What is FOAM?

FOAM stands for Free Open Access Medical education (on twitter the hashtag #FOAMed is often used). It is a collection of resources, a community and an ethos. The FOAM community spontaneously emerged from the collection of constantly evolving, collaborative and interactive open access medical education resources being distributed on the web with one objective — to make the world a better place (1). FOAM is independent of platform or media — FOAM is a personalized continuously expanding database of resources for medical education: it includes blogs, podcasts, tweets, Google hangouts, online videos, text documents, photographs, facebook groups, and a whole lot more (2). Traditional media are organized by few sources for many receivers. The quality is mediated by publishers and training is required. It is expensive to publish and access is limited. Publication process takes time and the publication is permanent once published. Social Media (SoMe) on the other hand has many sources (eg SMICC or social media in critical care and SMACC or social media and critical care) for many receivers. Quality is mediated by participants and there is no training. It is cheap or free to publish with unlimited accessibility. Publication is immediate and SoMe are flexible even after publication. By sharing our specific competencies, protocols and experiences we can shift to a new online learning paradigm that will carry medical education via internet 2.0 to a new era. Peer review seems to be broken as half-million papers published per year (>1 per minute)

Quality of FOAM?

The question arises whether FOAM could possibly replace peer review? The answer is maybe: FOAM ignores traditional hierarchy, it is free and has equitable access 24/7, it crosses professional boundaries, it is multi-national, transparent, robust and finally FOAM is apolitical. Recently because of the increase in and awareness surrounding FOAM a social media index (SMI) has been suggested (3) while others suggested the so-called Kardashian index (KI)(4). The SMI enables to assess the impact and quality of FOAM resources, and enables educators to receive scholarly credit and learners to identify respected resources. The KI a measure of discrepancy between a scientist's social media profile and publication record based on the direct comparison of numbers of citations and Twitter followers. Possible dangers of FOAM are related to the reliability and correctness of the information provided (5). Recently a quality label for medical websites has been launched (the so called HONcode by the Health on the Net foundation https://www.healthonnet.org/HONcode/Conduct.html). Another danger related to SoMe and FOAM is reductive education: First we read the textbook, then we just read the chapter, then just the paper, then just the abstract and now we just read the Tweet...

Imagine

Imagine the near future where a medical student or qualified doctor is surfing on the internet and looking for an answer to a specific medical problem: e.g. what is the current status of treatment of severe pulmonary. He goes to PubMed.com and finds an interesting review paper on the subject. However, as the paper is not published under the Open Access CC BY Licence 3.0 he cannot access the full-text and continues his quest. He lands on the homepage of a medical blog site where he reads that all patients should be treated with an intravenous thrombolytic agent. He gets back to his patient, writes the prescription and the nurse starts the treatment. Soon the condition of the patient deteriorates as he overlooked possible contra-indications that were not mentioned on the blog site. The patient dies after massive gastro-intestinal hemorrhage. This future is already here now as medical students search the internet for FOAM (it is apparently always better or easier when it is accessible for free) and too quickly translate this (often biased and unvalidated) information into clinical practice at the bedside with all possible adverse effects. In retrospect, the website with the therapeutic advice did not have the HONcode quality label and the information was biased and wrong. Herein lays an important task and challenge for universities namely to filter the available FOAM content.

The future is now

To illustrate the fact that medical students and doctors gather information via FOAM websites is described in the following paragraph on the Twitter handle @Fluid_Academy that was created 2 years ago as a personal research project. After 2 years the handle has almost 6000 followers and the FOAM content on the www.fluidacademy.org website is viewed and downloaded more than 100.000 times. So, by providing information for free the return and increased awareness on the topic are exponential. The final 82 pages Social Media report of the official symplur hashtag #IFAD2017 covering the information presented during the 6^th International Fluid Academy Days (iFAD), November 23-25 in Antwerp can be downloaded here: http://fluidacademy.org/component/zoo/item/ifad2017-social-media-report.html

The iFAD is an innovative Critical Care Educational meeting. This conference provides the highest quality of Critical Care education and is guaranteed to innovate and inspire. The iFAD Faculty is the most provocative, engaging, motivating and inspiring group of international educational speakers and as organizing committee we want to ensure we have the sponsors to match. This makes iFAD stand apart from other Critical Care conferences.

• The final Twitter statistics of the #IFAD2017 (data collection period 20/09/2017 – 16/01/2018) show a dramatic increase compared to #IFAD2015 with a total of 25,485,000 impressions, 11,092 Tweets, 1,567 participants and on average 4 Tweets per hour (official statistics on #IFAD2017 are accessible via www.symplur.com).
• The final Twitter statistics of the #IFAD2017 for the whole period are even more astonishing (data collection period 01/01/2017 – 10/03/2018) with a total of 33,763,953 (33 million!) impressions, 14,725 Tweets, 1,854 participants and on average 4 Tweets per hour.

References

1. Nickson C. FOAM – Free Open Access Meducation – Medical education for anyone, anywhere, anytime. https://lifeinthefastlane.com/foam/
2. Cadogan M, Thoma B, Chan TM, Lin M. Free Open Access Meducation (FOAM): the rise of emergency medicine and critical care blogs and podcasts (2002-2013). Emerg Med J. 2014 Oct;31(e1):e76-7. doi: 10.1136/emermed-2013-203502.
3. Thoma B, Sanders JL, Lin M, Paterson QS, Steeg J, Chan TM. The social media index: measuring the impact of emergency medicine and critical care websites. West J Emerg Med. 2015 Mar;16(2):242-9. doi: 10.5811/westjem.2015.1.24860.
4. Hall N. The Kardashian index: a measure of discrepant social media profile for scientists. Genome Biol. 2014 Jul 30;15(7):424. doi: 10.1186/s13059-014-0424-0.
5. Nickson C.P. Free Open-Access Medical education (FOAM) and critical care. ICU Management & Practice, 2017; 17(4): 222-225.

Check out corresponding website www.FOAMbot.org soon (this domain name has been registered on March 14 2018).

Picture courtesy: https://semalt.com/qa/search-engine.htm