Reading in residency

[Jabbed]

After working through chunks of the major sources, I'm still at a bit of a loss as to how to best study during residency. Hippo is too superficial. Rosen/Tint are outdated and contradictory enough that I'm generally too skeptical to use them clinically without crosschecking (which defeats the purpose of reading a 2k+ text in my opinion). So far I've settled on reading up-to-date articles + Rosh.

People poo-poo up-to-date, but at the end of the day it seems that any management strategies or interventions that come from UTD are infinitely more resourced than what comes out of any of the other EM-focused sources.

Ideally I should be reading more primary literature, but does anyone really have enough time/patience for that?

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[TheComebacKid]

Up To Date in my opinion is too tedious to go through. I would reference it as a medical student when I gave a brief presentation on a topic as a medical student on my IM rotation, but for ED practice I find it too cumbersome.

Overall, if you want it from me, our specialty is horrible when it comes to "definitive" texts. I agree with pretty much everything you said regarding Rosen's/Tintinallis, although I do know some people who post here are avid supporters of those texts.

I think Rosh Review is personally the way to go, supplemented with Hippo EM videos. That's what I used for the in service last year and I scored one of the highest scores in my program.

Podcasts and the FOAMEd movement seem like they are all the buzz, but I have found them to be fairly lackluster. Unless you are a practicing physician who is out many years from residency, much of the EMRAP content about "new and fun indications for ketamine!" are not really relevant. I do think C3 does have some quality stuff, though.

Regarding primary literature: I think people (i.e residents) who say that they are reading primary literature in residency are FOS. Not enough time or yield at this point in the game. Your program will summarize some big papers that are coming out during the didactics training portion of your residency i.e. the PARAMEDIC-2 trial etc and you can reference them if you want, but I would not make it part of my regular go-to study routine.

 

[gro2001]

My advice on reading in emergency medicine is not so different from advice on reading in any other academic discipline. To be truly engaged with the field, you need three pillars:

1) Have a solid understanding of the core, foundational, sometimes semi-mythic knowledge base (ie: what is known?).
2) Keep up to date on new developments in the field (ie: what is new?).
3) Engage in the conversation about how the new fits in with the old (ie: what do we all think about the new stuff?)

Each of these requires a fundamentally different approach. Here are my recommendations.

What is known?
Textbooks are a really good way to learn this, for a couple of reasons. They offer one curated source where you can learn all of it. The chapters are in similar formats and digestable chunks. You get a lot of satisfaction for getting through one of the big books over the course of a year or two, and you are sure you haven't missed anything from the dogma. You don't need it to be up to date with the latest and greatest trial, you just need this knowledge to be the skeleton on which you will fit the data that comes out of new trials, like your faculty do. My personal recommendation is Tintinalli's. Takes about a year to read if you work at the pace of one chapter per day.

What is new?
This is the hardest part. A good place to start is to get into the habit of skimming the titles of the articles in each new edition of your favorite journal, reading a couple of the abstracts that seem higher yield, and picking one new article to read in its entirety. Then, once you develop that habit (and have more time later in residency) you can start adding journals to your rotation. Annals or Academic Emergency Medicine would be my favorite.

What do we think about the new stuff?
New information needs to be fit into the context of preexisting knowledge. This is where podcasts and medical twitter fit in, in my opinion. Honestly, you probably don't need much of that stuff if you are involved in a residency program because faculty and residents will be discussing the new stuff in some format all the time. But particularly once you are out, it becomes important to have an indirect access to that conversation. The key is not to confuse the conversation about knowledge with actual knowledge, or eminence for evidence. Typical recommendations here are EM:RAP, EmCrit, and the other usual suspects.

 

[gamerEMdoc]

Depends on why you are reading.

If you are reading to pass the boards, then I'd stick to a text. Will it be slightly out of date info. Absolutely. But the boards are based on the basics of EM, not cutting edge medicine and should reflect the material covered in Tintinalli or Rosens.

If you are reading because you want a comprehensive overview of a topic including current literature/sources because you are giving a talk on something or just want to understand the topic more in depth than the text book, then I'd stick to a good review article. I've always liked EM Practice articles and I'm pretty sure you get them free through EMRA as a resident.

If you are reading because you want to know what on the cutting edge of medicine, then your best served sticking to FOEM like blogs and podcasts.

 

[Backpack234]

Made it to attending life, but in residency I had the same questions as you. There doesn't seem to be a THE BEST SOURCE for studying in residency. Didn't read through a textbook during residency because I listened to my upper levels who all swore it was useless. Now I kinda regret it. The attendings I looked up to most in residency read through that thing once or twice. and I definitely plan to give it a shot now.

