The Six Content Categories for the Holy Grail of E-Textbook Publishing

In my previous blog I talked about the holy grail of e-textbook publishing and why we need to create content not as a single unit that flows from a topic introduction through to a summary but as non-linear, compartmentalized chunks of related content. We're not doing that now, but we need to start soon.

Our ability to create content as non-linear chunks and then to present them to the user in a truly useful electronic environment depends on the ability to identify one type of content from another. In essence, we need to be able to categorize types of content differently than we're doing now.

Here's a list of the six key content categories I envision being used for health care e-textbooks, presented here in no particular order save the last, the most important content category of all.

#1: Process

Process content would consist of steps in a procedure, routine, or sequence, as well as key supportive text. We create a lot of process content in health care textbooks, particularly in such topics as:

• Medical coding and billing
• Assessment
• Clinical procedures (hand washing, transferring a patient, performing lavage, and many others)
• Administrative procedures

#2: Reference

Reference content would consist of items that support the main textual content, including:

• Charts
• Graphs
• Diagrams
• External links
• Definitions

#3: Pedagogical

Any activity or learning exercise to be completed by the student would fall into this category. In addition, heuristic information, such as learning objectives evaluative outcomes, would also fall into the pedagogical category. Pedagogical content would therefore include:

• Multiple-choice, true-false, short answer, or any other type of test item
• Learning or behavioral objectives
• Learning outcomes
• Relevant standards or competencies for accrediting organizations

#4: Supportive

Sidebar-type content that supports the main text but is secondary to it would be considered supportive text, including:

• Thematic sidebars, which typically make use of a special icon and cover the same topic, such as legal issues, patient education, safety tips, alerts, and so forth
• Non-thematic sidebars, which typically consist of stand-alone boxes of content
• Case studies or scenario-type situations

#5: Administrative

This category would consist of content that provides functionality support, navigational support, and other kinds of content that carry no clinical information. This includes:

• Navigational links
• Directions for functionality
• Help content for site

#6: Core

While all of the other types of content would allow students to wander through the e-text pretty much as they wish, core content would consist of the most important content every student must view and use. Core content would require special functionality that forced, in a way, students down a particular path of inquiry.

This kind of content might prove most difficult to develop because it requires authors to identify the most fundamental concepts for any particular topic area. It's critical, though, that those concepts be not only identified but also developed in such a way as to allow for focused learning.

To identify and develop this content, authors should look at what in a printed book would be, of all places, the summary.

Certainly the six content types outlined here are just the beginning. They need to be discussed, dissected, added to, and amended as needed.

My goal here is to present a foundation for moving forward into the next and essential level of e-textbook development. I hope it's at least a small start in that direction.

The Holy Grail of E-Textbook Publishing

Every time I turn around, it seems, we in educational publishing are discussing the impact of e-textbooks and how they're perceived by the market. We talk about how to sell them, package them, promote them.

But we're talking about the cart before we've figured out how to move the horse. To move the horse we need to completely rethink how we develop textbooks and, most specifically, how we generate content in the first place.

Retrofitting content

Right now, textbook publishers are generally taking already-developed content and merging it with whatever electronic content we can find. Basically, we're retrofitting printed content into an electronic format.

Oh, sure, we try to make all that content pretty and "intuitive," but we're retrofitting it nonetheless. Right now, I think that's pretty much all we can do.

Eventually, though, and I hope sooner rather than later, we need to start developing content specifically and only for electronic delivery. No easy task.

Deconstructing content

To create truly useful electronic content we need to completely deconstruct the way we write books, and then build out with an entirely new approach, one that starts with a summary and then branches from there.

Let me explain.

When you sit down to write a chapter in a textbook, you start with a global concept and then start breaking down that concept into its many disparate pieces. Let's call these pieces of content chunks.

The process works perfectly for print, with the reader delving deeper and deeper into the chunks and each subsequent concept opening itself to discovery. Then, at the end of each chapter, we summarize what was discussed, highlighting each key concept.

We've been trying to do the same thing with e-books, and we've been failing miserably.

Students find retrofitted e-books disjointed and incomplete. They find it hard to follow the flow, and it's little wonder. We can't expect a student to follow a flow of information that has been lifted from a textbook and force-fed into a pretty software shell.

No, we need to write the content specifically for that delivery, and that's one tall order.

Creating content

To create a truly useful e-textbook, we need authors who can write about complex and comprehensive topics in ways that go against pretty much everything they know about writing.

Logical flow from one concept to the next? Not so much.

Gradual building of concepts one on the other? Nah.

Overall organization from head-to-toe, inside-to-outside, normal-to-pathological? Ho-hum.

What we need to create instead are non-linear, compartmentalized, almost blog-like chunks of content that can be manipulated in a variety of ways by the learner. Here's how it would work:

• For linear learners, we would present the content electronically in a mostly linear way, much like a book, with links and other "off-shoot" functionality for related content always at hand.
• For visual learners, we would present the content in a highly visual way, perhaps using concept maps that allow the learner to navigate through the area based on what they'd like to learn, when, and how.
• For auditory learners, we would provide key concepts in audible and written format and allow them to navigate through the content through audible cues.

In short, we need to create content in such a way that it can be used by the end user  — the learner  — anyway they want it while still providing an effective learning environment. We just can't do that by retrofitting content from a printed textbook. It will take more, something new, and something revolutionary.

