CDEM Voice – Topic 360

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“If you want to know how we practiced medicine 5 years ago, read a textbook.
If you want to know how we practiced medicine 2 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.”

               – International EM Education Efforts & E-Learning by Joe Lex 2012


Since the movement of Free Open Access Medical Education (FOAM) started in 2012, many emergency practitioners and educators have adopted this concept to disseminate information to the medical community. FOAM is an independent platform that includes but is not restricted to blogs, online videos, twitter hashtags, webpage applications and podcasts. The current trend in education has expanded beyond textbooks, lectures, and peer-reviewed articles. FOAM allows for new and updated medical information to be distributed in a timely manner, anytime, anywhere, with the capability of interacting directly with the authors. FOAM is not just a concept; it has become an ideology.

Despite the growing use of FOAM, there are several professionalism issues that we as educators and researchers need to consider. For instance, who is to be blamed if a medical error occurs from using FOAM in patient care? How can you rate the quality of the information you are reviewing? To investigate these issues, Academic Life in Emergency Medicine introduced the concept of an Approved Instructional Resources (AIR) series. In this series, a nine-person executive board of clinicians created a 5-question rubric score. This tool can be used by medical educators to rate online resources and better evaluate the quality of the information to further help their learners effectively utilize FOAM resources.

Another issue that has not yet been addressed by the medical education community is how to maintain ownership when reviewing, sharing, or creating a FOAM idea. FOAM is defined as “open access,” which means: “free availability to the public internet permitting any user to read and distribute without financial, legal or technical barrier.” This is a beauty and a curse at the same time. Although it provides users unrestricted access to educational materials, it does not provide a copyright to authors over the integrity of their work and the right to be appropriately acknowledged and cited. One might assume that since we are in a highly professional field, users will follow common ethics and professionalism when it comes to sharing and crediting FOAM content. However, there have been instances where an individual publicly shared their innovative idea that was then translated into a successful project by another individual with no mention to the originality of the project.

A discussion on Life in The Fast Lane suggested composing a FOAM charter or a code, whereby FOAM creators register and are given a special “stamp” which indicates that they have adhered to the principles of ethical use and creation of FOAM. However, who should be appointed to the committee remains unclear.

As medical educators, we should discuss these issues with our learners. Until the medical education community comes forward with consensus on its use, we are relying on the current users of FOAM to challenge contributors, question the evidence, and maintain academic integrity.


Layla Salman Abubshait, MD

Medical Education Fellow

Department of Emergency Medicine

Beth Israel Deaconess Medical Center



  1. Chan, Teresa Man-Yee, Andrew Grock, Michael Paddock, Kulamakan Kulasegaram, Lalena M. Yarris, and Michelle Lin. “Examining Reliability and Validity of an Online Score (ALiEM AIR) for Rating Free Open Access Medical Education Resources.” Annals of Emergency Medicine6 (2016): 729-35. Web.
  2. Nickson, Chris. “Time for a FOAM Charter?” Blog post. Life in the Fast Lane. Chris Nickson, 28 July 2013. Web. <;.

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