rosens - The Colorado Compendium.

I kid, to illustrate my earlier point. And my earlier point was never that one must read any specific textbook. My point was and is that shooting for the minimum necessary reading is a sure-fire way to not read enough. Why? Because unless you've read too much, you'll never know what it is to have read enough. Why? Because you can't realize that you haven't considered what you don't know.

I sense that I'm about to get too abstract, so I'll stop after one last point: Passing boards doesn't make you the best EM doc you could be. And if that's not what you're striving for, well, I think that's unfortunate...and I don't mean unfortunate for your patients, I mean unfortunate for you.

 

[Arcan57]

Ah ha! So, we've found the new Tint /Rosens - The Colorado Compendium.

I kid, to illustrate my earlier point. And my earlier point was never that one must read any specific textbook. My point was and is that shooting for the minimum necessary reading is a sure-fire way to not read enough. Why? Because unless you've read too much, you'll never know what it is to have read enough. Why? Because you can't realize that you haven't considered what you don't know.

I sense that I'm about to get too abstract, so I'll stop after one last point: Passing boards doesn't make you the best EM doc you could be. And if that's not what you're striving for, well, I think that's unfortunate...and I don't mean unfortunate for your patients, I mean unfortunate for you.

Nobody gives a $%# about being the best EM doctor they can be, at least in terms of knowledge base. It's hard to think of another specialty in medicine that actively punishes you for having above normal competence. Knowing exactly how things should be done just makes dealing with the actual state of things that much more painful. So we learn where we can take shortcuts and what we can safely forget and rationalize that we can alway Google it until we forget enough about the subject to not even consider looking it up.

 

[WilcoWorld]

Nobody gives a $%# about being the best EM doctor they can be, at least in terms of knowledge base. It's hard to think of another specialty in medicine that actively punishes you for having above normal competence. Knowing exactly how things should be done just makes dealing with the actual state of things that much more painful. So we learn where we can take shortcuts and what we can safely forget and rationalize that we can alway Google it until we forget enough about the subject to not even consider looking it up.

I don't disagree with anything you wrote.

 

[Kal EI]

Nobody gives a $%# about being the best EM doctor they can be, at least in terms of knowledge base. It's hard to think of another specialty in medicine that actively punishes you for having above normal competence. Knowing exactly how things should be done just makes dealing with the actual state of things that much more painful. So we learn where we can take shortcuts and what we can safely forget and rationalize that we can alway Google it until we forget enough about the subject to not even consider looking it up.

I've noticed that EM which I traditionally didn't see as an overly academic field (as pre-med/M1) seems to be slowly becoming academic driven, i.e. like internal medicine docs. "You must read this 2200 page textbook", "I read every journal article published in my field" etc.