Practice Perfect 932
What Should I Read? Part 1:
An Initial Answer

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As a residency educator and someone who has spent a reasonable amount of time with students, I find myself commonly asking students if they have read certain research papers. I’ve also received the question, “What should I read?” more often than I’d care to relate. I’d like to try to answer this question, at least to some degree, since it’s really a question with a very very very long answer. There’s no way I could cover what should be read about every topic in podiatric medicine and surgery, so, by nature of the limitations of this forum, today will be the start of a limited series we’ll call What Should I Read? We’ll start with some generalities and then move to a few representative topics.

Read About What You See
I have always been an advocate of learners getting the most bang for the educational buck. First, you must keep in mind that you have a limited reservoir of both time and mental focus. Clinical rotations, by their nature, demand a significant amount of time and energy, and anything a clerk or clinical student reads will be most often consumed after (or before) hours. Because of this inherent limitation, students must be strategic about what they’re reading.

Second, as adult learners, students will be more motivated by incorporating their own experiences into their learning. This is a fundamental concept of andragogy (AKA adult learning), which is different from pedagogy (children’s learning). Adults will remember more about what they study when they are able to apply it to their own experiences. This is the reason why learning during clinical rotations occurs faster and lasts longer than material from the classroom. Students should then use this characteristic to their advantage.

Adults will remember more about what they study when they are able to apply it to their own experiences. So it is best to study what you have seen in your practice or expect to see in the near future.

The takeaway from these two concepts (a lack of time and learning from our own experiences) is to focus your after-hours reading on the topics you have seen or discussed during your daily clinical experiences. See a diabetic neuropathic ulcer in clinic? Read about ulcers. Participate in an ankle fracture ORIF? Read about ankle fractures. See a patient undergoing Ponseti casting for clubfoot deformity? Read about that. While reading, keep your patient in mind. Apply what you’re reading about that topic to the patient you saw. Reflect on how the information you’re reading would affect your own decision-making if you were the attending. Does what you saw in clinic or surgery make sense? Is there something you don’t understand about what you’re reading as it applies to your patient? Allow your own generated questions to become the map in which you seek research articles to read which will expand your knowledge greatly.

Do NOT Read Randomly
The biggest mistake I see students make is to read a textbook or board study document randomly. I’ve watched students do this between patients in clinic or before surgery where they read certain pocket-sized books that will remain anonymous. When I ask them what they’re reading, it’s universally something that has absolutely nothing to do with what they are experiencing when on rotations. Doing so violates the andragogical rule about learning from our experiences and leads to very poor long-term retention. It’s also very boring! The only time I would suggest violating this admonition is for topics that you have not experienced during rotations. The model example might be bone tumors. How often do each of us see, say, malignant fibrous histiocytoma of bone? Topics like this are the only situations in which you should periodically brush up to maintain your knowledge base.

Only read randomly about rare topics that you are not likely to see in the near future, just to remain familiar with them.

Read Actively
I’ve additionally observed many trainees over the years reading a textbook or journal article as if it were a book for fun. Simply passively reading something and thinking it’s going to stick into your head, even if it’s pertinent to a pathology you just saw that day, is a complete, total, and utter waste of time. Stop that now because you’re not going to remember much. The key is to read and study actively. To do this, you should take active notes from that research article you’re reading about neuropathic wounds or that review article about ankle fractures. You must have something to refer back to later when your Ebbinghaus forgetting curve kicks in. Don’t know what that is, students? Go look it up, now! Humans are subject to forgetting a large percentage of what they learn within less than 24 hours (see Figure 1). You must have something to refer back to when you inevitably forget what you just read.

Figure 1. Ebbinghaus Forgetting Curve.¹
Your notes should then take the form of a one-pager document. See Practice Perfect 849 - Staying Informed Using the One-Pager Method for a discussion about one-pagers. This is simply a highly condensed, concise set of notes about a subject. Keep these one-pagers somewhere accessible to you when you are on-the-go (ie, Notes App in your phone), and as you continue your rotations and read about other aspects of the pathology you experience, you will add information to those one-pagers. Over time, you will have built a compendium of knowledge to refer back to, in your own words, in a format that makes the most sense to you. By building and maintaining your one-pagers, your active study method will lead to longer-term recall.

Use Resources Appropriately
All resources have their advantages and disadvantages, and it’s important to use this to your advantage. Textbooks have a lot of information, but that information is usually presented in such a comprehensive manner that it is not the reference to use when you need a quicker answer. McGlamry’s Textbook is something all podiatrists should read during training, but there’s so much information in that revered tome that one can easily get lost. Instead, finding an updated review article about a topic in the medical literature may be a faster way to gather high-yield information in a hurry.

On the other hand, certain textbooks may provide discussions about important fundamental principles and concepts that planned reading sessions will be in every student’s best interest. The best example of this is Douglas Richie Jr’s Pathomechanics of Common Foot Disorders Here is a link to Amazon to obtain this book, perhaps the most important information source about biomechanics of foot and ankle disorders in recent years. This should be mandatory reading for all students and residents. For those looking for what else to read within the lower extremity biomechanics domain, here’s a bibliography.

Finally, if a trainee is looking for the answer to a specific clinical question (For example, what are the success rates and complications of plantar fasciotomy for plantar fasciitis?), using the published research in journals is mandatory.

I could go on for days on this topic, so we’ll end here. We’ll continue with more specifics about active studying topics in our next issue. As a teaser, we’ll discuss a set of five landmark articles about the first ray and medial column that will pack your brains with powerful and practical information to grow your podiatric knowledge that you’ll use for years to come!

Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]