The other day I had an interesting interaction with some colleagues on Twitter on whether to use the digital medium for reading textbooks and journal articles versus the traditional use of paper. In this article I am going to argue for the use of the digital medium to replace the traditional paper and highlighter. I will also suggest some tools that will help you to make a smooth transition to the new era.
The argument for the paper
I will start by contradicting myself and first give the case for the use of the traditional paper medium. The experience of opening the textbook in the morning, the way the paper touches your hand, even the smell of the textbook and the ink is just some other thing. No digital medium can replace this.
Perhaps this experience brings back memories of older days when no digital medium was available. When I was in school, we did have a computer, but they did elementary functions. The best you could do anyways with them was print an article and then read it the traditional way. Those years were formative years for everyone, and since most doctors had a successful schooling life, the experience of using the conventional paper and pen is just unmatched.
Some people suggest that the traditional medium gives better visual and muscle memory to better retain and process information. I don’t think this is a valid argument in the era today in which you have much better digital tools to achieve the same objective.
So the argument for the traditional medium mainly hangs on personal preference and perhaps nostalgia. I respect that. However, the time to change has come, and I will tell you why.
Why do we HAVE to change to the digital medium?
The strongest argument for the need to change to the digital medium comes from compulsion due to network effect.
Most of the medical journals now publish digitally. I don’t remember the last time I read a research article in a traditional paper journal. You are compelled to download the digital versions of the research articles. Some people would like to print the same and then use the conventional way. If you are a voracious reader of medical literature, how many pages are you going to print? Do we have that much time, paper, and ink to print the boatload of medical literature that comes our way? If we wait for the print version of the journals to arrive at our doorstep, the article would have likely grown stale !
Most textbooks are also now available in a digital format. If I need to access a new textbook or non-fiction, I can either download it on my Amazon Kindle in just five minutes or wait for the expensive print version to be shipped by Amazon only to arrive many days later.
We have to accept that publishers are going to push digital publications since it saves them a considerable amount of time and money. We are compelled to use digital sources of information these days, and we hardly have a choice.
The storing of information
So I wrote some beautiful handwritten notes during my MBBS days, my MD days, and also during my DNB Endocrinology days. I kept getting better with my handwritten notes, and I would say that my notes during my super specialty training were a work of art. So while I pat myself on my back for my marvelous work, the irony is that I cannot find those notes. I moved three houses after I completed by Endocrinology training, and the notebooks were lost in transition. I cannot find them. The same holds for the notes I made during my MBBS and MD days.
Sure, you can argue that I needed to be more careful in cataloging and storing them. Still, such incidences are bound to happen when you use traditional sources of storing information. The next time I need to present congenital adrenal hyperplasia, I need to start researching from scratch since I can’t find the beautiful handwritten notes I had on the topic during my DNB days.
Suppose the same information was available in a digital format; in that case, I could have done a quick search on my computer and imported all the material on my presentation or my talk saving me ample time.
The biggest problem of using the traditional system is, we just cannot save it for eternity. It WILL be lost, sooner or later.
The C.O.D.E system
I am a big fan of an internet productivity guru called Tiago Forte. One of the exciting ideas he has suggested for storing information is C.O.D.E. This stands for — Collection, Organization, Distill, and Express.
I have seen one pattern with doctors, both young and old, especially in India. They are great at the C and O part of the C.O.D.E, but inefficient with the D and E parts. Let me explain.
In my experience, doctors tend to collect the information, often organizing them into spiral binds or folders. They are good at that. Also, they are good at speed reading and are often able to digest an article very quickly. What they are not always good at, however, is to distill the information in such a way so that it can be retrieved at the opportune moment when the need arises or to use that information to generate more articles or blogs.
For example, you have read a great article on the Celiac disease in patients with type 1 diabetes. You were impressed with the finding and learned a few things. You have stored the key ideas in your brain, but the finer details are often lost as the time progresses. The next time you see a patient with Celiac disease and type 1 diabetes, can you retrieve all your information? If you have stored it in pen and paper, do you have the time to browse through the information you have stored and get a quick refresher on the topic when the patient is right in front of you? If the answer to this is NO, then I would say the time you spent reading the article a few weeks or months back was a colossal waste of time! The information came to no use for the benefit of the patient.
