Continuing medical education is transitioning away from static and unidirectional methods such as lectures and textbook material. The FOAMed (for free open-access medical education) movement has made great strides in transforming the education of medical professionals, particularly in the field of emergency medicine.
Free open-access medical education (#FOAMed, as it’s known on Twitter) is a term coined by Mike Cadogan in a 2012 talk he presented at the International Conference on Emergency Medicine.1 The term was invented to rebrand the use of social media in medical education. FOAM is not a teaching philosophy but rather “a globally accessible crowd-sourced educational adjunct providing…asynchronous content to augment traditional educational principles.”2 Composed of diverse online resources such as podcasts, blog posts, Twitter feeds, and Google Hangouts, FOAMed is both an educational resource and a community of medical professionals wanting to further their own education.
Since the founding of “Life In the Fastlane” by Cadogan and Chris Nickson in 2007, the number of FOAMed blogs and online educational resources dedicated to topics in emergency medicine and critical care has grown at an exponential rate.3 Several studies of social media use in medical education suggest this trend is beneficial and that use of online learning resources promotes clinical excellence.4,5
As adult learners who work shift schedules that can make synchronous education less accessible, EMS providers may benefit greatly from use of FOAMed. Indeed, free open-access medical education for EMS providers now has its very own acronym: FOAMems. But do most EMS providers use online resources and/or view themselves as part of this vigorous and collaborative online learning community?
A Brief Survey
Between November 2015 and September 2016, we conducted an anonymous e-mail survey of EMS providers through the mailing lists of top organizations. Our questions were based on a prior survey of emergency medicine residents but modified for EMS providers (see Figure 1).6
Some 426 EMS providers responded, ranging in age (19 to 74 years) and prehospital clinical experience (4 months to 57 years); see Table 1. Most respondents (81%) were trained at the ALS level. Respondents worked in all types of EMS services and practiced in 33 different states (Figure 2).
Most respondents spent at least some time on extracurricular educational activities each month, with 65% spending at least 2–4 hours. Most organized their reading topics based on recent patients seen (39%) and used web searches (87%) and online videos (82%) to find additional information. Textbooks followed closely behind (63%). Those responses closely matched what participants found most useful.
While use of online materials was common, familiarity with the concept and community of FOAMed was rare (Figure 3). The majority of EMTs (85%) and paramedics (72%) were not at all familiar with the term FOAMed. Overall 16% of nonphysicians and 50% of physicians were at least somewhat familiar with the term. Despite this, survey participants used a number of resources that could be considered FOAMed: 32% of survey respondents read blogs, and 34% listened to podcasts for their asynchronous education. Even among those unfamiliar with the term FOAMed, 25% utilized blogs, and 24% listened to podcasts.
Among EMS providers who were at least somewhat familiar with the term, 36% found blogs and 50% found podcasts the most useful source for asynchronous education. Among a small sample of popular EMS blogs and podcasts, EMSWorld.com and ems12lead.com were the most popular (Figure 4).
Learning Theory and a Model for EMS CE
Paramedics, EMTs, and other prehospital providers are adult learners. Adult learners learn best by being self-directed and problem-oriented, and by relating new knowledge to past experiences.8 One tenet of adult learning theory relevant to prehospital providers is readiness to learn: “Adults become ready to learn those things they need to know and be able to do in order to cope effectively with their real-life situations,” wrote Malcolm Knowles, the father of adult learning theory.8
Standard educational formats that require prehospital providers to sit during lectures at specified times do not cater to this readiness to learn in the same way FOAMed can. Online resources can provide educational content where and when the student is ready to learn. This is further supported by our survey results, in which online educational materials were most commonly accessed based on recent patients seen—i.e., likely when a desire to refresh or broaden knowledge is triggered by patient experience. This makes FOAMed particularly useful for “just in time” education regarding emerging topics. Moreover, by decreasing the time window between research and knowledge dissemination, FOAMed can help change practice and enable informed incorporation of evidence into clinical care.9,10
A growing body of evidence indicates asynchronous education is not only preferred by learners but also may be more effective.11,12 For example, social media-based asynchronous learning has recently been endorsed by the Council of Emergency Medicine Residency Directors as a valuable tool, and emergency medicine residencies have been encouraged to formally incorporate FOAMed into their residency curricula.7 Metrics to evaluate the quality of FOAMed content are currently under development.13,14
Similarly, FOAMed can be incorporated into developing models of continuing EMS education. This can be in the form of the “flipped classroom,” where FOAMed resources provide background information prior to interactive class discussion, or curated FOAMed resources for asynchronous education. In addition, the microblogging platform Twitter, typically used to share brief pearls and links to resources, can be used to mediate discussion of classroom and conference content.15
From the perspective of the educator, creating and sharing FOAMed content has a number of benefits, including sharing of educational resources, more rapid and effective dissemination of ideas and evidence-based protocol changes, and recognition for social media-based scholarship.7,13,16 Maximizing the use of quality asynchronous learning also has the potential benefit of being more cost- and time-effective for both provider and agency by utilizing on-duty downtime rather than overtime, although the inability to claim continuing education credit remains a limitation.
