Date:  April 25, 2014

Guest Skeptic: Dr. Nicholas Genes is an Assistant Professor in the Department of Emergency Medicine at the Mount Sinai School of Medicine in New York City.

The SGEM is always trying to cut the knowledge translation window down from 10 years to 1 year. It does this using social media to get you the best evidence, critically appraised and easily accessible. This is so you can provide the best care to emergency patients.

We usually do a critical appraisal of a recent paper. However, every so often I like to take a step back to look at the forest not the trees. In this case the beer not the bubbles. So it is time to sit back, relax and discuss a medical education issue.

Nick recently took part in a PRO/CON debate in EP Monthly. The title was Why #FOAMed is NOT Essential to EM Education. The person asked to provide the PRO side: Why #FOAMed is Essential to EM Education was Dr. Joe Lex. Joe has been referred to as the godfather of the FOAMed movement. Everyone in the FOAM community should be familiar with Joe’s famous quote.

Dr. Joe Lex

Dr. Joe Lex

  • 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 last year, go to a (good) conference.
  • If you want to know how we practice medicine now and in the future, use FOAMed

Free Open Access Meducation (Life in the Fast Lane)

Coined in 2012 over a pint of Guinness in Dublin by Dr. Mike Cadogan. FOAM stands for Medical education for anyone, anywhere, anytime. “FOAM should not be seen as a teaching philosophy or strategy, but rather as a globally accessible crowd-sourced educational adjunct. It proveds inline (contextual) and offline (asynchronous) content to augment traditional educational principles.”

FOAM has One Objective — to make the world a better place.


Dr. Nick Genes

Dr. Nick Genes

Nick and I discuss FOAM:

FOAM Moderation – The concept of moderation has been suggested for thousands of years. The ancient Temple of Apollo at Delphi says μηδέν άγαν (mēdén ágan = “nothing in excess“) Any learning tool used in excess could be counter productive to education. People learn using different strategies and FOAM just represents one tool that can be employed.

Twitter – I think twitter was made for the short attention span of emergency physicians (squirrel). We only get 140 characters to get our message across.

Knowledge Translation – Pathman Leaky Pipe Model demonstrates how it can take an average of 10 years for high quality, clinically relevant to reach the patient bedside.

Screen Shot 2014-04-27 at 8.21.21 PM

Retention from Podcasts – There is conflicting data on this idea in the literature. Here is an article by Schreiber et al and by Zanussi et al which discuss podcasts for medical education.

Quality of FOAM – Podcasting quality can vary. Some excellent examples are by David Newman (SmartEM) and Scott Weingart (EMCrit). Poor quality does not just happen in social media but also in traditional media used for medical education.

Screen Shot 2014-04-27 at 8.52.03 PMBEEM Process: Best Evidence in Emergency Medicine (BEEM) is a knowledge translation and dissemination project started at McMaster University by Dr. Andrew Worster. The  mission is to provide Emergency Medicine practitioners with the best clinical evidence to optimize patient care. BEEM has the only validated audience rating tool in emergency medicine continuing medical education.

  • Worster et al. Consensus Conference Follow-up: Inter-rater Reliability Assessment of the Best Evidence in Emergency Medicine (BEEM) Rater Scale, a Medical Literature Rating Tool for Emergency Physicians.Acad Emerg Med Nov 2011.
  • Carpenter CR et al. Best Evidence in Emergency Medicine (BEEM) Rater Scores Correlate With Publications’ Future Citations. Acad Emerg Med. 2013; 20:1004–1012

Referencing FOAM – It is difficult to search and reference FOAM material. However, ALiEM and LITFL are addressing this problem.

FOAM is Too Sexy and Not a Curriculum – There are excellent FOAM resources that look at the boring and fundamental aspects of emergence medicine. These include Brent Thoma (Boring EM) and Steve Carroll (EM Basic).

Finite Time of Trainees – Turn your car into a classroom. Exercise your mind while you exercise your body.

FOAM Too Good – We might get intellectually lazy if we just rely on some of the great FOAM resources (EM Literature of Note) and not dive into the data further.

Final Thoughts –  FOAM is a good way to get up to speed. It is fun to interact with emergency medicine leaders and easy to use. Ironically, without FOAM listeners to this podcast could not get up to speed, have fun and interact with a leader like Nick Genes.

Your conclusion is that you can still be an excellent physician without FOAM. I think the evidence suggests that is very difficult, expensive and time consuming to be an excellent physician without FOAM. Just look at the knowledge translation problem. We know the traditional method takes far to long for high quality, clinically relevant, evidence based information to reach the patients bedside. One definition of insanity is trying the same thing over and over again and expecting a different outcome.

FOAM offers a possible solution to the knowledge translation problem. It is definintetly not a pancea. Research is on-going and I look forward to seeing if FOAM will improve the qualty of care provided to patients. Why not try FOAM as an adjunct to traditional medical education?

KEENER KONTEST: Last weeks winner was Maja Tuta and RN from Hamilton, Ontario.  Maja knew that the Boston Marathon runs through the town of Framingham. This town is famous Framingham Hearth Study started in 1948 looking at cardiac risk factors.

Listen to this weeks podcast for the Keener question. If you know the answer then send your answer to TheSGEM@gmail.com with “keener” in the subject line. Be the first one with the correct answer and I will send you a cool SGEM skeptical prize.

Remember to be skeptical of anything you learn, even if you heard it on The Skeptics’s Guide to Emergency Medicine.