As medical education moves rapidly into laptops, tablets and smartphones, an important practical question keeps returning: does reading on screens reduce retention compared with reading on paper — and if so, how big is the effect for learners who must master dense, complex material? The short answer from high-quality syntheses is: for many types of academic, informational texts (especially when depth, recall and extracting details matter), reading on paper tends to produce better comprehension and retention than reading on screens — but the difference is moderate and strongly influenced by task, text type, time pressure and student habits. ScienceDirect+2PMC+2
What the best evidence shows
Large meta-analyses and systematic reviews that pooled experimental studies find a small-to-moderate “print advantage” for comprehension and recall of informational texts. Delgado and colleagues’ meta-analysis (2018) found that paper reading gave better comprehension than digital reading across many studies, and the advantage grew for time-constrained tasks and informational (non-narrative) texts. ScienceDirect
A complementary meta-analysis and reviews confirm that — while many studies find no difference for short or leisure/narrative reading — for dense academic materials the paper advantage is consistent (meta-analytic effect sizes describe a small-to-moderate benefit). Factors that moderate this effect include device type (phone/tablet/desktop), how experienced the reader is with screens, whether the task requires searching or skimming versus deep study, and whether readers annotate or print excerpts. PMC+1
Why paper can aid retention (mechanisms)
Researchers suggest several reasons paper helps with memory and comprehension for complex material:
- Spatial/tactile cues: the physical layout (where information sits on a page, ability to flip pages) helps form mental maps of content that aid retrieval.
- Reduced distractions & shallower processing: screens often invite multitasking (notifications, tab switching) and encourage skimming; this reduces deep encoding.
- Metacognitive calibration: some studies show readers overestimate comprehension on screens and therefore use less effective study strategies.
These mechanisms are discussed across narrative reviews and experimental work synthesised by Salmerón and co-authors and others. uv.es
What medical-student–specific studies say
Surveys and cross-sectional studies among medical students show strong preference for e-resources for convenience, quick searches, portability and up-to-date access — but many students still choose print for extended study, revision and complex learning tasks because they perceive better concentration and retention with paper. A recent Indian study of medical students (NMJI) found most students use both formats: e-books for quick reference and print for in-depth study and revision. That pattern mirrors international findings: preference ≠ equivalence in retention. The National Medical Journal of India+1
Important moderators — when digital is at least as good
Digital formats can match or exceed print for certain situations:
- Searchable reference tasks (looking up a fact, cross-referencing guidelines) — screens win on speed and convenience.
- Multimedia learning (videos, interactive quizzes, linked images) can enhance understanding, especially for procedural knowledge.
- Experienced screen readers and well-designed e-readers/tablet apps (with good annotation/highlighting tools and distraction controls) narrow the gap.
So for clinicians and students who frequently need quick access to guidelines, calculators, images or videos, e-resources often offer clear advantages. PMC+1
Practical recommendations for medical students and educators
- Adopt a hybrid strategy. Use e-resources for searchability, updates and multimedia; reserve printed texts or printed extracts for concentrated study and revision of core concepts. This combines the strengths of both media. The National Medical Journal of India
- If you study on screens, force “paper-like” habits. Print critical chapters or use full-page view, annotate by hand (or simulate annotation fully), turn off notifications, and schedule uninterrupted deep-study sessions. These behaviours reduce the screen inferiority effect. uv.es
- Practice active strategies known to improve retention regardless of medium: spaced repetition, retrieval practice (self-testing), summarisation, teaching others, and creating concept maps. These strategies have much larger effects on retention than medium alone. (General learning science; see Salmerón review for interaction with medium.) uv.es
- For exam prep (time-constrained recall), prefer paper for final, intensive revisions. Meta-analyses show paper has an edge under time pressure for informational texts. ScienceDirect
- Institutions should support both. Libraries and curricula should continue to provide up-to-date digital access plus physical copies or print-on-demand for foundational textbooks and long-form study materials. Student training in digital metacognition (how to read deeply on screens) is also valuable. The National Medical Journal of India+1
References:
- Delgado P, Vargas C, Ackerman R, Salmerón L. Don’t throw away your printed books: A meta-analysis on the effects of reading media on reading comprehension. Educ Res Rev. 2018;25:23–38. ScienceDirect
- Fontaine G, et al. A meta-analysis of the effect of paper versus digital reading on comprehension. (Systematic review / meta-analysis). 2021. (PMC article). PMC
- Salmerón L, et al. Reading comprehension on handheld devices vs. on paper: narrative review and meta-analyses of tablets/e-readers. 2023. (Review). uv.es
- Khanna A, Sharma R, Ink or Pixels: Preferences of medical students between printed books and e-books, Natl Med J India. 2025. (Survey of medical students — use of e-books vs printed). The National Medical Journal of India
- Amirtharaj AD, Raghavan D, Arulappan J. Preferences for printed books versus e-books among university students. Heliyon. 2023;9:e16776. PMC
