EmergencyMedicineCriticalCare #FOAMEd – the next step


Sub Cruce Lumen

Sub Cruce Lumen, the motto of Adelaide University where I trained as a doctor and where Howard Florey, of penicillin fame trained as well. The motto is Latin for ” Under the light ( of learning) under the (Southern) Cross”

Today I had a Google Hangout session with Dr Haney Mallemat and Dr Rob Bryant from USA. They are keen advocates of #FOAMEd, a term encompassing the concept of Free Open Access Medical Education, attributed to Dr Mike Cadogan and Dr Chris Nickson of the Life in the Fast Lane blog site. Of late there has been a stirring and discussion within the #FOAMEd community as to what is the next step in our evolution. It all crystallised with a blog article written by Dr Mike Jasumback, FOAM a deontological ethos

At the moment #FOAMEd is conducted in a fairly ad hoc and random manner due to the fact its created in people’s spare time, with their own money and must fit around mundane things like actual work.

Haney , Rob and  Dr Jeremy Faust had a Google hangout session and tried to map out a basic plan to structure the delivery and content of EmergencyMedicineCriticalCare #FOAMEd.

I joined in late but we seemed to be able to come up with a plan that looks something like this

  1. There should be two streams of EDCC #FOAMed – one for basic review and resident training, another for advanced review and attending/consultant training/discourse
  2. A regular monthly online journal club
  3. A case based learning online session
  4. A crazy concept I have of an online emergency airway training program

Much of what #FOAMEd is right now is the advanced stream , with discussion and debate about areas of controversy and advanced practice. This is by its very nature, unstructured and free flowing and whilst stimulation for advanced providers, it may not be helpful nor useful to trainees and residents. In fact it may well be distracting from review of core issues in training curriculum.

Now heaps of this training material is already collated in a huge repository that is Life in the Fast Lane. What Haney et al are suggesting is that we have a regular online forum , like a tutorial whereby volunteer senior mentors can go through cases , review core issues and the like, to help inspire and teach via a social media vehicle. There are some aspects of training that cannot be simply learnt by reading a textbook or blog site. For example oral exam preparation would be a perfect opportunity to utilise a senior mentor to strategise and individualise a better approach to performing under viva voce conditions.

OKay now for Haney and I to progress, we need to hear from the residents , registrars, medical students etc out there as to what you all think would be helpful in an online #FOAMEd curriculum?

For example, a monthly case based curriculum online could look something like this:

  1. Chest pain assessment and management
  2. The shocked patient
  3. The febrile child
  4. Severe trauma patient
  5. Common ENT emergency presentations
  6. Acutely agitated patient
  7. Common poisonings
  8. Acute Musculoskeletal/orthopaedic presentations
  9. Acute common neurologic presentations
  10. Lumps, bumps and rashes
  11. Acute respiratory presentations
  12. Medicolegal issues in EDCC

What do you think , folks?



14 thoughts on “EmergencyMedicineCriticalCare #FOAMEd – the next step

  1. I reckon go with the existing … we a re all big boys n girls… especially the postgrads. FOAM is ideally suited to the fast moving critical appraisal of papers and new ideas. I reckon FOAM is better used as illustrated by last few years – Cliff Reid’s critical appraisal of papers, LITFL doing same, your PHARM site etc. The basic stuff…well, that’s best done at bedside and in early postgrad training. FOAM should rise to the top, like a good cappucino…not risk being diluted down and to lowest common denominator…like a flat white.

    Keep it for discussion, scenarios, paper appraisal a la journal club.

    Anyhow, isn’t AHPRA going to shut us all down anyhow?

    Hopefully not. The online airway tutes sound interesting…

    1. thanks Tim! hows the road kill on KI in early spring?
      I appreciate your thoughts but believe there is capacity for two levels of FOAM and for rural docs it makes perfect sense. the rural registrars benefit the most from remote education, online, asynchronous and portable..but they need to pass exams , do viva voce stuff etc

      whilst I have described RSI as being really stupid idea, in fact it is still the foundation of critical airway management..you need to learn a foundation before you can improvise and adapt .

      the post grad rural docs, need to be inspired to excellence, stay up to date and appreciate the areas of controversy and where innovation is heading. they have a foundation already, in adult learning theory, its called a scaffold, to allow them to climb higher in their learning.

  2. Hi there,

    I’ve been following you and the other online greats (Life in the Fast Lane, Academic Life in Emergency Emergency Medicine, scancrit, etc) for some time now. I’ve been working in private medicine as a full time emergency doctor in South Africa for the last 4 years and have learned so much from you guys!
    I have, however, decided to take the plunge and I’m starting as a registrar in emergency medicine in January of next year. My one fear up to now was that I would have to abandon you guys in favour of time spend with the core text books, as not much of the basics are really covered in the blogs. After being on call over the weekend I’m frequently greeted with 400 new tweets, all Emergency Medicine related (and I have been quite selective who I follow!) Shifting the focus to two different streams would however change all that! So….. Hope you do!

    Carry on the great work!

    Willem Jooste
    East London
    South Africa

  3. I don’t know that registrars/residents want to be left out of the “advanced/consultant-level” stuff. We do want to keep up to date as well – was great that trainees introduced apnoeic oxygenation for intubation in my department.
    But you’re right Minh, it is certainly easy to be distracted. There are less exciting “core topics” which do generally get left out of online discussion. LITFL and other blogs do explore these less sexy topics from time to time which is great. The benefit of bedside/blog/online discussion is the ability to learn from cases and experience. And to ask questions about difficult cases or scenarios. That’s what I would like to see/hear.

    Can we please put chest pain assessment and management down the bottom of the list though? There’s so much out in the blogosphere already and I suspect what we do with our low-risk patients is currently down to local policy – very unlikely to change from a registrar point of view.

