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Tablets versus textbooks
Back to the established roots

Originally published in 2015
Re-read and commented in June 2023

Rinckside 2023; 34,3: 7-9.

rinted medical textbooks are dead, e-publishing is the future. There seemed to be a general unison: Instead of primers and schoolbooks — and textbooks in science and medicine — computers screens are better, more flexible and cheaper. But after more than two decades of step-by-step implementation of this speculative notion, the school board of one of the countries most dedicated to digital teaching made a U-turn. The Swedish National Agency for Education backs away from screens in schools.

We had come to the same conclusion earlier: The electronic format is not always best for teaching and learning. Certain kinds of publications are appropriate for e-publications, but others need to be in print.

The starting point. To use a real-life example, let me tell you about our very successful basic textbook on MRI. Since the mid-1980s, new print editions were published every four or five years. Five years ago, the sixth edition was turned into an e-learning textbook. One and a half years of demanding work resulted in a new website with about 320 pages and several hundred figures and animations. Meanwhile, two more electronic editions have followed. The print edition was translated into six languages, the electronic version was translated into Spanish and Chinese.

The bookshop price of a copy of the last English print version was around 120 euros. The electronic version is free because we believed that a free and easily accessible textbook would be beneficial for everybody in the field.

In the foreword to the e-book I wrote:

“We like books — printed on paper, if possible with a beautiful hardcover binding. Thus, putting one of the standard textbooks on the Internet was a challenge for us. We hope that the looks of the real textbook have not been lost completely — and, at the same time, that the advantages of e-learning bear fruit.”

The brave new world of e-publishing. The reasons for the change from print to web were the commonly heard arguments: e-books and texts are cheaper, faster, easier to make and environmentally better. TRTF sponsored the project. If one has an existing infrastructure to create educational material, as we had, you also need neither a publisher nor distributors — both are very costly.

Digital publications of all kinds are taken for granted to be the concept of the future, printed books are considered outdated. However, after these last years I started wondering. Although layout-out and printing processes have also gone through rapid changes, the final result, the printed book, is still the same.

Creating an e-textbook in Hypertext Markup Language (HTML) involves far more effort, time, and money than a printed book. Besides, hard- and software for electronic publications change every year; it's a typical unstable throwaway society technology and will remain so. Do the advantages of the final product justify a close to seven digit project budget?

An attempt to come to terms with the topic was published some time ago in the monthly Scientific American [1], and an in-depth review of printed versus electronic books was written by Valerie A. Moore as a master paper in library science in 2014 [2].

What we learned the hard way
was partly thrilling, partly disillusioning.

The lessons. What we learned the hard way was partly thrilling, partly disillusioning. First, contents and layout of a printed textbook have to be adapted for e-learning. To facilitate reading from a computer screen, sentences have to be shortened and additional paragraphs introduced. E-publications are not necessarily for simpler minds, but they are processed in different parts of the brain. Figures have to be newly fitted, scrolling pages should be kept at a minimum. On the other hand, animations and short videos can be added, but they again are costly.

Feedback rapidly made clear what others had already described in recent years: Even with high-resolution screens, reading from a tablet is draining and contents are forgotten faster. Reading from a screen tires one's eyes; headache, muscle tension of the neck and back, and blurred vision are typical complaints of people spending a long time in front of any screen. Users seem to screen the text like looking at a picture, but don't read it in depth. Now and then they move to other programs, reading e-mails or newspapers or playing games. Their concentration is split, not focused.

Using and owning. The personal relationships to books and e-books are different. Physically, books on computer screens are temporary and bodiless. Readers might not be able to recreate the text five years from now or even tomorrow on their machines, nor on a different machine. Even on the same computer, text and figures change according to the software used. One doesn't own a textbook on computer; usually one pays for a license to read; even if the files are downloaded they are here today, yet perhaps gone tomorrow. If the vehicle necessary to read the textbook breaks or runs out of electricity, the contents and notes are gone.

Books in their traditional paper style don't change, the text doesn't disappear and doesn't require a complicated carrier — and they can easily be archived. Archiving computer files for more than a few years is difficult and expensive. Therefore a whole industry has developed around data archiving.

Differences to take into account. The human brain processes and reacts differently to printed books and to text on screens. Although the text and figures of a printed book and an e-book might be the same, the reader does not extract the same information from them.

It seems as if long texts are easier navigable when published in books. As a side effect, books allow readers to find a physical satisfaction, both hapticly and tangibly, sometimes even in smells and the general craftsmanship of books. More so, books have an easier topography; their mapping is clearer for the human mind. One can go forward or backward just by flipping some pages. People easily lose the overview of the entire book when it is turned into an e-book.

Which medium is best? There is a multitude of studies from all over the world examining and highlighting people's likes, dislikes, and objections to certain aspects of reading texts from computer screens. Of course, most of the responses researchers got were subjective, for example that many people consider reading and learning from a book as more serious than reading a text on an e-reader, tablet, or regular laptop or desktop. However, can one really play one medium off against another?

Valerie A. Moore summarizes in her thesis:

“Some readers seemed more likely to trust information they read in print than in electronic form. Print’s immutability and material stability helped reassure them that the information could not be altered surreptitiously and would be accessible in the future.

