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FOAMed: How to find and evaluate medical information on social media

Understand the advantages and challenges of community-created content and where to find it to improve your clinical practice and system operations


This feature is part of our Paramedic Chief Digital Edition, a regular supplement to EMS1.com that brings a sharpened focus to some of the most challenging topics facing paramedic chiefs and EMS leaders everywhere. To read all of the articles included in the Spring 2016 issue, click here

By Rom Duckworth

Medicine and health sciences are advancing at a dizzying pace, leading health care professionals of all backgrounds to social media resources to help them stay informed and on pace with this increasing rate of change.

"The world of medical education has not just expanded, it has exploded," wrote doctors Mike Cadogan and Chris Knickson of the Life in the Fast Lane medical blog [1].

Paramedics are active participants in the Free Open Access Medical education movement. (Image courtesy Rom Duckworth)
Paramedics are active participants in the Free Open Access Medical education movement. (Image courtesy Rom Duckworth)

Traditional sources of medical education, including textbooks and peer-reviewed journals, are notoriously costly and difficult to access. Those publications also present information that was, at best, up to date when it was written months or years prior to publication.

While trade magazines and conferences can be more accessible and arguably more current, they still demand a significant investment in time and resources. They may make it easier to keep up with the new information in EMS, but they still aren’t free, and they provide limited options to interact directly with authors and researchers in a way that can help readers or listeners apply academic information to real-world systems of care.

A better way to access and deliver medical education
"If you want to know how we practiced medicine five years ago, read a textbook. If you want to know how we practiced medicine two years ago, read a journal. If you want to know how we practice medicine now, go to a (good) conference. If you want to know how we will practice medicine in the future, listen in the hallways and use FOAM (Free Open Access Medical education)." –Joe Lex, M.D. [2]

Today, if access to information is your problem, the Internet is the solution, right? While a global social network of health care providers and educators sharing free cutting-edge medical information sounds great, it can be difficult to distinguish scientifically valid information from something that someone "heard from some guy" on Facebook.

FOAM over a pint of Guinness changes the medical profession
In a Dublin pub while attending the 2012 International Conference on Emergency Medicine, emergency physician and medical educator Cadogan was pondering a tremendous increase in the use of Internet resources, including social media networks, podcasts and blogs such as his own "Life in the Fast Lane" for critical care and emergency medical education.

This up-and-coming movement needed a name to help better identify and focus it, allowing medical providers, educators and content creators to more easily connect and collaborate to put internet resources into real-world medical practice. As the tale goes, Cadogan conceived of Free Open Access Medical Education, or FOAMed, while pondering the foam head on a pint of Guinness beer, further accelerating a movement of forward-thinking health care providers unsatisfied with traditional medical education methods and media [3].

The FOAMed movement was — and is — not confined to emergency and critical care physicians. EMS providers, nurses and other allied health professionals of all specialties have been both FOAMed creators and consumers. In the years since its inception, the FOAMed movement has become more diverse, with subdivisions including:

In April 2014, FOAMems was launched by Alan Batt of Prehospital Research Support to improve the exchange of EMS-specific resources under the FOAMed umbrella [4].

FOAMed advantages and challenges
Of course, FOAMed isn’t magic. Like any teaching medium or methodology — and FOAMed is both — it has its own advantages and challenges.

FOAMed advantages:

  • Free: FOAMed does not require any entry or subscription fees to participate in the community.
  • Openly accessible: Every participant in FOAMed has a voice. No one is held back.
  • Easily accessible: Information is available on every imaginable topic in medicine.
  • Interactive: The FOAMed platform — leveraging social networks and blogging services — allows community members to discuss content and concepts with peers, information aggregators, editors and even content creators. This can help members in applying information to real-world circumstances rather than just consuming content for academic contemplation.
  • Timely: FOAMed scientific and educational material can be available and interacted with the second it is published.
  • Concise: By nature of the speed of the Internet, most FOAMed content must get right to the point to avoid being bypassed. As Albert Einstein said, "If you can't explain it simply, you don't understand it well enough."
  • Fashionable: The FOAMed philosophy is highly attractive to up-and-coming emergency medical providers who already create, consume and collaborate in communities professionally and socially.

FOAMed challenges:

  • Free: Some providers perceive FOAMed as "you get what you pay for" — and in some cases this may be true.
  • Openly accessible: Every participant in FOAMed has a voice, although not every voice is contributing in a positive manner.
  • Easily accessible: The sheer volume of FOAMed information can be overwhelming.
  • Interactive: Not everyone knows what he or she is talking about, making it sometimes difficult to validate content.
  • Timely: FOAMed information may be hastily put together by a community member striving to be first to post. Likewise, the educational value of even high-quality content is diminished if providers simply breeze over it to get to the next nugget of information.
  • Concise: There is a fine line between brief and oversimplified. A little knowledge can be a dangerous thing.
  • Fashionable: Many of these challenges cause old-guard medical practitioners and educators to look down on FOAMed as a passing fad with little reliable substance or validity.

Getting started in FOAMed
While FOAMed content may take the form of text, images, audio and video, the real essence of FOAMed is the community's interactive conversations. Content is not expected to be consumed without comment.

Perhaps the most active face of the FOAMed community is on Twitter through the hashtag #FOAMed. The hashtags #FOAMed and #FOAMems act as identifiers of medical education content and conversations, typically of very high quality. Use these hashtags in the search function of the Twitter website or any Twitter app to find FOAMed- or FOAMems-related content.

Twitter currently allows messages of up to 140 characters, so FOAMed content usually consists of a shortened web link to a photo, graphic, video, article or blog post, along with a title, statement or comment. FOAMed community members then typically question, comment on or further share (retweet) the information with other community members.