I think this new process is the holy grail of textbook publishing, and I for one can't wait for it to evolve.

Let Designers Design

I try very hard to let authors author and designers design.

Seems rather simple, doesn't it?

But you would be surprised how many times in textbook publishing authors or even editors try to become designers, and it just doesn't work.

Years ago editors at my company actually designed the interior of books, and I must tell you, those designs were almost universally horrendous. Editors and the vast majority of authors are word people. They're linear, they think in words, phrases, and sentences. They tend to be not very good at colors, shapes, white space, and the like. Those elements belong more rightly with designers, those glorious, right-brained picture people.

I believe publishers like me should let authors and designers do what they do best.

For instance, I never tell an author what the dosage of a particular drug should be or which ICD-9-CM code should be used for a particular disease. They're the authors, they're supposed to know that clinical stuff. The only time I step in is when I know a piece of information is wrong, and even then I typically ask the author to check it and make sure I'm correct in a suggested edit.

I never tell a designer which colors to use for a cover or an interior design unless I want to make sure we don't select a color palette that's too close to the palette of a competing text.

I never tell designers what font to use for a heading or how big to make it unless the color or size impinges on the reader's ability to discern content hierarchy. Subheads should look subservient to main heads, and if they don't, there's a problem. Even then I don't specify what to do, I just tell them that, say, head 2s need to be more pronounced visually than head 3s.

I steer the overall vision for the book and the basic design to make sure they're meeting market needs but I try never to get into things so deeply that I become an author or a designer. Believe me, no one wants that.

The Four Types of Content and Who Owns What

In publishing there are four main types of content—clinical, editorial, graphical, and administrative. If you're thinking about writing or authoring, you should make yourself familiar with them, because they all need to work together to make the finished product successful. Let's take them one at a time.

Clinical

I call this content clinical because I work in healthcare publishing, but it exists in all areas of publishing. Clinical content is the meaning you want the reader to take away from a word, phrase, sentence, or paragraph. In a pharmacology textbook, for instance, you might want the reader to understand that nausea and vomiting are typical side effects of a particular drug. In a how-to manual about kitchen remodeling you might want the reader to understand the importance of a proper foundation for obtaining a perfect seal between slabs of granite. In a magazine article about avoiding the January doldrums you might want the reader to understand the role of sunlight in sleep disturbances. Clinical content (or technical content or whatever else you'd like to call it) is the meat and meaning of what is written.

The author is the sole arbiter of clinical content. If you're a cardiologist writing about coronary artery disease (CAD), you're held responsible for making sure your description of CAD is fully accurate. Your editors certainly aren't going to know whether it's accurate, and even if they do, they're not going to take responsibility for the final description. That's your job.

Editorial

Editorial content is largely embedded within clinical content. It's punctuation, grammar, and spelling. It's consistency in the treatment of numbers, dates, names, and places. It's the making sure that clinical content is prepared for the reader in the clearest and most meaningful way.

It is here in editorial content that differences arise among publishers. Does a book follow the Chicago Manual of Style or the AMA Style Guide? Are numbers over ten spelled out (eleven) or written as numerals (11)? Is the first letter of a bulleted list uppercased or lowercased? These and other specifics vary widely from publisher to publisher, and in most cases, authors have little or no say in their execution, and rightly so. Those kinds of decisions are best made by the experts in that field: the editors, a term I use here in the widest possible meaning and including publishers, acquisition editors, content editors, copyeditors, proofreaders, and the like.

Graphical

Graphical content refers to everything involved in presenting the content on the page to the reader. It's photographs, icons, and illustrations. It's the choice of font, font size, leading (basically the vertical space between lines), and kerning (horizontal spacing between letters and words on a line). It's the color of headings, the width of a rule around the box, the size of a bullet in a list. These and other elements can vary widely from book to book or article to article, depending on the intent of the work, and in most cases, authors have little or no say here either.

Now, I don't mean to suggest that the cardiologist author doesn't have any say in how the heart illustrations in her book look. Not at all. But she will "own" only the clinical aspect of an illustration, not the editorial or design elements. For instance, the author must determine whether the leaflets of the mitral valve are shaped properly in a drawing. She does not, however, have a say over what shade of beige, say, is used, unless that particular color is clinically important.

A clearer example: An author prepares a graph of data. An illustrator draws the graph using colors that fit the overall design of the book. The author has control and decision-making authority, certainly, over any data point or label on the graph, but none whatsoever on which color, say, is used for which column. The designers know best about colors, shapes, and how graphical items work visually together. We authors and editors ought to stay out of it as much as possible.

Administrative

Administrative content refers to all the other non-clinical, non-editorial, and non-graphical content necessary for to make book (or blog, article, or newsletter). It's the folio, running heads, and sequence of elements in the front of the book (front matter). It's the copyright page, the table of contents, the indices. Easy, peasy.


The most successful books, I believe, are published by houses that grant wide latitude to authors in developing clinical content, editors in helping authors prepare effective manuscripts, and designers in presenting visually appealing manuscript to the reader. Publishing should be, and usually is, a team effort in which no single person holds decision-making power over all four types of content. Rather, each member of the team manages their own type of content and works with other team members to create the final product.