What did I actually do? some hodgepodge of EMRAP, Rosh, Hippo, and other review sources. Each time learning as I went. Not the best.

 

[OneTwoThreeFour]

It was recommended to me by a senior resident in my program to use the ALIEM (academic life in EM) AIR series-sources vetted by PD's with associated literature. I think you're also able to get conference credit/CME(?) credit for completing the little quizzes that go along with them. I have started using them and I appreciate them for at least helping me systematically go through topics.
Approved Instructional Resources (AIR Series)

 

[gamerEMdoc]

Made it to attending life, but in residency I had the same questions as you. There doesn't seem to be a THE BEST SOURCE for studying in residency. Didn't read through a textbook during residency because I listened to my upper levels who all swore it was useless. Now I kinda regret it. The attendings I looked up to most in residency read through that thing once or twice. and I definitely plan to give it a shot now.

What did I actually do? some hodgepodge of EMRAP, Rosh, Hippo, and other review sources. Each time learning as I went. Not the best.

Yeah I definitely think there is value to getting a base knowledge by reading the text. Will it be absolutely up to date, cutting info. Absolutely not. But understanding the basics at the beginning of your career will set the foundation, followed by a lifetime of keeping up with the more up to date stuff using blogs and podcasts and CME products like EMRAP.

 

[deleted547339]

It sounds like you already made up your mind. I think you will be well served to read a text cover to cover. I did and I’ve never regretted it.

 

[Birdstrike]

After working through chunks of the major sources, I'm still at a bit of a loss as to how to best study during residency. Hippo is too superficial. Rosen/Tint are outdated and contradictory enough that I'm generally too skeptical to use them clinically without crosschecking (which defeats the purpose of reading a 2k+ text in my opinion). So far I've settled on reading up-to-date articles + Rosh.

People poo-poo up-to-date, but at the end of the day it seems that any management strategies or interventions that come from UTD are infinitely more resourced than what comes out of any of the other EM-focused sources.

Ideally I should be reading more primary literature, but does anyone really have enough time/patience for that?

There's no time to read a huge text cover to cover. There's also no need to trudge through subjects you see constantly in the ED. Your experience alone is enough. I only read on cases that were interesting, that I didn't see often or didn't know much about. Also, you need to study the rare stuff you don't see often, Peds congenital heart disease, ID, parasites, weird neuro and things that board examiners love to hit you on. Bottom line: Do targeted high-yield reading, not rote, big-book, year-1 medical school type reading. Then cram hard core for the boards. This is what I did and I never had any problems with testing. Scores got better as I progressed in residency, obviously.

 

[deleted547339]

There's no time to read a huge text cover to cover. There's also no need to trudge through subjects you see constantly in the ED. Your experience alone is enough. I only read on cases that were interesting, that I didn't see often or didn't know much about. Also, you need to study the rare stuff you don't see often, Peds congenital heart disease, ID, parasites, weird neuro and things that board examiners love to hit you on. Bottom line: Do targeted high-yield reading, not rote, big-book, year-1 medical school type reading. Then cram hard core for the boards. This is what I did and I never had any problems with testing. Scores got better as I progressed in residency, obviously.

Bird, your statement that theres no time to read a textbook cover to cover is just not true. It’s hard, yes, but doable.

 

[thegenius]

Some people suck at reading...it would be difficult to read a text cover-to-cover.

But I guess if you are smart enough to get into medical school, you should be able to read a 2K text in 3 years.

But if you are reading, when are you going to hit on the hot nurses?

 

[gamerEMdoc]

Our residents read through Tintinalli's in the first two years of their residency as part of our conference curriculum. It comes out to just over 20 pages a week after eliminating the admin chapters. It's very doable. Yes, it's extra work, but the residents work way under the 60 hour cap for EM months (our interns work an average of 41 hrs/week in a 31 day month). Part of keeping the work hours well under the cap is the academic responsibilities we have them doing to prepare for our flipped classroom style of conference each week.

 

[Backpack234]

Yeah I definitely think there is value to getting a base knowledge by reading the text. Will it be absolutely up to date, cutting info. Absolutely not. But understanding the basics at the beginning of your career will set the foundation, followed by a lifetime of keeping up with the more up to date stuff using blogs and podcasts and CME products like EMRAP.

Agreed. Hopefully I pass boards then I can start back up with reading and learning! For now it just reminds me of questions I wasn't sure on and adds to the stress of waiting.

 

[Birdstrike]

Bird, your statement that theres no time to read a textbook cover to cover is just not true. It’s hard, yes, but doable.

I guess, but giving equal time to chapters of subjects you know cold, because you see it everyday, at the expense of rare things you see less and have a greater need to study, wasn't ever my most efficient method of studying. But if that works for some people, then great. Different people may benefit from different styles of studying. Whatever works for someone, is what they should do.

