Friday, April 1 2016

Reflection on Blogging (Week XII)

I’ve grown up with social media. Blogs, wikis, message boards and so on are not new to me. I have spent my whole adult life plus my adolescence with these tools being largely present. I have also been involved in developing these tools as I was a web developer during my undergrad years. With this background, one might assume I would be enthusiastic about blogging and social media. I am not.

Sure, this technology has a role. It is useful for collaborating and for disseminating certain types of information. It also has an undeniable entertainment role. The use of social media within education has become routine in my educational and professional experience. Throughout my entire medical training blogs and podcasts, often produced by near celebrity medical educators, have been present and personally occasionally used. My exposure to this tool in an education context is frequent. My medical specialty leads in the use of such tools towards educational purposes within medicine (Nickson et al., 2014).

Despite all this I think social media and blogging is terribly overrated when it comes to education. I highly suspect that within the next 10 to 15 years this current period will stand as one overly enthusiastic about social media in general.

Sure, I have read a multitude of papers supporting the use of this technology. I don’t deny that it has a purpose. I just think it is overused, and too enthusiastically adopted. Yes, blogs are wonderful for applying constructivist principles. They allow learners to construct knowledge and form new understandings within specific context (Xie et al., 2008). Yes, blogs can help shape knowledge being learned, and provides scaffolding for transfer of knowledge. I’ll even admit that blogs can enhance metacognition, promoting reflection and critical thinking (Shepard et al., 2000; Xie et al., 2008).

My point isn’t that blogs are bad, it is that they are overly used when other options may be better suited. When blogs, or similar equivalents, are used as a means to promote content creation and application of readings I have my doubts that the connectavist goals behind adoption of this technology are being fulfilled. Yes, a blog does allow for construction of knowledge around readings, for self-directed learning, discovery learning and adult learning principles (Turner, 1980; Xie, et al., 2008). Where the issue lies is in the very features which makes blogs attractive. A blog is a blank canvas. If the collaborative process is not an enriching one, then the social aspect of the blog completely breaks down. This is obviously context and situation dependent. However, in the education context, discussion around blog articles is often mandated. Due to this fact there is often minimal effort to acquire intrinsic motivation behind student blog discussion. In this environment the collaboration quickly becomes very artificial (Xie et al., 2008). The moment “discussion requirements' are met conversation abruptly ends. This isn’t always the case, but unless there is a particularly inspired or motivated group, my personal experience is that this often is the case.

I appreciate the self-directed nature of creating a blog, and how this speaks well to adult learning principles (Turner, 1980). Nevertheless, some instructional structure behind blogs has been shown to be beneficial, particularly when used as an adjunct  supplementing a larger curriculum. This in itself is not failsafe, readings and other directed activities inspiring blog pursuits still must speak and be relatable to the student to be educational (Xie et al, 2008). If these factors are not achieved the whole concept of connectavist and adult learning through a blog breaks down. There won’t be any motivation for an activity that is non-contextual.

I did not embrace this blog assignment. This is my failing.

I should have taken greater responsibility for my own learning within this course. My participation in this blog assignment reflects the perceived value versus time relationship behind the assignment. Nevertheless, once I had this perception I should have sought guidance. Instead, I just continued with my other independent work, and my own readings on this topic. Maybe I missed a potential learning opportunity from an augmented assignment would have possibly been afforded?

I have this perception because I’ve been involved in academic medical education for several years. My background in online technologies, prior to my current career, has led me to read a fair amount around the medical peer-reviewed literature pertaining to the course modules. I’ve been doing this before this course started, during it, and will continue afterward. Therefore, the blog did not play a role in motivating me to construct knowledge and make connections between concepts. I’ve already been doing this, plus attending relevant face-to-face journal clubs to discuss this literature.  The social aspect of the blog was largely removed for me due to the lack of intrinsic motivation behind the comments. Blog dialogue was frankly limited. Again, I should have continued with my comments, in hindsight it would have helped create a more fruitful overall environment and combated the very issue that turned me off from the assignment.

