Dr. Niran Argintaru was in the middle of his shift at St. Michael’s Hospital in Toronto when a patient who had experienced a brief loss of consciousness was taken to the emergency room. A junior resident who was supervising reviewed the patient’s electrocardiogram (ECG) to rule out a cardiac cause.
“He brought me the ECG and said, ‘It looks good.’ But when I asked her what she was looking for, she only knew a few things,” says Argintaru, a senior resident at the University of Toronto. “I took out my phone and went into (the website) Life in the Fast Lane, I showed him some ECGs of things you don’t want to miss.”
Like thousands of other doctors around the world, Argintaru, 30, uses free and open access education (FOAM) to teach residents and keep his own medical knowledge up to date.
“I never carry a book with me,” he says. “All of this is available for free and is in the palm of my hand.”
FOAM is not a unique website, nor is it just a podium to spread anecdotes or opinions. It’s a community for openly sharing medical knowledge and distilling peer-reviewed research into bite-sized, digestible points. Information is shared freely on Twitter, podcasts, blogs, and other platforms under the #FOAMed hashtag.
The nature of medical education is changing, as students and professionals gain access to the latest research at an accelerated rate. But some educators are concerned about the consequences of trusting unregulated information online.
“Textbooks can no longer keep up with the information cycle or the technology cycle,” says Dr. Sara Gray, an emergency and critical care specialist at St. Michael’s Hospital and associate professor at the University of Toronto. “The answer that was correct two years ago is no longer necessarily the correct answer today, and that rate of change makes it very difficult for everyone to agree on exactly how we should practice at any given time.”
I never carry a book with me. All of this is available for free and is in the palm of my hand.
Traditionally, research was presented at conferences, discussed at meetings, and gradually incorporated into international guidelines and textbooks. It would then leak into clinical practice, years after its original publication. This process is known as the “knowledge translation cycle”. With FOAM, things move much faster, and that’s not necessarily a good thing, says Dr. Chris Hicks, an emergency medicine specialist at St. Michael’s Hospital and an associate professor at the University of Toronto.
“The knowledge translation cycle has gotten so short that we’re starting to implement things that maybe we shouldn’t, because they look cool and contemporary on social media… whether or not it’s influenced in practice,” he says. “I don’t know if anyone has actually looked at that.”
On the other hand, FOAM has democratized medical information, Hicks says, giving researchers access to insights they might not otherwise have been exposed to. “In the end, you can do a more thoughtful and comprehensive analysis.”
Dr. David Carr, a staff physician and associate professor at the University of Toronto, is an advocate of the use of social media in medicine, but says students risk ending up with a “Swiss cheese knowledge model.” “, with large gaps in their understanding.
“One of the challenges with FOAM is that if you are only looking for medical knowledge obtained through open access medicine, it tends to romanticize the topics, so sometimes you miss the basics,” he says. “They want to take the weird case, what they know they can talk about on social media…they’re looking for romantic, zebra, esoteric stuff…but they don’t know about basic[things].”
Until recently, social media and medical education shared an uneasy association. Some educators discussed the research on Twitter or posted to blogs, but many doctors were reluctant to participate in traditional social media.
If you want to know how we will practice medicine in the future, listen in the halls and use FOAM
“The word ‘social media’ turns people away,” says Dr. Mike Cadogan, an Australian ER doctor considered by many to be the father of FOAM. “Everyone thinks we’re a bunch of internet geeks who want to know what Snoop Dogg had for breakfast… (so) what we’ve tried to do is come up with an alternative name for social media… we’ve come up with the FOAM project. ”
Cadogan coined the term in 2012 and since then the community has thrived. Symplur, a healthcare social media analytics company, reports that between 2012 and 2016, #FOAMed tweets increased from 40 million to 725 million.
And a study published in the Emergency Medical Journal in 2014 showed that the most popular FOAM websites receive about 11 million visits each year. Students can even find links to pirated copies of textbooks on these sites.
But the latest information is found outside of those textbooks.
“If you want to know how we practiced medicine five years ago, read a textbook,” says Dr. Joe Lex, a retired American physician who helped start the FOAM movement. “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 lecture. If you want to know how we will practice medicine in the future, listen in the hallways and use FOAM.”
Medical schools haven’t reached a consensus on how to deal with FOAM, but are introducing other resources online in the meantime.
Simba Information, a US market research company, found that digital media accounted for more than 42% of undergraduate course materials in 2016, up from 31% in 2014.
Mei Wen, a second-year medical student at the University of Toronto, says her internship includes required online modules and interactive cases.
“Individual tutors, often residents, can point us to a particular online resource (FOAM),” she says.
But your school has not adopted FOAM as part of its curriculum.
It’s unclear how medical schools will engage with (or distance themselves from) FOAM in the future, but the sheer volume of people using it makes it likely that the resource is here to stay. And many learners and educators now say that blog posts and podcasts can actually have a more powerful and immediate impact than publishing in medical journals.
“If I publish a magazine article that a few hundred people read, and they skim it, what is the impact of that?” Carr says. “If I give a talk at SMACC (Social Media and Critical Care Conference), it might be downloaded 100,000 times… that’s where the biggest impact is. I get emails all the time from doctors I’ve never met, I get people coming up to me at conferences, thanking me for something I said on a podcast that helped them save someone’s life.”
Dr. Conor Lavelle is an Emergency Medicine Resident and Global Journalism Fellow at the University of Toronto’s Munk School of Global Affairs.