Twitter is not the only social media channel for FOAMed community members. Facebook, Reddit and other sites all have thriving FOAMed communities that can be found by searching for the word "FOAMed" or by using the #FOAMed or #FOAMems hashtags. There is even a custom Google search engine specifically for FOAMed content.

While the #FOAMed hashtag may thrive on social media channels, much of the FOAMed content is still produced where the community started — on the numerous blogs and websites of FOAMed founders and contributors. Top-quality FOAMed posts are collected and aggregated by sites such as LITFL Review, FOAM EM, ITeachEM, and ILearnEM to help FOAMed members find and digest articles specific to their interests.

For the more adventurous FOAMed consumers, the website Taming the SRU has set up a primer on using an RSS reader to automatically deliver FOAMed content from reader-selected sites as soon as new content is published.

Find FOAMed audio and video podcasts, such as the St. Emlyn’s Virtual Hospital Podcast, HEFT EM Cast and the RCEM FOAMed Network on iTunes, as well as through a comprehensive database at Life In The Fast Lane.

ABCs of evaluating FOAMed content
While any of the sources already mentioned are all good starting points for high-quality FOAMed and FOAMems content, the open, free and instant nature of this content puts the weight of evaluating it and determining its use squarely on the consumer.

"We are drowning in information but starved for knowledge."
–John Naisbitt, "Megatrends"

Evaluation checklists have been developed for medical education blogs and podcasts that break down a list of 151 quality indicators [5]. Although this and other similar checklists can be helpful for more research-oriented providers, there is a much easier-to-use field guide to identify top-quality FOAMed resources — or anything else you might find on the Internet — and steer clear of the real stinkers. This process, which librarians have long taught for evaluating online and offline reference materials, uses a format with which all EMS providers are already familiar: Assess the ABCs.

Authority

  • What is the website or organization creating or sharing the content?
  • Who is the author, publisher or distributor of the information?
  • What is their reputation for delivering quality, reliable content?

Accuracy

  • What sources are cited for the information presented?
  • If the content is original research, was sound research methodology used?
  • If the content is editorial opinion, is the position based on sound logic or simple emotional reaction?

Background

  • Is the author, publisher or distributor speaking within the depth of his or her expertise?
  • Is the content within or at least related to the author’s, publisher’s or distributor’s field of expertise or practice?

Bias

  • Is the source of the information attempting to sell a product, service or idea?
  • What is the author’s, publisher’s or distributor’s agenda or benefit for creating or distributing this content?

Currency

  • How current is the information?
  • It may have been posted recently, but when was the content originally created?
  • When was the data or information for the content originally collected?
  • Is this content just a new package of older material?

Coverage

  • Is this the right content for me or the audience with whom I am going to share it?
  • Is this content relevant to what I am trying to accomplish?
  • What is the sum total of the authority, accuracy, background, bias and currency of the content?

Using FOAMed today
Many EMS providers currently use information gathered from the FOAMed community to improve their knowledge and understanding of issues affecting our profession, both clinical and nonclinical. Some EMS educators are using the FOAMed community in a flipped classroom education model, having students research and evaluate FOAMed resources on a particular topic and bring them back for facilitated in-class discussion.

While I have been a creator, distributor and proponent of FOAMed for some years now, my first real glimpse into the future of FOAMed was when I spoke at the Royal College of Emergency Physicians Annual Scientific Conference in Manchester, England. During the conference I was part a roving FOAMed reporter. With other members of the brigade, I shared live content in the form of photos, videos and text messages via Twitter under the #FOAMed hashtag.

My presentation was covered live and was later published in an article, podcast and a video summary, not just by individual med-ed geeks looking to justify carrying the latest smartphone technology, but also the Royal College itself, eager to distribute the cutting-edge content of their conference as far and wide as possible. And far and wide it went, with questions and comments coming back to me from all across Europe, Africa, Australia and, of course, back home in North America.

In years past, if you weren’t able to afford to travel to Manchester, you might be lucky to see a reference to content presented at the RCEM conference months later in a trade magazine, but FOAMed allows you to read and even hear and see the information as it is presented live. You can question and comment on the information with other FOAMed community members from around the world and together figure out how this information might change your practice or improve the EMS system in which you work.

The Social Media and Critical Care (SMACC) conference, spearheaded by the founders and leaders of the FOAMed movement, will be returning to Dublin, where FOAMed began, in June 2016. Rest assured, the content will be blogged, podcasted, streamed and live-tweeted across the globe.

The question is, will you be ready to take what is taught and include it in your own classroom and personal EMS practice?

About the author
Rom Duckworth is a dedicated emergency responder and award-winning educator with more than twenty-five years of experience working in career and volunteer fire departments, hospital health care systems, and public and private emergency services. Currently a career fire captain and paramedic EMS coordinator, Rom is an emergency services advocate, and contributor to research, magazines and textbooks on topics of leadership, emergency operations, and educational methodology. Rom is a frequent speaker at conferences and symposia around the world and can be reached via RescueDigest.com.

References

1. Mike Cadogan, M. D. Creating the FOAMed network. Life In The FASTLANE (2012). at <http://lifeinthefastlane.com/creating-the-foam-network/>

2. Joe Lex, M. D. International EM Education Efforts & E-Learning. (2012).

3. Nickson, C. P. & Cadogan, M. D. Free Open Access Medical education (FOAM) for the emergency physician. Emergency Medicine Australasia 26, 76–83 (2014).

4. Batt, A. #FOAMems is now here! - Prehospital Research Support Site. The prehospital research support site (2014). at <http://prehospitalresearch.eu/?p=747>

5. Sherbino, J. et al. Criteria for social media-based scholarship in health professions education. Postgrad Med J postgradmedj–2015–133300 (2015). doi:10.1136/postgradmedj-2015-133300

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