Will I continue with the blog? Probably not. But I do think that I will participate in a voluntary online medical education Journal club. This is somewhat like a blog. I believe this format, although using the same underlying technology as a blog, will overcome some of the precieved issues. Recent evidence supports such a notion (Sortedahl, 2012). The Journal club being voluntary will mean conversations will be generated out of genuine interest, and there will be a loose structure governing the readings and topics generating dialogue. I’m excited to see if this online learning activity augments my regular readings with the connectavist and social learning principles discussed in this course.


Nickson, C. P., & Cadogan, M. D. (2014). Free Open Access Medical education (FOAM) for the emergency physician. Emergency Medicine Australasia, 26(1), 76-83. doi:10.1111/1742-6723.12191

Shepard, L. A. (2000). The Role of Assessment in a Learning Culture.Teaching and Learning, 29(7), 229-253. doi:10.1002/9780470690048.ch10

Sortedahl, C. (2012). Effect of Online Journal Club on Evidence-Based Practice Knowledge, Intent, and Utilization in School Nurses.Worldviews on Evidence-Based Nursing, 9(2), 117-125. doi:10.1111/j.1741-6787.2012.00249.x

Turner, J. D. (1980). The meaning of adult education. Manchester: University Library of Manchester.

Xie, Y., Ke, F., & Sharma, P. (2008). The effect of peer feedback for blogging on college students' reflective learning processes. The Internet and Higher Education, 11(1), 18-25. doi:10.1016/j.iheduc.2007.11.001

A competency based medical curriculum requires digital technology (Week IX, Added week XII)

CanMEDS FrameworkToday, in the 21st century, the volume of medical knowledge has grown exponentially. Historically, medical education was focused on developing clinical skills and medical knowledge. Today such a narrow focus is deemed completely inadequate. Now a physician is expected to be a medical expert who is also a scholar dedicated to lifelong learning, and who integrates new and rapidly progressing knowledge. He or she is expected to be an excellent communicator, a patient advocate, a leader within the health care system, and a collaborator working with a multitude of other professions. In 1996, the Royal College of Physicians and Surgeons of Canada recognized the need for this broad skill set with the publication of the CanMEDS physician competency framework (Frank, 2015). The CanMEDS framework provided a new set of goals within medical education. With these new goals come new challenges. The now antiquated assessment models struggle to evaluate many skills demanded in a competent physician. Studies have shown that traditional means of evaluation cannot easily assess the performance of many of the physician roles defined in the CanMEDS framework (Chou, 2008; Sherbino, 2013).

A new means of evaluating and determining the progress of a learner within medical education is required. This has led to the educational model of competency-based medical education (CBE) becoming adopted as the optimal means to evaluate and determine the progress of the medical learner. A CBE curriculum operates on the premise of defined educational objectives. The trainee must demonstrate proficiency in these define objectives to progress to more advanced tasks. The notion of CBE is not new, and the theoretical behaviorist underpinnings of this construct were first defined by experimental psychologists such as Thorndike and Skinner (Morcke, 2013).

The Royal College has responded to the adoption of a CBE framework by defining the physician roles with various competencies now called milestones. Collectively, these are to be evaluated (Frank, 2014). Now a new challenge is on the horizon for the medical educator. How can the educator evaluate proficiency within these now defined milestones? How can we determine if the medical trainee is indeed competent for his or her expected level of training in a given role? Without developing valid methods of evaluation, an effective CBE curriculum is impossible. I believe digitally assisted instruction will play an essential role in empowering both the medical trainee and the educator in learning, teaching and evaluating CBE milestones. Likewise, a growing body of work has demonstrated that technology-enhanced simulation is a superior for teaching and demonstrating mastery of many procedural skills required by healthcare professionals (Cook, 2013; Willis, 2015). Cognitive and problem solving tasks can also be effectively and efficiently taught and evaluated through the application of digital technologies. The digital medium is superbly poised to address such needs by applying connectivist theory. Furthermore, such technology facilitates discovery learning and learner centered design principles. Additionally, online assessment of graduate medical trainees has also been found to be effective in improving learner performance (Karakus, 2014; Nacca, 2014; Pusponegoro, 2015; Wickens, 2015). Collectively, these developments and insights into the digital facets of medical education suggest that these tools are useful adjuvants in instruction and assessment. This technology is particularly advantageous when applied to curricula based on CBE milestones, and due to the Royal College mandate towards this instructional design model, this technology is needed more than ever within medical education. Digital tools allow instructional objectives which are not commonly encountered at the bedside nor easily assessed within the everyday clinical environment to be teachable and assessable within a CBE curriculum. Therefore, the medical educator must be versed in educational theory and practice, along with digital technology application. Though successful implementation of clinical bedside teaching together with mindful instructional design which is inclusive towards digital technology the best possible learning opportunities to the physician in training can be provided.