This is essentially where the digital platform is helpful. You are effectively storing the information and retrieving the information at the right time with a click of a button.
Digital tools you can use to create a perfect C.O.D.E system for doctors
Let me share some digital tools that you can use to create a perfect C.O.D.E system as doctors.
The collection of information is very easy for doctors. This is because of the citation tools and cross-reference databases that are readily available for doctors.
The tools I would recommend for collecting information are Evernote, Pocket and if you are writing many papers, I would also suggest you use Mendeley.
Evernote is the most widely used notes application in the world. It is available for every single platform in the world. It has a handy web clipper application. So the next time you come across and interesting article, all you need to do is to ‘clip,’ and save it in Evernote either using your browser or your mobile phone, add a few tags if required, and it will be filed away for later use. You can store almost anything on Evernote- from PDF files to voice notes and even videos. Evernote, in that sense, is a perfect filing cabinet.
The great part of Evernote is that it has a great search feature. So the next time you want to give a talk on Diabetes Insipidus, search the Evernote app, and it will pull out everything you have stored on the topic. It also searches the text within the PDF files or pictures using its OCR system, making it brilliant.
Pocket is another app that is mainly for storing articles. I generally use it for non-medical articles. Again, with a click of a button on the chrome extension the article is stored in an easy to read format. You can then read it whenever you have more time to spare.
If you are writing a paper or thesis, the best app to collect information is Mendeley. Use the Mendeley chrome extension to store all the articles that you come across on Pubmed or any other journal site. The article is filed away in the Mendeley app. If you are using Word for writing your article, you can use the Mendeley’s Word link to add citations to your text and create a bibliography. All this is free of charge!
With the digital medium, you don’t have to do any organization. It is already done for you by the apps that I had suggested in the earlier paragraph. With the app’s improved search features, the data is easily searchable and hence the organization is outdated!
Distill information is basically taking notes from what you have read and organizing them in a format that would be useful for you in the future. For this, a tool that I find handy is a new note-taking tool called “Roam research”.
Roam research is a revolutionary new product for conducting research, organizing thoughts, and storing information for a later project or article. It uses simple text editing features and a revolution bidirectional linking system. When I am making notes on any topic, you just need to add [] to the keywords, and it creates a ‘link’ to that word. For example, if I was reading about Hypophysitis and I wrote something about Diabetes Insipidus in my notes, I put the [[ ]] around diabetes insipidus. Next time I am giving a presentation on diabetes insipidus, I conduct a search. I find my information on Hypophysitits as well, which can then easily be referenced and added to my work.
If you are good at making handwritten notes, the new tablets with stylus like devices like the new iPAD with Apple Pencil and Samsung Tab S7 are very useful. I use the Samsung Tab S7 and it has significantly changed my workflow. If I am listening to a webinar or reading a book, I just take a screenshot, underline the relevant parts, add my notes and store it away with tags.
The new tablets’ reading process is also very smooth, and it is almost like reading a real textbook or paper. The handwritten part is also close as it could be to actual writing on pen and paper. The best part is you don’t have to go hunting for different colored pens, highlighters etc; everything is there for you at your service in unlimited quantities. The tablets can also recognize your handwriting and convert into text so that it can be saved in a searchable format.
So you have learned something new. How do you express your learning? How do you show it out in the world for all to see? Well, in today’s world of COVID19, it is only possible digitally.
The information you have collected, organized, and distilled is often used to write articles, publish papers, or make presentations, videos, or podcasts. All this is done in a digital medium. If you have stored your data digitally, the process of expression is a breeze. You open your Roam research, search for the relevant keyword, and all your thoughts, ideas, and information are presented to you in an instant on a single page! You copy the relevant information and paste it in your presentation.
Alternatively, if you are writing a review article, open your Roam, collect the information, add it to a word processor and add your references using Mendeley. All this is done within minutes. Need to work as as team ? No problem, Google docs and Office 365 come for your rescue, and you can collaborate in real-time with your co-authors.
Summary of the workflow
The benefits of using the digital medium for reading, storing, and expressing information is just enormous. Here I have summarized my own workflow for this process. I hope it would be useful to you. Perhaps you might like to tweak it in your style using the tools that you are comfortable using, but I am sure it would definitely make you more productive.