Knowles wrote that the “resource of highest value in adult education is the learner’s experience.”8 The EMS experience is diverse, challenging, and asynchronous. It is time the EMS model of continuing medical education reflected this.
Interested in accessing free open-access medical education? Check out the customized search engine for FOAMems on the educational blog of the National Association of EMS Physicians: www.naemsp-blog.com/search-foamems/.
1. Nickson CP, Cadogan MD. Free Open Access Medical education (FOAM) for the emergency physician: Education and Training. Emerg Med Australas, 2014; 26(1): 76–83.
2. Cadogan M. FOAM. Life in the Fastlane, https://litfl.com/foam-free-open-access-medical-education/.
3. Cadogan M, Thoma B, Chan TM, Lin M. Free Open Access Meducation (FOAM): The rise of emergency medicine and critical care blogs and podcasts (2002–2013). Emerg Med J, 2014; 31(e1): e76–7.
4. Mallin M, Schlein S, Doctor S, et al. A survey of the current utilization of asynchronous education among emergency medicine residents in the United States. Acad Med, 2014 Apr; 89(4): 598–601.
5. Cheston CC, Flickinger TE, Chisolm MS. Social media use in medical education: A systematic review. Acad Med, 2013; 88(6): 893–901.
6. Batt-Rawden S, Flickinger T, Weiner J, et al. The role of social media in clinical excellence. Clin Teach, 2014; 11(4): 264–9.
7. Pearson D, Cooney R, Bond MC. Recommendations from the Council of Residency Directors (CORD) Social Media Committee on the Role of Social Media in Residency Education and Strategies on Implementation. West J Emerg Med, 2015; 16(4): 510–5.
8. Knowles M, Holton E, Swanson R. The Adult Learner, 6th ed. Elselvier, 2005.
9. Weingart SD, Trueger NS, Wong N, et al. Delayed sequence intubation: A prospective observational study. Ann Emerg Med, 2015; 65(4): 349–55.
10. Leeuwenburg TJ, Parker C. Free open access medical education can help rural clinicians deliver “quality care, out there.” Rural Remote Health, 2015; 15(3): 3,185.
11. George DR, Dellasega C. Use of social media in graduate-level medical humanities education: Two pilot studies from Penn State College of Medicine. Med Teach, 2011; 33(8): e429–34.
12. Curran V, Lockyer J, Sargeant J, et al. Evaluation of learning outcomes in web-based continuing medical education. Acad Med, 2006; 81(Suppl): S30–4.
13. Lin M, Thoma B, Trueger NS, et al. Quality indicators for blogs and podcasts used in medical education: Modified Delphi consensus recommendations by an international cohort of health professions educators. Postgrad Med J, 2015; 91(1,080): 546–50.
14. Chan TM, Thoma B, Krishnan K, et al. Derivation of two critical appraisal scores for trainees to evaluate online educational resources: A METRIQ Study. West J Emerg Med, 2016; 17(5): 574–84.
15. Thoma B, Joshi N, Trueger NS, et al. Five strategies to effectively use online resources in emergency medicine. Ann Emerg Med, 2014; 64(4): 392–5.
16. Sherbino J, Arora VM, Van Melle E, et al. Criteria for social media-based scholarship in health professions education. Postgrad Med J, 2015; 91(1,080): 551–5.
Maia Dorsett, MD, PhD, is an emergency and EMS physician at the University of Rochester Medical Center. She completed her residency in emergency medicine and EMS fellowship at Washington University in St. Louis. She is medical director for the EMS education programs at Monroe Community College–SUNY; a member of the ITLS editorial board; vice chair of the National Association of EMS Physicians’ Education Committee; and lead editor of the NAEMSP’s educational blog.
Sabina Braithwaite, MD, MPH, FACEP, FAEMS, is EMS fellowship director at Washington University in St Louis and Missouri’s state EMS medical director. She has been active in leadership of several national organizations and projects, including International Trauma Life Support and the EMS Culture of Safety Strategy project. She is board-certified in emergency medicine and subspecialty-certified in emergency medical services.
Jason Wagner, MD, is assistant professor and residency program director at Washington University in St. Louis. He is a lieutenant colonel in the Missouri Air National Guard, where he serves as both a flight surgeon and critical care air-transport physician. He’s been writing and lecturing on the integration of technology with medicine and education for the past decade. Follow him on Twitter @TheTechDoc.
Hawnwan Philip Moy, MD, is medical director for Phelps Air, co-medical director for ARCH Air Methods, editor of the Prehospital Emergency Care podcast, assistant medical director for the St. Louis City Fire Department, and assistant professor of emergency medicine at Washington University in St. Louis. He completed his emergency medicine residency at Barnes Jewish Hospital/Washington University in St. Louis and his EMS fellowship at the University of North Carolina in Chapel Hill.