Chou, S., Cole, G., McLaughlin, K., & Lockyer, J. (2008). CanMEDS evaluation in Canadian postgraduate training programmes: Tools used and programme director satisfaction. Medical Education, 42(9), 879-886.

Frank, J., Snell, L., & Sherbino, J. (2015). The Draft CanMEDS 2015 Physician Competency Framework. CanMEDS 2015.

Sherbino, J., Kulasegaram, K., Worster, A., & Norman, G. (2013). The reliability of encounter cards to assess the CanMEDS roles. Advances in Health Science Education, 18(5), 987-996.

Karakus, A., & Şenyer, N. (2014). The preparedness level of final year medical students for an adequate medical approach to emergency cases: Computer-based medical education in emergency medicine. International Journal of Emergency Medicine, 7(3), 1-6.

Morcke, A., Dornan, T., & Eika, B. (2013). Outcome (competency) based education: An exploration of its origins, theoretical basis, and empirical evidence. Advances in Health Science Education, 18(4), 851-863.

Nacca, N., Holliday, J., & Ko, P. (2014). Randomized Trial of a Novel ACLS Teaching Tool: Does it Improve Student Performance? Western Journal of Emergency Medicine, 15(7), 913-918.

Pusponegoro, H., Soebadi, A., & Surya, R. (2015). Web-Based Versus Conventional Training for Medical Students on Infant Gross Motor Screening. Telemedicine and E-Health, 21(12), 1-6.

Wickens, B., Lewis, J., Morris, D., Husein, M., Ladak, H., & Agrawal, S. (2015). Face and content validity of a novel, web-based otoscopy simulator for medical education. Journal of Otolaryngology 54(11) 1-8.

Efficacy of Simulation Technologies in Medical Education (Week VIII, Posted Week XII)

Head_and_Chest__1_.jpgA growing body of work has demonstrated that technology-enhanced simulation is a superior method for teaching and demonstrating mastery of many procedural skills required by healthcare professionals. A recent meta-analysis reviewing 82 studies evaluating medical high fidelity simulation and traditional instruction towards mastery learning demonstrated that high fidelity simulation based instruction was associated with large effects on mastery of skills (Cook et al., 2013). A similar study focusing only on emergency medicine trainees also supported the use of high fidelity simulation based instruction. This study compared the efficacy of skills acquisition between technology-enhanced simulation and traditional instruction and demonstrated significant effect sizes in regards to knowledge, time to mastery, and demonstration of skills favouring high fidelity simulation usage within medical training (Ilgen et al., 2013). The use of simulation within post-graduate medical education has shown direct benefits within clinical practice and emergency care. An excellent case control study demonstrated that those trained with supplementary simulation provided significantly improved resuscitation standards while running real cardiac arrest scenarios (Wayne et al., 2008). Such findings suggest that greater use of simulation towards novel instructional tasks may convey similar patientcare advantages.

Some concerns have been raised that high fidelity simulation based instruction is more time consuming than traditional non-simulation learning. A meta-analysis addressing this topic found that ten out of eleven studies demonstrated high fidelity simulation learning being more time consuming, yet these same studies demonstrated greater mastery of skills upon training completion (Cook et al., 2013). Nevertheless, a meta-analysis using only emergency medicine based studies as an inclusion criteria demonstrated the opposite finding. This analysis showed that time towards skill acquisition was significantly reduced when high fidelity simulation was utilized (Ilgen et al., 2013).