    As far as topics – you could just take anything from the ACEM curriculum. The key is having mentors who have expertise or a special interest in the subject. No point in having someone with my experience talking about neonatal emergencies for example. Might be even worth trying to involve outside specialists (blasphemy I know) to give their perspective

    And as an aside, I take offence at the slur towards those of us who did undergraduate medicine… 😉

  4. I think you are on to something. I just looked at steve’s EMBasic which covers the basic stuff. But having a FOAM project in this same direction would be helpful for the newbies. One thing that needs to be clear, not all end users are Physicians, med students etc. My third job as medical director for an Air ambulance has me directing the education of my crews. A lot of that is from FOAM

  5. Whoops, no offence intended Kath. Ultimately FOAM will be what it wants to be, driven by users.

    I hope you won’t mind if I sip occasionally from the foam at the top of the cappucino. But more than happy to contribute to make a cup of instant brew. I trained in the NHS, and was fuelled by the stuff (hands on medicine, popping central lines in broom cupboards etc).

    Minh’s done great content for us rural docs here in Oz on the RRMEO platform…having streams will be necessary

    1. thanks Chris! I think keeping it in one location is sensible. the teaching material is all on LITFL already . it just takes some volunteer mentors to conduct sessions using the material. it is not meant to supplant traditionAl teaching locally but provide opportunities for people require extra coaching, practice And networking. Great teachers like Andy Buck at EdExam are already doing this so we are just trying to stand on the shoulder of giants like him And help out

  6. This highlights a serious educational point. Most online education migrates toward advanced concepts, as this inevitably will draw more attention; however, basic foundations are imperative! Many of my residents and students are more well versed with what the latest trending medical topic is, yet have a hard time with basic management strategies.

    Personally, I love this refocusing on what the various learners need… And would be honored to help bring about useful and meaningful ends.

    Thank you for the trailblazing,

  7. I really like the idea of the case based curriculum Minh, especially if it allows for input from other experts in the field regarding how and why they might approach certain aspects of the case differently.

    As for the two streams;
    1) I imagine it would be fairly difficult to draw the line as to what information falls into each stream, and any information that lies in this “grey area” would potentially create redundant data sets, which take up extra server space, require extra administration etc (though this is probably also dependent on the site design and the way the information is accessed)

    2) I can understand that it’s important to avoid core knowledge cluttering advanced information, but from my perspective it’s not too difficult to separate information that is relevant to me as a student, from the info that is intended for advanced practitioners. It usually means I pick up on a few extra pieces of information that I may not have otherwise, and often provides some useful context. Though, from the advanced physician’s perspective, wading through core material to get to advanced concepts may not be so enjoyable.

    To address these issues, rather than trying to create 2 separate streams, it it possible to keep the information in a single stream and use an alternative means of differentiating advanced information from basic information? For example, crudely identifying an article / info as being for RMO level and up…. it can still obviously be of benefit to students and interns, but they have some context as to the level that this information applies, and that it should not be a focus of their current study.

    Obviously this creates a little more administration, but I don’t think it would be any more than administrating for separate streams of info.

    I’m looking forward to seeing where FOAM goes in the future, thanks to the efforts of yourself and the other pioneers willing to step up and direct a concept of this enormity and potential.

    1. thanks Adrian! the advanced stream is in my opinion already happening. Cliff, Scott etc discuss the cutting edge stuff, the latest guidelines..this is all good..
      the basic stream is pitched in my view at getting foundation knowledge. EMRAP already has a stream aimed at residents preparing for Board reviews, called EM Core content I believe. Two attendings go through textbook stuff on common topics . its great stuff…its not free and open access though.
      Although I think you get annual subscription if you join ACEP as a resident as part of your annual fee.

      But for others around the world, there is not much free and open education. And then there are finer aspects of education like exam technique, oral viva voce preparation, essay writing etc. Its not just the knowledge and skills..its about becoming a health professional and making an impact through all your faculties.

      Some may regard free education as being somewhat suspsicious due to concerns of a hidden agenda. My agenda in this whole FOAMEd community is to improve the situation of rural and remote professionals who have trouble travelling to educational events and meetings. My whole thing is remote education that is impactful and practical. If I can attract students of all professions to consider work in rural and remote areas, that is great too.

      I confess I am inspired by the likes of Scott , Cliff, Cadogan, Nickson and many more who freely donate their time and money to this endeavour. The excellence they strive for, motivates me to not sit on the sideline and be cynical. my efforts are to honour them. None of you know the the generosity they have shown to you all and to me, in teaching and online education.
      It is not just about knowledge sharing and simple input, output. In many ways #FOAMEd is about inspiration, what Cliff has written about before, as the search for islands of clinical excellence. If some resident in NZ can read Scott’s blog teachings on surgical airway or my online videos on needle cric and then feel empowered to successfully perform that procedure, that is not just a simple exchange of knowledge and psychomotor skills..it goes much deeper than that..it is in fact a teacher inspiring a student to do something that they have never done before..without ever physically meeting for a lesson.

  8. ‘islands of clinical excellence’? You talking ’bout us on Kangaroo Island again?

    This FOAMed stuff is just so exciting. I accept that there are significant advantages to having resident level stuff, and it can do no harm to cover,this – aint rhat the whole point of PBL anyhow?

    But I must confess that excited as I am, I am stuggling with some of the technology (and this from a chao who is considered a geek by friends n family). Whilst I can network my house, sunc my iOS devices seamlessly, ai have no bloody idea what acadogan was on about at ICEM2012. Symplur? APIs? I’m relieved that he doesnt rate facebook, but puh-lease, can someone give us a basic intro on how to get involved in FOAMed using twitter…i feel likean absolute Luddite…,

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: