Where to from here?
The cross roads for social media medical education/ FOAMEd(Free open access Medical education)
by Dr Minh Le Cong
author of prehospitalmed.com blogsite and podcast
January 2013
Introduction
Whilst blogging and internet based medical education has been available for some time now, it is only in the last three years that the rise of social media platforms has taken off as a method of widespread dissemination of medical education and personal professional development. This has been likely driven by the massive adoption of personal media devices ,making it within the easy reach of individual health care providers to stay continuously connected via social media networks and to create and update medical related material on such networks, with little difficulty nor technical prowess.
In the beginning, only a few medical education blogsites and podcasts existed and these were often seen as purely personal hobbies. Now there are clearly over a hundred or so medical education blogsites, ranging from basic personal sites to fully featured podcast associated blogs. Add to that the growth of commercial online medical education sites and the adoption by virtually all medical journal publishers of online editions of their print journals, the whole array available online directly to personal smart media devices is daunting and often bewildering to newcomers.
It is clear in this climate that there will be many skeptics. The current generation of medical practitioners in established positions would not have trained with these media platforms or methods of remote education. However some see the advantages in maintaining professional development and staying abreast of cutting edge developments in their professional fields. The next generation of medical providers in training currently, are one of the largest groups of early adopters to this phenomenon.
In 2013 the community loosely subscribed to the principle of Free Open Access Meducation or so called FOAMEd, finds itself at a crossroad. Here are my thoughts.
Discussion
- Quality – this by far and away is often the most asked question when the topic of FOAMEd appears to new comers. It is free by definition, created in personal time and so quality can vary. The content is uncontrolled and subject to author discretion and feedback. There are really no existing guidelines nor principles of conduct apart from the main one of the HON Code ( Health on Net), which many current bloggers in the community do not subscribe to. In the main the content is subject to the personal interests of each author. In many ways this is akin to a chef deciding what is on the menu for the day. There are many restaurants and each has a chef who decides what they are going to serve. It is left to the user/diner to decide what their tastes are for that day or month and choose to dine at which restaurant. For podcasts, users can choose what they want to consume by looking at the menu and picking and choosing. And just like dining out, if you dont like a meal or podcast you can stop eating/ turn it off. This is the true appeal of FOAMEd, the variety, freshness of thought, the immediacy of catering to a yearning mind on a search for knowledge. The desire to stay current with the best minds in the business. Normally you would need to go to a conference or subscribe to a paid journal but FOAMEd allows the access to the minds of innovators in their respective fields of medicine in an unprecedented manner. It is Somewhat akin to inviting some of the masterchefs from around the world, to cook some of their best dishes for you at your own home, for free, every night or day! And they come! But like the restaurant industry the consumer should expect some degree of standard quality in preparation and content.Just because it is free does not mean it should not meet a minimum standard. This is where FOAMEd community needs to take action and set agreed standards for content and dissemination of information. In essence an international society is needed and membership requires attainment and maintenance of regulatory standards. Just as restaurants might get awarded Michelin stars for high quality food and service, a similar international standards body needs to be established to award such certification.
- Medicolegal and copyright issues – this is an issue that needs a standard approach and advice to newcomers as it can be a potential source of much angst if not correctly addressed from the beginning. The enthusiast/hobbyist nature of blogging and podcasting often gives a sense to newcomers of an artistic license to use whatever materials available on the internet. This is of course not true and international copyright applies. An international society can ensure such respect for copyright amongst membersites. Patient confidentiality and consent issues should be the same as applied for peer reviewed medical journals when creating and publishing material for FOAMEd digestion. I see this again as a role fit for an international society. The society must have chapters for each country representative of its members so that local medical registration and professional policies relevant to Social media use can be applied
- Open access and social media responsibility – The greatest benefit and potential of FOAMEd is to allow quality medical education to all levels of health care provider in lower socioeconomic status nations. This is an improvement from the traditional charity practice of donating old textbooks to students and doctors in developing countries. With FOAMEd they can access the latest developments and information relevant to health care for their populations. Many doctors from developing nations simply cannot afford to travel to attend and present at medical conferences, but with the power of FOAMEd, the conference content can be delivered to them in real time and asynchronously. This I forsee is the greatest role of an international society of FOAMEd , the dissemination of conference material in real time and via podcasting to colleagues unable to attend due to financial, political or social constraints.