Interestingly, simulation using virtual patients, existing only on a computer, has been effective at teaching and refining clinical practices. A virtual reality simulation combining video, voice recognition and dynamic computer scripts has been used to create virtual patient interview encounters. The use of such simulation demonstrated significantly improved patient alcohol screening scores when contrasted to traditional live instruction (Fleming et al., 2009). This finding suggests some clinical skills may benefit from the increased repetition and diversity of experiences afforded by digital simulation may be superior to traditional means of medical instruction in certain tasks. It would be interesting to see further research on the use of online based simulation; this is a relatively novel area within medical education. Such online based simulation could hold multiple benefits, from lower costs, to decreased maintenance and set up needs. Because of these factors online-based simulation may further reduce the time requirements needed for instruction utilizing simulation.


Cook, D. A., Brydges, R., Zendejas, B., Hamstra, S. J., & Hatala, R. (2013). Mastery learning for health professionals using technology-enhanced simulation. Academic Medicine, 88(8), 1178-1186. doi:10.1097/acm.0b013e31829a365d

Fleming, M., Olsen, D., Stathes, H., Boteler, L., Grossberg, P., Pfeifer, J., & Skochelak, S. (2009). Virtual Reality Skills Training for Health Care Professionals in Alcohol Screening and Brief Intervention. The Journal of the American Board of Family Medicine, 22(4), 387-398.

Ilgen, J., Sherbino, J., & Cook, D. (2013). Technology-enhanced simulation in emergency medicine: A systematic review and meta-analysis. Academic Emergency Medicine, 20(2), 117-127. doi:10.1111/acem.12076

Wayne, D. B., Didwania, A., Feinglass, J., Fudala, M. J., Barsuk, J. H., & Mcgaghie, W. C. (2008). Simulation-Based Education Improves Quality of Care During Cardiac Arrest Team Responses at an Academic Teaching Hospital. Chest, 133(1), 56-61. doi:10.1378/chest.07-0131

Gamification Ideal for Medical Education? (Week V, Added Week XII)

Within recent years the concept of gamification has acquired increasing popularity (Mckeown, 2016) More recently such educational technology utilizing gamification principles has been explored within medical education (Graafland et al., 2012). The interactive and collaborative nature of many online applications possibly lends well to both clinical and educational gamification principles. Central to the concept of gamification is motivations towards learning and changing behaviour. Evidence is shown that intrinsic motivation is more successful towards long-term behaviour change. Mandated change or extrinsic motivation has been shown to be less successful over long periods of time. The goal of gamification is to provide intrinsic motivation in the learner by connecting with their core values in providing rewards and positive reinforcement towards self-determined change (Ryan, & Deci, 2000). Successful games to continually challenge the player in order to keep the user interested with new tasks and experiences. This fits well with Ericsson’s theory of deliberate practice. A player should not be automatically good at the game however with repetitive training the player should be guided towards becoming an expert (Blohm, & Leimeister, 2013). Such a principle facilitated through carefully designed software holds much potential within medical education. After all, these basic principles are proven extremely motivational within the commercial context. Many of these concepts are used successfully within the video game industry in order to “hook” players into the game environment for long periods of time (Wit-Zuurendonk, & Oei, 2011).

Gamification within education falls under the category of “serious games”. The so-called serious games have non-entertainment purposes behind their design. They may be entertaining, and they should be intrinsically motivating, but their main purpose is towards changing behaviour and learned tasks. Upon review of the medical literature a few recent studies show promise (Graafland et al., 2012).

Digital laparoscopic simulation is shown a statistically significant correlation with handling surgical tasks within a live animal model (Rosenberg et al., 2005). An emergency department simulator game has also been developed and has shown promise in significantly increasing triage accuracy amongst nurses (Knight et al., 2010). Virtual patient simulators have also been developed which apply gamification principles. For instance, a virtual emergency department has been created were medical students manage six cases simultaneously. It has been shown that this technology improved team and leadership performance scores and enhanced medical content knowledge (Youngblood et al., 2008). These principles of gamification have also been applied at the organizational level. An online award based system was implemented for a surviving sepsis campaign which demonstrated a significant reduction in mortality (Mckeown et al., 2016).

