?The most important development in the world of literature after Gutenberg is the electronic book, or e-book?
-Siriginidi Subba Rao
Medical Ebooks Breaking into a New World
Written & Researched by Laura Maaske, MSc.BMC, Medical Illustrator & Medical Animator
The Love of Turning Pages
It’s not a fair choice to have to make, between digital and printed books. And overall as readers, we are choosing both in different ways. But how?
Both print and ebook sales are on the increase2. But the ebook rate accelerates faster because its market is newer.3 Traditional books are objects we know well: we use them and manipulate them intuitively. We can feel how much we’ve read through a book, using our fingertips, and without having to search for any number or dial on a screen.
Books can last ages and they are printed in a way that lasts. They do not need to be charged at night in order to function. They may even endure some floods and high temperatures. Words form a path, a stream, and you follow that path straight and true from beginning to end. There is beauty, elegance, and simplicity in the design of a book.
E-book advantages: design flexibility, ease of use, cost
But e-books offer an added way to explore. As children, we’ve imagined that the pictures move and that we can dive into them. This is closer to reality now. With an e-book images can become more dominant, and images can become a more intuitive metaphor for exploration, rather than a traditional table of contents. For example, we might enter an anatomy book with an image of the body. This is fun, interesting, educational, and intuitive. This way, too, we can see what the book covers in an instant.
What if you are a wanderer and you don’t want to follow the chained letter? What if you enjoy listening? What if it is a surgical procedure and you want to see how it is being performed, or how it was performed in the past? Might it even be possible for a reader to choose their own navigational approach, when learning?
There are also use considerations. E-books are lightweight and easy to carry and they do not waste a tree4. Librarians I spoke with told me that medical students express joy, simply because they can hold their entire required booklist in their lab-coat pockets. Before Apple’s new mini-iPad, in fact, some medical schools had specifically sewn full iPad sized pockets into their students’ lab-coats to make carrying iPads easier.
And then, finally but most drivingly, there’s the practical considerations. Digital books are a great deal less expensive than traditional books, sometimes a third to a quarter of the cost of a tradition book. They can be published more rapidly and can be changed and updated frequently, as needed, unlike with printed books. This difference is significant for medical students in developed nations. But it an even more profound difference for students in developing nations, and may improve access to medical information around the world. Students at UWI found the conversion to e-books a significant financial relief.5
It is unfortunate but necessary first step, that for the most part in their current format, medical textbooks are not much more than text files converted into a digital form. And the reader’s movement through the information is still a strictly linear one.
Truly interactive content offers the option for other paths of learning. Inkling offers some of the most dynamic e-textbooks available. But there is more potential for interactivity and breaking the linearity of books than has yet been realized. Inkling CEO Matt Macinnis points out that living up to the dynamic potential of e-books is expensive, initially, and will take time to incorporate as readership improves.
Inkling has taken the first steps to offer useful interactive features, such as ?Test Yourself? sections, a sophisticated search engine, highlighting, and the ability to save notes into a notebook. Also, readers can buy just the chapters they need for a fraction of the cost of the book.
This is the very beginning of exploring the possibilities of etextbooks.
Which comes first, innovation or leadership?
Ebooks are not always the favorite way to read because they are not entirely intuitive or easy to use, not yet.6 They have not yet lived up to their potential, but ebooks are the cheapest and therefore, students are choosing them more.
Professors are enthusiastic too, but for a different reason. Professors know that a third of students do not buy the current version of the recommended course books. These students use outdated versions or go without. Universities can obtain cheaper ebooks for students by purchasing outright a digital copy for each enrolled student. This is a ?forced? way for professors to offer students books for the course, but it is also far cheaper per book.7 And this has created a momentum that has encouraged both students and professors to adopt ebooks.
The first question to ask in seeking the source of innovation and risk is, ?Who has been making the decision to offer ebooks?? Publishers, to begin with, choose the option to offer. An ebook is cheaper than a print book, so there is a smaller profit margin, but more can be sold. Professors like this because it means their authorship has a wider base. University libraries cannot afford to purchase rights to all the required medical books, but they can offer their students a list of vendors, each of whom chooses a book list. Occasionally a publisher, such as Inkling or Kno, might offer themselves directly to a medical school library. But typically a vendor will create an aggregated list from various medical publishers. Students may then have some choice about where to purchase their books. Additionally, there are Barnes & Nobel, Amazon, and Apple, offering competitive prices on eBooks, each with their own proprietary book formats.