 

[deleted109597]

Some people suck at reading...it would be difficult to read a text cover-to-cover.

But I guess if you are smart enough to get into medical school, you should be able to read a 2K text in 3 years.

But if you are reading, when are you going to hit on the hot nurses?

You read at home.
What I did was cut the spine off of our book, and have it drilled for 3 ring binder. Then I could put small chapters in a smaller binder while keeping the rest at home. Plus that way you don't look like a tool reading a medical textbook at Starbucks/local indie hipster coffee bar.

 

[gamerEMdoc]

You read at home.
What I did was cut the spine off of our book, and have it drilled for 3 ring binder. Then I could put small chapters in a smaller binder while keeping the rest at home. Plus that way you don't look like a tool reading a medical textbook at Starbucks/local indie hipster coffee bar.

Pdf copy of the text. Ipad pro. No giant book necessary.


Sent from my iPhone using SDN mobile

 

[Birdstrike]

You read at home.
What I did was cut the spine off of our book, and have it drilled for 3 ring binder. Then I could put small chapters in a smaller binder while keeping the rest at home. Plus that way you don't look like a tool reading a medical textbook at Starbucks/local indie hipster coffee bar.

That way you could be on your way to a 99th%ile on the boards while sipping on organic cucumber water, wearing your favorite Che Guevara shirt, with your beard oiled, mustache waxed, smoking cloves and have everyone assume you were reading a book about militant veganism that explains how cheese is murder, at an establishment that is actively saving the planet by refusing to use electric lighting.

 

[thegenius]

That way you could be on your way to a 99th%ile on the boards while sipping on organic cucumber water, wearing your favorite Che Guevara shirt, with your beard oiled, mustache waxed, smoking cloves and have everyone assume you were reading a book about militant veganism that explains how cheese is murder, at an establishment that is actively saving the planet by refusing to use electric lighting.

And hitting on all the patchouli smelling, hippie women. Gotta remember to avoid those and hit on the hot women!!!

 

[deleted109597]

Pdf copy of the text. Ipad pro. No giant book necessary.


Sent from my iPhone using SDN mobile

That didn't exist when I was in residency. If they let you do it now, great. pdfs are searchable.

 

[thegenius]

That didn't exist when I was in residency. If they let you do it now, great. pdfs are searchable.

Yea it's nice to have. Although it takes a bit of effort to get Rosen's or Tintinalli's on PDF without paying for it. I have a bunch of PDFs of various books on my computer.

 

[Birdstrike]

That didn't exist when I was in residency. If they let you do it now, great. pdfs are searchable.

Back in my residency we read texts of papyrus and a jar of leeches. If you had a question, you just asked Hippocrates, by carrier pigeon. 160 hour resident work-week had just been approved, and that was roundly mocked as too short, likely to create generations of snowflake soy-boys. If you didn't meet patient expectations, they didn't give you 1 star, they fed you and the patient to a hypoglycemic lion.

 

[Apollyon]

Back in my residency we read texts of papyrus and a jar of leeches. If you had a question, you just asked Hippocrates, by carrier pigeon. 160 hour resident work-week had just been approved, and that was roundly mocked as too short, likely to create generations of snowflake soy-boys. If you didn't meet patient expectations, they didn't give you 1 star, they fed you and the patient to a hypoglycemic lion.

True story - in the early days of the FDNY, in the 1850s, firemen got 1/2 a day off per month. They did work 29.5 or 30.5 days per month.

 

[Jlaw]

There's plenty of time to study in residency, you're not going to be able to sit down and bang out 8 hours like in med school but you can do an hour or two a day if sufficiently motivated and more when you're on off service rotations with a lot of sitting around like ICU. Study hard intern year, your motivation will drop every subsequent year.

I personally watched the entire hippo series intern year and took notes, its basic, bread and butter stuff but 95% of what you see in the ED and what you'll be tested on is basic bread and butter stuff. I'm a third year and will review those notes again this year before the inservice. Rosh is great for in service and eventually boards, I do it on my iPad and screenshot the high yield visuals and explanations then review all of them from time to time as I study for the in service. We do Tint reading review but its pretty boring and not very high yield. We also do the Ali EM Air series, its ok, I like Rosh better. My residency provides all of this stuff for free, i'm assuming others do too, you should ask if yours doesn't.

Basically intern year find a bread and butter source and work hard on it, make an outline to review down the line. Supplement with questions. After intern year do questions and start hitting the areas you need work on- radiology, EKG, etc. You will be spending a lot of time in the ED 2,3,4th year and a lot of your learning will be from seeing patients, you will be able to answer a question about something because you've seen it and treated it.