With this success, these games could potentially replace certain aspects of clinical teaching. The self-directed nature of many such of many such games lends itself well to discovery learning and learner centred instructional design. One obstacle towards more readily adopting this technology has been proving content and face validity of the particular computer programs, which are often simulators (Graafland et al., 2012). Such evidence-based practice within medical education is required in order to adopt educational technologies which of the potential to directly or indirectly affect patient care. Recent systematic review demonstrated that out of 30 serious games identified within the medical peer-reviewed literature, only six had completed full validation (Graafland et al., 2012).

Within the future, and with the increasing evidence behind such games, this validation will likely accelerate, however this will slow adoption of this innovation. It may be more expedient to apply principles of gamification to junior medical trainees who are not yet immersed in the clinical environment. Massive online open courses (MOOCs), have applied many of these principles of gamification successfully (Harder, 2013). This is achieved through providing online badges, and applying the benefits of social media as a reward. In this way a learner who is successful in tasks is positively reinforced by receiving social capital (Harder, 2013). The development of such MOOCs is still a relatively early stage within medical education. This would be an area ripe for further research.

The need to train medical experts efficiently and to provide intrinsic motivation towards tasks which may not be generally immediately recompensing, demonstrates a potential demand for further gamification within medical education. The underlying educational theory behind gamification makes sense especially with the medical education context. The initial researchers produced over the last 10 years shows promise for profound benefits. Nevertheless, further research of gamification is required, especially in simulation-based learning.

References: Blohm, I., & Leimeister, J. (2013). Design of IT-based enhancing services for motivational support and behavioral change. Business and Information Systems Engineering, 55(4), 275-278.

Graafland, M., Schraagen, J. M., & Schijven, M. P. (2012). Systematic review of serious games for medical education and surgical skills training. British Journal of Surgery, 99(10), 1322-1330. doi:10.1002/bjs.8819

Harder, B. (2013). Are MOOCs the future of medical education? BMJ,346(2). doi:10.1136/bmj.f2666

Mckeown, S., Krause, C., Shergill, M., Siu, A., & Sweet, D. (2016). Gamification as a strategy to engage and motivate clinicians to improve care. Healthcare Management Forum, 29(2), 67-73. doi:10.1177/0840470415626528

Ryan, R. M., & Deci, E. L. (2000). Intrinsic and extrinsic motivations: classic definitions and new directions. Contemporary Educational Psychology,25(1), 54-67. doi:10.1006/ceps.1999.1020

Wit-Zuurendonk, L. D., & Oei, S. (2011). Serious gaming in women’s health care. International Journal of Obstetrics & Gynaecology, 118, 17-21. doi:10.1111/j.1471-0528.2011.03176.x

Social Media Use in Medical Education: The blurring of boundaries?

Web 2.0 technology has had an impact on education by facilitating a transition from static online resources to dynamic user-created resources. Such modern systems allow for continuous modification of content through the participation of users. These features present numerous educational opportunities for instructors and students alike.

Unsurprisingly, this technology has been embraced in medical education. Namely, social media have been increasingly used to educate healthcare trainees. A recent review of social media with medical education has revealed that collaborative online educational projects use platforms such as Wikimedia, and social bookmarking applications. This technology also uses blogs and forums such as Twitter and WordPress or phpBB which allows for interaction between instructor and learners through the posting of comments. Features of both of these technologies have led to content communities existing on platforms such as YouTube, Flickr, and Slideshare, and the use of social networking sites such as Facebook, ResearchGate and LinkedIn (Hamm et al., 2013). North American medical educators have led this adoption of Web 2.0 technology. A recent review revealed that approximately 63% of such resources are created by those based in this geographic location. Of the available technologies discussion forums, blogs and social networking are the most popular platforms used within medical education (Hamm et al., 2013).

This has led to discussions and the exchange of information formally confined to the clinical environment being brought online and made widely and publically available. This raises some important questions about professionalism. For example, nursing students who posted photos of a placenta, which they examined on an obstetrical rotation, on Facebook were expelled for unprofessional activity (Parkinson & Turner, 2014). Similarly, a recent study surveying Facebook profiles of medical students within one medical school class revealed 1% of trainee profiles demonstrating unprofessional content, such as demonstrations of excessive alcohol consumption or explicit language (Gupta et al., 2015). Likewise, 60% of American medical schools’ report cases of medical students inappropriately using social media in a clinical context (Moses et al., 2014). Such cases require the careful attention of those creating and using medical education content online within the educational context. Another concern is the dissemination of medical knowledge and possible and inappropriate use of this information. Liability concerns for content creators also warrants consideration.

Issues about patient confidentiality and professional boundaries are inherently raised through the adoption of these technologies. The greatest strength of free open access medical education (FOAM) is the ability to democratize medical knowledge. This requires the use of Web 2.0 technologies and for public dialogue. This same strength when misused can lead to professionalism and boundary concerns. Medical educators and trainees must find a balance between empowering medical professionals and students, facilitating reflection and self-expression, while defining necessary boundaries.

To assist those using these resources most regulatory bodies within medicine have created guidelines for the appropriate use of social media (College of Physicians and Surgeons of Ontario, 2016). Generally, this involves maintaining the professional and ethical principles expected within the clinical environment, especially those regarding patient confidentiality. Often it is also recommended that disclaimers be added to any general medical advice provided, and to be careful to represent professional designations carefully. Also, it is recommended that healthcare and academic institutions develop auditing policies for trainees and faculty (Moses et al., 2014). Through the mindful use of online digital tools, traditional medical education instructional methods can be enhanced. However, like any new technology, we must be aware of its limitations and potential dangers. The clinical setting holds some unique challenges that require particular attention in this respect and the specific rules governing appropriate use require frequent updating and re-evaluation as these digital tools rapidly evolve.

College of Physicians and Surgeons of Ontario. (n.d.). Social Media - Appropriate Use by Physicians. Retrieved February 07, 2016, from

Gupta, S., Singh, S., & Dhaliwal, U. (2015). Visible Facebook profiles and e-professionalism in undergraduate medical students in India. Journal of Educational Evaluation for Health Professions, 12(50), 1-5. doi:10.3352/jeehp.2015.12.50

Hamm, M. P., Chisholm, A., Shulhan, J., Milne, A., Scott, S. D., Klassen, T. P., & Hartling, L. (2013). Social Media Use by Health Care Professionals and Trainees. Academic Medicine, 88(9), 1376-1383. doi:10.1097/acm.0b013e31829eb91c

Moses, R. E., Mcneese, L. G., Feld, L. D., & Feld, A. D. (2014). Social Media in the Health-Care Setting: Benefits but Also a Minefield of Compliance and Other Legal Issues. The American Journal of Gastroenterology, 109(8), 1128-1132. doi:10.1038/ajg.2014.67

Parkinson, J., & Turner, S. (2014). Use of social media in dental schools: Pluses, perils, and pitfalls from a legal perspective. Journal of Dental Education, (78), 1558-1567.

Monday, February 1 2016

Student Blog Comments for EDUC5101G (Week III)



In regards to assessment of resources, I think at the end of the day one needs a replicable and systematic approach towards evaluating online resources in education. I ideally such a system would be validated statistically.

You may find the eLSE Methodology interesting in this respect. This methodology isn't validated, which is unfortunate , however it does present a framework for systematic assessment (Lanzilotti et al., 2006). It roughly consists of two phases:

The preparatory phase:

Consists of the identification of guidelines to be considered during the assessment. One of the goals is to identify specific tasks which are actual tasks that users are required to perform with the online resource.

The execution phase:

Consists of inspection, performed by evaluators. User-based evaluation is conducted when there is a disagreement among the evaluators. The user testing sessions, involve real users of the technology, such as students and so on.

The result of this activity is an assessment report describing the problems detected, possibly revised in the light of the user testing outcome, and a summary of the user experience with the technology assessed.

An interesting read if you are interested in such things.

R. Lanzilotti, C. Ardito, M. Costabile, & A. De Angeli. (2006). eLSE Methodology: a Systematic Approach to the e-Learning Systems Evaluation. Journal of Educational Technology & Society, 9(4), 42–53.

Sunday, January 31 2016

Towards next-gen free open access medical education (FOAM)?

The rise of free open access medical education, arguably the most popular use of digital tools within medical education, has greatly altered the manner in which a clinical educator and trainee approach online learning. FOAM consists of various online tools such as blogs, podcasts, wikis and online videos. An adjuvant to this digital learning environment are certain elements of mainstream social media such as Twitter (Nickson & Cadogan, 2014). Although the term "FOAM" was coined only in the last few years the creation of these digital resources are not new, the origins of these tools within medical education date to at least 2002. Nevertheless, the popularity and mainstream acceptance of these resources have ballooned over the last decade with the most popular FOAM websites receiving over 10 million visits a year (Cadogan et al., 2014).

As a medical learner, I have certainly been aware of FOAM for several years. I have also used all of the mentioned incarnations of this resource, from blogs to podcasts. Nonetheless, my use of these resources has been fleeting at best. This runs somewhat counter to my trend to eagerly adopt technology in other realms of my life. At best these resources have remained on the very periphery of my medical education. Integrating these resources into my instruction of learners, has been largely relegated to passing on quotes found within an interesting blog here and there.

The next logical question to ask is why this is the case? On responding to this question I have a passionate response both as a medical learner, budding educator and as someone who envisions online learning as a fundamental aspect of the future of medical education. FOAM represents potential. It provides a glimpse at the power held by the digital platform when used as a medium to educate. This digital technology is not used to its full potential today, other areas of education outside of medicine stand as testament to this fact. One needs only to look at the many massive open online courses (MOOC) available to see this technology used more optimally.

When considering FOAM the following analogy comes to mind: The internet provides one of the most powerful tools ever developed to facilitate collaborative, interactive and learner-centered instruction. The internet which powers FOAM is the automotive equivalent to a Ferrari. If we push this technology, we could go 300km/hr. Today we do not use this potential power in how we apply FOAM. Instead, we drive our Ferrari 10km/hr...

Here are the underlying issues I have with FOAM as it stands today. Firstly, every day we have more and more blogs, podcasts and so on. How do we organize these resources? Sure, FOAM Search, a search engine utilizing google's underlying search engine and dedicated towards FOAM resources is a start. It does not resolve the underlying issue of disjointedness between different independently crafted resources. One would imagine a database resembling something more like PubMed would better serve this purpose. Alternatively, and even better yet, the format of a MOOC could gather up independent "lessons" crafted by various individuals and across different sites to over a mini-curriculum. Such integration would allow for comprehensive implementation of various learning theories and offer more evidenced based educational experiences. The application of MOOCs within a postgraduate medical education setting has shown much promise. The pre-existing FOAM resources would lend themselves naturally to this format (Subhi, 2014).

A MOOC format would also be a useful medium for increasing interactivity between learners and with instructors. FOAM applied in this manner would no longer be limited to instructional blogs and a comments. Instead, assignments and active participation of learners and instructors within the digital environment would be possible. This opens up many exciting instructional design principles (Subhi et al., 2014). Furthermore, elements of gamification are easily integrated within MOOCs. Of interest, the benefits of gamification have been recently presented within the medical education setting (Muntasir et al., 2015).

Another issue with FOAM today is quality insurance. Anyone can create a blog, podcast or post a wiki article. When conveying clinical information, the validity of the source is of importance. A peer-review process used by open access journals is a possible solution of this problem. A validated scoring system adopted within the FOAM community would help overcome this issue. Such a system is currently in development, yet such peer-review certification processes are not widespread at the moment (Thoma, et al., 2014).

FOAM must also look beyond current formats such as WordPress blogs and WikiMedia sites. Purpose built digital education sites would offer even further customizability and user interaction. Virtual patients have proven useful for various medical education experiences. Purpose built sites such as the could allow for FOAM based simulation, combining the collaborative benefits of FOAM with the advantages of virtual online patients (Dafli, 2015).

