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 VirtualER.org 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 http://googlefoam.com/