FOAMing at the mouth

(an introduction to FOAM, for people who have no idea what I’m talking about)


The rise of the internet over the last 20 years has had a profound impact on both practice and education in medicine. Working in the ED, there is not a shift that goes by without my consulting The Oracle to look something up (usually something that I once knew but have long since forgotten).

Medical material on the internet previously consisted mostly of static web pages and images akin to online reference texts (quality variable!) Now, with widespread access to high speed internet services and newer internet-based forms of communication and information dissemination (twitter, facebook, youtube, podcasts….), the store of medical information on the internet has expanded rapidly. More importantly however, multiple means of communicating online AROUND medical information have led to an international explosion of collaboration on knowledge and ideas. This phenomenon has become known as FOAM (free open-access meducation).

The term FOAM was apparently coined over a pint of Guinness in Dublin in 2012. Surprisingly the people who came up with the idea managed to remember it until the morning, and FOAM has become the term that ties together multiple online sources of medical education. Life In The Fast Lane have a great page describing FOAM here, and describe it thus:

FOAM resources are sophisticated, cutting edge learning resources that enable clinicians and students to update their knowledge and improve their understanding in a fun, motivating and time efficient way. It is all free, and can be accessed by anyone, at anytime, anywhere. We believe that together with asynchronous learning and the flipped classroom, FOAM is the future of medical education and lifelong learning

I am a relative neophyte when it comes to FOAM, having heard the term only since setting up this site (late 2012) and scouring the internet looking for resources that may be helpful for our service.

What has struck me about FOAM is how powerful it is at rapidly promoting, refining, and disseminating knowledge that changes practice.

This landmark paper by Richard Levitan and Scott Weingart was published in the Annals of Emergency Medicine in 2012. It provides a superb review of evidence around preventing desaturation during ED airway management, and contains multiple practical (and evidence-based) tips, as well as introducing some lesser known but highly effective concepts like apnoeic ventilation.

While changes in practice would be expected to result from the publication of a landmark paper in a respected and widely circulated journal, FOAM allows even faster dissemination    of knowledge worldwide. Scott Weingart’s podcast, for example, is downloaded by over 100000 people per episode! The techniques described in the paper above are already being used on a daily basis in the Auckland ED, and are equally relevant to our pre-hospital airway management.

Such a rapid evolution in clinical practice would not be possible without FOAM. Changes of practice that rely on textbooks and journals require a timeframe of years rather than weeks or months. FOAM allows people to learn in a time and manner of their choosing.

FOAM also allows people to add their own personal perspectives and stories to medical educational material. Much of the training performed by Auckland HEMS involves airways (RSI being arguably the most important technical skill the addition of doctors to the helicopter has provided). As such I have read, listened to, and scrounged a lot of FOAM resources regarding airway management for this site. With surgical airways in particular, FOAM has provided me with the following pearls that I would probably never have found in a text or journal:

  • announcing loudly “I can’t intubate, I, cant ventilate, I am doing a surgical airway” is a great technique for honing the focus of the team and getting everyone ‘on the same page’ (and it sounds a but more professional than ‘F$@#’)
  • there is a lot of bleeding during a surgical cricothyroidotomy – so much so that some people have abandoned the procedure! Be prepared for this
  • when performing a needle cricothyroidotomy, setups involving syringes/3 way taps/ETT connectors are not necessary – have a look at this!

Snippets of information like these could make the difference between a good outcome and  death in the event of a failed airway – and yet the chances of finding them outside a FOAM format are probably pretty small. Many thanks to Minh Le Cong and Scott Weingart!

To quote Joe Lex (a highly respected emergency medicine educator):

“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 conference.

If you want to know how we will practice medicine in the future, listen in the hallways and use FOAM.”

If you wish to learn more about FOAM, this page is a great place to start.

This is a talk about FOAM by Mike Cadogan at ICEM in 2012:

Plus, of course, SMACC is less than a month away…

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