- Establishing the evidence base for FOAMEd – there is a need to assess , document and research the strengths and weaknesses of this phenomenon in medical education. There are many skeptics and little success stories or affirming evidence exists in an open forum. Holding medical conferences with strong social media focus will help start to disseminate proven success stories and promote the benefits of FOAMEd.
- Mentorship of FOAMEd – a society needs to setup a group of mentors and educators who can pass on the skills and knowledge in establishing and developing blogsites and podcasts and working on social media platforms as a health professional.
Conclusion
In the short time I have been involved in FOAMEd , in setting up my own blogsite and podcast, I have improved my clinical practice, skills and knowledge several fold, more so than many years of attending conferences and short medical courses. Almost all of my FOAMEd teachers I have never personally met. In the words of a doctor witnessing the first ever general anaesthetic, “This is no humbug!”
MARCH 2013 News flash
Check out Chris Nickson’s article released on Kevin MD blogsite!
THE FLIPPED CLASSROOM MIGHT JUST BE THE FUTURE OF MEDICINE
Prehospital and Retrieval Medicine - THE PHARM dedicated to the memory of Dr John Hinds 
Many valid points Minh. I still think the greatest limitation of FOAMed is the “preaching to the converted” nature of the whole phenomenon. People don’t know what they don’t know, and I’m regularly flummoxed at work when I mention a great blog, podcast or educational point that I picked up online, only to be met with blank stares. This was illustrated disturbingly well by Mike Cadogan at the ACEM 2012 conference in Hobart, when he got an entire auditorium of Emergency Physicians to stand up, and sit down one by one if they didn’t use any of the long list of social media tools that he read out. At the end there was about 2% of the audience left standing. I would say that currently, most doctors don’t use FOAMed.
Promotion, and overcoming the ignorance of FOAMed is also therefore paramount. I know people who are using apnoeic oxygenation for RSI in the ED, an evidence based practice, promoted widely by FOAMed, who have anaesthetists come down and pull the nasal cannulae off, or even worse, pull the ET tube that the ED Reg is holding out of their hand because they think the Reg doesn’t know what they’re doing. The phenomenon of FOAMed widening the practice divide between early and late/non-adopters can be troublesome.
Having said that, your points about standards and monitoring are very valid, and surely as the next generation comes up through the ranks, uptake will be higher, and we owe it to them to have certain standards in place so they can trust the information they get online.
As usual, a very though provoking post!
Great post Minh. I particularly resonate with your fifth point. I really want to learn how to setup a blog and provide information, for the FOAM community and my own learning. I anticipate picking a lot of brains at SMACC
My first thought is that instead of calling it “education,” it could be called
FOAMEX: ….Medical EXPERIENCE”
Since the info is not academic, not peer reviewed, it is not strictly EDUCATION.
It typically presents a viewpoint, opinion, case study, or random pearl or
pearls from a medical or nursing practicitioner who thinks that this particular
fact or synthesis might be valuable based on their experience.
To argue in favor that EDUCATION is the CORRECT term for what we are doing here,
I would point out that a lot of the clinical pearls that have been dropped on my
by fellow practitioners, or even IN NURSING SCHOOL, (which were often presented
to me with a flourish and fanfare suggesting that they were immutable truth) are
or were often not the right fit for my practice, did not fit in with my
department protocols, or were JUST PLAIN WRONG.
Education is prone to error. That’s just the way it is. You take info, you
investigate, you try it out, and you use it if it works or you discard it if it
does not.
Keep writing, keep posting, keep FOAMING!
Nice article Minh,
I have mixed feelings about your call for some sort of accreditation for FOAMed resources. Certainly an indicator of quality may help convince some skeptics but I think this medium should always remain “buyer beware” to some extent. Sometimes the blog comments sections work as a highly effective peer review system and other times the FOAMed community seems to follow a trend of self-congratulation and group-think. Despite any accreditation system, FOAMed resources must be interpreted with a critical eye. I would add, the same is true of peer-reviewed journals.
Referring back to the recent EMCRIT comments, the unregulated opinion-based nature of FOAMed may be what makes it powerful in transmitting tacit knowledge. Putting rules on it might just serve to inhibit the sharing of creative, but unproven ideas. That being said, I would say that a FOAMed “best practice” of sorts would be to link to original research articles concerning the topic at hand.
Keep up the good work!
What Sean said.
People will gravitate to good sources of info (em-crit, pharm, resus.me, LITFL, BroomeDocs) and ignore the crap (ki-docs.com)
By all means have a set of guiding principles (scancrit and resus.me’s constant referencing of sources and journal review is excellent example)
But lets not have a series of ‘gold stars’
Keep it mixed up…
The point is well made earlier about the power of FOAMed in changing practice (apnoeic ox one example)…but sad that novel ideas lead to friction (ripping lff nasal specs for example). Power of FOAM is to get ideas out there quickers than the usual conference, paper, textbook process.
Lets not stifle this through over regulation…
thanks Tim
I am aware you may not be the most supportive of regulation , bureaucracy and red tape..right now.
I pose you this question.
What would you tell an intern to do with their learning if they asked what does FOAM offer for them?
Ha! i would tell ’em to dive in, talk to their peers, present stuff back at journal club…and I would encourage them to follow the feeds we follow…and see if they opened more doors
Not against guiding principles – quality Material will always rise to surface
A merit award system may stifle new enterprise
Just my tuppence worth
Bottomline – have faith in the FOAM…the good stuff will prevail, the detritus will sink…
For that intern I believe FOAMEd needs to incorporated into traditional training not SUPPLANT IT
For that we need to be organised not like a Master Chef cook off
How did EMST/ATLS get to where they are? It is ironic but you must admit standards and accreditation get you where you need to be otherwise why else would you keep doing EMST ?
thanks Sean.
Agree that everything we read and watch and listen to needs to be critically considered,regardless of medium/format
Just because you write a blog or post twitter messages does not mean you should behave any less of a professional. thats what I think the benefit of a society can help with.
Consider that many professionial regulatory bodies are going to consider and publish policies anyway on social media use and the health professional. Now we either stand as a community with some sense of order or a mob of individuals…and let the regulatory bodies make up the rules for us. This is likely to happen in Australia in the very near future.
I suspect in Canada its either already happened or will very soon
Ah, I see – yes , we need code of co duct, guiding principles and for SoMe users to shape ise, not a profession that is 10yrs behind…
Great point Minh, why would you do keep doing EMST, when there are newer, better alternatives being developed?! (shameless plug: http://www.etmcourse.com)
On a serious note though, while using medical short courses as an example, there are NO minimum standards or uniform accreditation process for medical short courses, yet it is a multimillion dollar international industry, that we all keep giving our money to! What these courses do have though, is peer-review and peer accreditation. Being scrutinised by people in the niche industry who belong to a recognised professional body (eg specialty College) lends them credibility, but it doesn’t mean what they teach is right, it’s just what a self-selected bunch of people think is right.
I agree that FOAMed is a different, more organic beast, but it would be good to know that you can trust certain information. Equally valid arguments for and against some sort of accreditation/certification process, not sure what the answer is but it’s worthy debate.
we are going to move closer to the answer after SMACC2013! Is not SMACC 2013 the very process of becoming an organised community, with standards..our own conference. Its not like we asked people to turn up, take a ticket and have 20 minutes on the podium to speak about whatever they fancy?
We set limits, standards, formats etc.
I have been amazed at how a diverse community across the globe, of different backgrounds has been able to coalesce to a single point in time and geography and support an organised event to such a high level.
This to me is FOAMEd evolving and maturing. The pint of Guinness is becoming something else now..more than what an individual holds in their hand.
I cant believe you got a plug in for ETM course. Folks check it out.
I can hear Amit applauding now..
Mate, I;m ready to pull the pin on EMST – not up to date, limited…it’s fine as entry-level but am more interested in getting the finesse out to established target audience – whether a rural masterclass or Andy’s course
That hypothetical intern should be an adult learner. He or she will have done PBL at med school and be au fait with using the net. I would expect him/her to embed FOAm into his/er learning early in – yes, there will be structure…but part of the experience will be them using FOAM and sifting whet from chaff
Otherwise,it all gets a bit ‘elearning’ doesn;t it?
Don;t hurt me at SMACC!
Sure thing!
You have arrived at that conclusion after years of training and experiential learning and teaching EMST etc.
Do you really expect an intern to come to same conclusion on blind faith just because we now say FOAMEd is to be more trusted and reliable?
In other words, is EMST still relevant to the novice practitioner, the intern, still trying to sort out how to manage their ward work, let alone run a resuscitation or trauma call?
I think it still does..everything plays a part in the learner’s journey..to where you are now for example.
I just think you need to have a healthy mind to digest it all and some trusted guidance never goes astray.
Finding that trusted guidance relevant for your own learning..thats the hard bit..the sifting the wheat bit..that might not be so useful to an intern who has to pull the 36 hr shifts. Hence my original question.
What does FOAMEd off the intern learner?
Inspiration, a community, a social medium of learning, an asynchronicity.
But I think they deserve a respected standard to it all.
If they listen to EmCrit podcast and hear scopolamine, etomidate and IV lignocaine for RSI…I think contextual guidance or mentoring is the least we can offer.
Advising that the first anaesthetic rotation you do in OZ, might be better to observe and practice the basics rather than proposing every intubation is done as DSI with ketamine and NODESAT, is not going to win you points with the senior anaesthetic consultant and might not help your future career prospects. There is a time and place for all and everything to help our professional development!
Indubitability!
However, my experience with the SoMe learning fora of doctors.net.uk since 1998 has been that the more ‘free form’ the conversation(s), the more ideas are thrown up
yes, there has to be some moderation…but self-moderation (by the likes of people like you Minh) is actually the best way ahead
That (hypothetical) intern will learn more from the chaos of FOAM, the challenge of sifting wheat-from-chaff than from a proscribed filtered content
Yes, he or she may overstep the mark with some new-fangled idea like NODESAT and be whipped into shape in traditional medical learning/humiliation…or he may inspire old Dinosaurs (like me) to start to question my practice and start learning again…
There are many chefs. Choose wisely. If you get indigestion or stuff causes doarrhoea, choose more wisely next time.
I don;t want to eat at Maccas anymore!
This is a good debate.
The only fear is that SoMe will be regulated by the likes of AHPRA and made to conform to carefully regulated boundaries
Better to keep content in line with ‘good medical practice’, act professionally, assume everything you read/write is public and to cite references as well as anecdotes
But I reckon often it’s the anecdotes that give best education…
The smart interns know when to use, and when to leave alone…
The APHRA regulation is coming Tim
Prepare we must
Very Yoda, sensei.
Agree AHPRA regulation coming – that’ll be guiding principle of SoMe
But regulation for FOAMed? Probably need some sort of endorsement or principles (a rider at bottom of webpage or ‘code of conduct’ if will). But I fear that a system of accreditation/gold stars/whatever will turn off some enthusiastic new contributors – would Casey have started up BroomeDocs a few years ago if he was up against ‘accredited’ sites like em-crit or resus.me?
[actually, bad example – rural docs will usually try and bite off more than they can chew, tilt at windmills etc]
I like the free-for-all that is FOAMed and fact engenders debate – like I said, good stuff will rise, bad stuff will fall via the mob.
off now to do battle with bureaucrats. New media release coming soon…
Learnign that common sense is not that common when it comes to health bureaucrats.