“Print was preferred for reference materials or 'heavier' reading by some as well, primarily due to its physical structure that allowed readers to flip back and forth through the pages … The focus inherent in print’s self-contained pages, too, facilitated learning.

“For others, however, the immediate access to supplementary information enhanced their ability to learn, so they preferred digital text for serious reading.”

In this context, however, it is interesting to observe that paper use has increased nearly linearly during the last thirty years. To not lose the information, people print notes, e-mails, protocols, all kinds of text they see on their screen. The 'paperless office' has turned into a fairy tale.

Similarly, sales of printed book versions of both fiction and non-fiction books are said to rise after people have read parts of e-books.

Personal conclusions. Which consequences did we draw from our observations? Certain kinds of publications seem to be appropriate for e-publications, others rather for printed publications. E-publishing is popular and fashionable. Yet, it's questionable whether it fulfills its declared objective in teaching and learning. What is and will be the best vehicle for certain reading and teaching/learning applications remains unclear at present. The professor/teacher plus textbook combination is proven over centuries, in particular if both professor and book are good.

For the very limited sector of scientific textbooks it is clear that people don't read them entirely on screen to acquire fundamentals of a certain topic. After following more than half a million page clicks over a continuous period of time, I clearly understand that, in this case a magnetic resonance e-textbook — and most likely other e-textbooks too — are not used for in depth learning.

The Swedish government's reaction. Swedish Minister of Schools Lotta Edholm aban­don­ed the strategy of the Swedish National Agency for Education (Skolverket) that favors the pursuit of digital technology. In December 2022 she wrote in the newspaper Expressen [3]:

"Sweden's tomorrow is determined by the school students' everyday life. The government wants it to be filled with reading and knowledge — not screen time. There has been an uncritical attitude to digitization; it was considered good regardless of content … the Swedish government wants to see more school books instead … There are several benefits to printed texts. When reading digital, the reader spends less time just reading. The students went through the text faster at the expense of understanding what they had just read. Those who had read printed text could better reproduce main points, remembered more parts and generally showed a better reading comprehension.

"At the same time, every third teacher states that they cannot buy the analog teaching materials they need in their teaching … as a consequence, teachers spend valuable time printing up teaching materials. Time that could go into preparing, implementing and finishing teaching."

On 15 May 2023 she added, according to the Paris paper Le Monde [4]:

"The goal is to guarantee one book per student and per subject. This ratio is no longer the case today. For the past fifteen years or so, screens have gradually replaced textbooks in Sweden. From middle school onwards, students spend an increasing amount of time in front of computers, usually provided by the school. No matter the subject, they have to connect to the internet in order to search for information online, write an assignment or revise for their courses."

"It was an (expensive) experiment … The omnipresence of screens also means that students have lost the habit of reading, … and they rarely or never wrote by hand."

This was our conclusion too.

We returned to an updated printed version of the magnetic resonance textbook, parallel to the existing e-version. It was also a question of price, both in production and for the reader, as well as of readers' reactions and feedback. An update of the e-book edition on the web was rejected despite the more than 1.2 million clicks; but it's too much work, too expensive, and the reader feed-back was zero (except for a single "thank you" from Ecuador).

Offprints of selected chapters of the latest printed edition can be downloaded free of charge from this webpage.

To give this column an electronic touch at the end: There is a beautifully Spanish-made video about books [5]. It's short. You should watch it.

Apologetic disclaimer. Five months later: Sometimes are are big gaps between how things should be and reality of life. Despite the fact that printed textbooks are better for personal learning, the insistent requests for a digital textbook site was overwhelming. Thus we produced another digital version. For this latest digital edition we have up­dated and optimized contents and lay­out, and made the visual pre­sen­ta­tion lighter to produce a more plea­sant, informative and efficient user experience [6].


1. Jabr F. The reading brain in the digital age: the science of paper versus screens. Scientific American. 11 April 2013.
2. Moore VA. Public perception of the differences between printed and electronic books: a content analysis. A Master’s Paper for the M.S. in L.S. degree. November 2014. University of North Carolina at Chapel Hill.
3. Edholm E. Digitaliseringen i skolan har varit ett experiment | Skolverket (Digitization in school has been an experiment | National Agency for Education). Expressen (Stockholm). 21 December 2022.
4. Hivert A-F. La Suède juge les écrans responsables de la baisse du niveau des élèves et veut un retour aux manuels scolaires (Too fast, too soon? Sweden backs away from screens in schools). Le Monde (Paris). 21 May 2023.
5. Did you know the BOOK? Spanish with English subtitles.
6.Rinck PA. Magnetic Resonance in Medicine. The Basic Textbook of the European Magnetic Resonance Forum. 14th edition; 2024. e-Version 14.

Citation: Rinck PA. Tablets versus textbooks. Back to the established roots. Rinckside 2023; 34,3: 7-9.

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Rinckside • ISSN 2364-3889
is pub­lish­ed both in an elec­tro­nic and in a prin­ted ver­sion. It is listed by the Ger­man Na­tio­nal Lib­rary.


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