Speaking with librarians at the medical schools, I heard about what students want most in ebooks. Students want ease of access. Some libraries, for example, offer textbooks but there can be obstacles like the double-entry of a password to access both the library and the vendor or publisher. At the simplest level of user design, there are kinks to be worked out. Students frequently request better highlighting capabilities. A highlighting tool should be a simple as a marker. But it often requires awkward manipulation and makes gaps when it is created in a vector-based tool. And then, the highlighting may be deleted when the book is updated. Students want to be able to depend on their highlighting and notes not disappearing.
Innovative publishers like Know and Inkling are repeatedly praised by students. And these companies are both beginning to break boundaries of the traditional text file.
Where to find medical e-textbooks
There are roughly a dozen major access providers of medical e-textbooks, which service over fifty medical publishers. It is a list that is rapidly changing, as new companies form and merge, and others are pushed aside. Below is a list of the major vendors and publishers who provide direct medical e-textbooks access to readers. While accessed by medical students and universities, most of these medical e-textbooks are available for individual purchase directly via the links provided:
? AccessMedicine, provided through Mcgraw Hill. http://www.accessmedicine.com/textbooks.aspx
? AccessSurgery, provided through Mcgraw Hill.. http://accesssurgery.com/textbooks.aspx
? Apple. http://www.apple.com/itunes/. Apple offers iBooksbookshelf app for access to e-textbooks. Many books cannot be viewed on personal computers.
? Amazon. http://www.amazon.com. In addition to its own Kindle device, Amazon offers the free Amazon bookstore app for IOS devices, and the free Kindle bookshelf app through iTunes.
? Inkling. https://www.inkling.com.Offers iphone Inkling bookshelf app.
? Jaypeedigital. http://www.jaypeedigital.com/Listing.aspx?Opt=Title
? Kno, Inc. is an education software company. http://www.kno.com. Offers iPad bookshelf app but no iPhone bookshelf app.
? Ovid, provided Wolters-Kluwer parent company of LWW medical publisher. http://www.ovid.com/webapp/wcs/stores/servlet/category_Surgery_13051_-1_9013052_50029430
? Springer. http://link.springer.com
? R2 Digital Library (Rittenhouse). https://www.rittenhouse.com/rbd/web/contentpage.aspx?con?g=r2library
? STAT!Ref. http://www.statref.com
?Thieme Electronic Book Library : TEBL. http://ebooks.thieme.com
? Unbound Medicine (uCentral for medical schools). http://www.unboundmedicine.com
? Vitalsource Technologies, Inc. access portal provided by Ingram. http://bookshelf.vitalsource.com
? Wiley. http://www.wiley.com/WileyCDA/Section/id-351297.html
? Wolters Kluwer | Lippincott Williams & Wilkins. LWW.com estore. http://www.lww.com/webapp/wcs/stores/servlet/category_Anatomy_11851_-1_9012052_50011653_50011653_Y
E-textbooks are at the early stages and will be evolving as the very definition of a book undergoes some serious re-positioning. It is an exciting time to be a reader and an author.
1 Electronic Books: Their Integration into Library and Information Centers. Siriginidi Subba Rao. 2005. Electronic Library 23, no. 1: 116?140. http://www.deepdyve.com/lp/emerald-publishing/electronic-books-their-integration-into-library-and-information-rveCbyWoKs
2 Print book sales rise hailed as a sign of a ?ghtback in a digital world. Zoe Wood. ?e Guardian 28 December 2012. http://www.guardian.co.uk/books/2012/dec/29/print-book-sales-rise-digital
3 As E-Book Sales Rise, Apple iPad Bests Amazon Kindle. Laura Hazard Owen. Bloomberg Businessweek. http://www.businessweek.com/articles/2013-01-31/as-e-book-sales-rise-apple-ipad-bests-amazon-kindle
4 How Many Trees Does it Take to Make a Book? Candy Baker. http://artsnorthernrivers.com.au/pages/news-featuresnews-how-many-trees-does-it-take-to-make-a-book
5 UWI med students save big with ebooks. November 15, 2012. http://www.jamaicaobserver.com/news/UWI-medstudents-save-big-with-ebooks_12998580#ixzz2QpMCWA70
6 For Many Students, Print Is Still King. Jennifer Howard. ?e Chronicle of HIgher Education. January 27, 2013. http://chronicle.com/article/For-Many-Students-Print-Is/136829/
7 Should College Students Be Forced To Buy E-Books?. Janet Novack. Forbes Personal Fiance. May 18, 2012. http://www.forbes.com/sites/janetnovack/2012/05/18/should-college-students-be-forced-to-buy-e-books/
Laura Maaske, MSc.BMC, Medical Illustrator & Medical Animator