At the end of the day, this all boils down to next generation FOAM focusing on integrating concepts of learning theory. FOAM should be assessed based on how well such theory is applied. A recent systematic review concluded that core learning principles derived from well-known learning theories should be applied to the creation of digital tools. This proposed system highlights optimizing modality, minimizing extraneous cognitive load, applying elaboration and discovery theory, spiral curriculum elements, optimizing modality through various online media formats, providing clear objectives to facilitate connectivist learning, and framing objectives (Lau, 2014).

FOAM holds an enormous amount of potential. I would even argue it is the future. However, the days are early yet. With the rise of more digital medical educators, the transition to next generation FOAM is likely inevitable. This transition is poised to be an exciting process and one which I thoroughly look forward to both as a learner and as an educator.


Cadogan, M., Thoma, B., Chan, T. M., & Lin, M. (2014). Free Open Access Meducation (FOAM): The rise of emergency medicine and critical care blogs and podcasts (2002-2013). Emergency Medicine Journal, 31(E1). doi:10.1136/emermed-2013-203502

Dafli, E., Antoniou, P., Ioannidis, L., Dombros, N., Topps, D., & Bamidis, P. D. (2015). Virtual Patients on the Semantic Web: A Proof-of-Application Study. Journal of Medical Internet Research, 17(1). doi:10.2196/jmir.3933

Muntasir, M., Franka, M., Atalla, B., Siddiqui, S., Mughal, U., & Hossain, I. T. (2015). The gamification of medical education: A broader perspective. Medical Education Online, 20(3). doi:10.3402/meo.v20.30566

Lau, K. H. (2014). Computer-based teaching module design: Principles derived from learning theories. Medical Education, 48(3), 247-254. doi:10.1111/medu.12357

Nickson, C. P., & Cadogan, M. D. (2014). Free Open Access Medical education (FOAM) for the emergency physician.Emergency Medicine Australasia, 26(1), 76-83. doi:10.1111/1742-6723.12191

Subhi, Y., Bojsen, S., Nilsson, S., & Konge, L. (2014). Massive open online courses are relevant for postgraduate medical training. Danish Medical Journal, 21(10), A4923.

Thoma, B., Chan, T., Desouza, N., & Lin, M. (2014). Implementing peer review at an emergency medicine blog: Bridging the gap between educators and clinical experts. Canadian Journal of Emergency Medicine, 12(2), 188-191. doi:10.2310/8000.2014.141393

FOAM Search, Retrieved January 31, 2016, from

Sunday, January 17 2016

About the Author

Kenneth Van Dewark BMSc MD
McMaster FRCPC Emergency Medicine - PGY4

I'm currently an emergency medicine resident at McMaster University. Long before I had a passion for medicine I enjoyed exploring and developing online technologies. Over the years of my medical training, I have grown increasingly interested and involved in education. I believe all of these interests, medicine, digital technology, and education can work synergistically together to improve the care delivered to patients seen in our emergency departments.

To facilitate this aim, I am currently compleating a Masters of Education at the University of Ontario Insitute of Technology. This graduate program has a particular focus on digital technologies within education. I have also been developing a novel educational tool, an online simulated emergency department called the VirtualER. Research into this tool is ongoing and validation of this online simulator is underway. It is my strong belief that the online medium can assist in the education of tomorrow's physicians and that this technology must be continuously pushed forward. Blogs and podcasts are very useful tools and are the current foundation of Free Open Access Medical Education (FOAM). Yet, the online medium holds potential to greatly expand the current offerings and to facilitate the development of more interactive and learner-centered educational experiences. Similarly, it is my firm belief that as digital technology becomes an ever more important factor within medical education a further subset of clinicians who have a background in digital technology, education theory and bedside medicine will be required.

Regarding these various ideas, recently the Royal College of Physicians has generously assisted me in providing the opportunity for further development of such expertise through the Robert Maudsley Fellowship. This support has greatly assisted in both the development of the VirtualER and with my current graduate studies in education.

This blog will outline some of these ideas and explore the related literature. Oh, and of course, I will be testing out some new online technologies and sharing my thoughts! Please feel free to comment and provide your insight! I look forward to the exchange of ideas and related discussion!

- Ken