Free Open Access Medical Education (FOAM) — A Bona Fide Overview Of The Resources and Their Impact
Open Access

Free Open Access Medical Education (FOAM) — A Bona Fide Overview Of The Resources and Their Impact

Sumalatha G
Sumalatha G

Table of Contents


The term Free Open-Access Medical education was coined at the International Conference on Emergency Medicine in June 2012, Dublin. The near exponential development of the internet and digital platforms changed the way to access information and altered the mode of educational resources. Now, the teachers and supervisors are not the primary points of academic access. On the contrary, social media has become the hotspot for imparting easy, flexible, and rapid dissemination of educational resources and acting as immediate access points.

FOAM: Free Open Access Medical Education refers to free medical education access for anyone, anywhere, anytime. It is a collection of community, resources, and ethos. The objective of FOAM is to provide interactive and collaborative open-access medical, educational resources using the digital platform. The platforms might include blogs, podcasts, tweets, Facebook groups, and more. Social networking sites are the primary source of FOAM access in collating and distributing the resources for healthcare professionals and students who participate in the FOAM movement.

The medical education system is currently transforming by curating and distributing high-quality data and actionable diagnostic plans, and FOAM is its cornerstone. It uses online channels and forms a knowledge-sharing community to disseminate ideas and hastens the interpretation of study into clinical practice.

Social media platforms and physicians in emergency medicine & critical care are the primary leads in expanding the online resources to share FOAM content.

Social Media in a Nutshell


To be precise, health care professionals are increasingly using social media platforms like Twitter and Facebook to disseminate and discuss papers and other resources. It is evident that whatever is distributed on the forum will reach millions or thousands of people within no time. Also, people can comment, save, link, retweet, and share their perception on the topic and keep the post trending. Unfortunately, many academic communities are still not aware of the intense power of social media.

As per Chan TM, Thoma B, et al.; "Still, the growing impact of FOAM was not acknowledged in many academic circles. The FOAM community primarily integrated with the rest of the medical community at conferences, where they would speak broadly about social media, addressing misconceptions and skepticism regarding its use and describing how it could be used as a tool for medical education" - A Short History of Free Open Access Medical Education. The Past, Present, and Future.

Impacts of Using Social Media

Social media plays a significant role by helping learners participate in public-facing discussions, establish professional networks, and facilitate conversations about the latest and advanced medical practice and literature globally. It is a crucial resource for physicians to offer advice and partake in medical knowledge.

Here's what Joe Lex quoted about Social Media;

"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" - Joe Lex, International EM Education Efforts & E-Learning (2012).

In the same vein, let's discuss the prevalent social media features more ubiquitously!

The section talks about;

How social media is strengthening remote learning

There are numerous symposia and conferences that exist today; with the help of the internet and digital connectivity, anybody can attend the conference using meeting links that permit remote access (real-time). Such platforms encourage not only parallel discussions and learning but also build professional networks on a global scale.

For example, online journal clubs act as the virtual venue to disseminate the medical, educational resources and partake in current and latest developments or activities of medical literature among hundreds of medical practitioners and groups of peers regardless of their location and with a solitary intent of transforming knowledge into practice.

The etiquette and cautions of using social media

The fundamental principle of social media in medical education is to empower the interlinking of like-minded people via Tweets at conferences or meetings. Thus it enhances the research groups' communication. Also, it promotes the use of open access journals and prompt access to the article that facilitates free data distribution! On the contrary, the risks and consequences are part and parcel of online education. Since instantaneous access for the new trial results without any peer-review process is readily and freely available online, there are chances the information can get distorted or misinterpreted because of various reasons like broken internet issues or unchecked dissemination of misinterpreted information! So, the readers need to be mindful while consuming the information.


Adaptation of social media in medical education

Adapting open educational resources amidst an ever-changing environment is challenging, yet the efforts of healthcare professionals in training the next generation to deliver high-quality care are astronomical. Furthermore, it isn't easy to gauge the impact of social media. For example, a single tweet about a paper might attract several followers, retweets, and shares, but formulating an impression or impact report compared to traditional education is tedious. However, the web analytics and the number of attendees or visitors' traffic over the blog/website could be the probable mapping parameters on social media platforms.

Hundred of FOAM resources are emerging lately despite the impact factor grading, allowing a broad audience to participate in critical discussions and enhanced learning!

List of FOAM Resources

With the inexorable employment of the internet and technologies in emergency medicine and critical care, there has been an exponential rise in the number of free medical, educational resources. The rise was substantially high, particularly from 2002 to 2013. The decade witnessed the origin of great learning resources stride as the websites and podcasts sprouted from 1 blog & 1 podcast (2002) to 141 blogs & 42 podcasts (2013).

Let's just quickly look at a few of the FOAM resources that offer quality medical - educational support.

  1. LITFL (Life In The FastLane Library): A website for emergency medicine and critical care features the ECG library, blogs, podcasts, and other resources.
  2. A website created by Scott Weingart provides knowledgeable blogs and podcasts on Maximally Aggressive Curative Care and Maximally Aggressive Palliative Care
  3. (Academic Life in Emergency Medicine): A reputed website that offers free, peer-reviewed, and quality online health professions education.
  4. Rebel EM (Rational Evidence-Based Evaluation of Literature in Emergency Medicine): They cover innumerable emergency medicine topics with the fundamental focus on evidence-based clinical topics
  5. Emergency Medicine Cases:  A free medical education website that offers insights on emergency medicine and CME (Continuing Medical Education) for student nurses, paramedics, and physicians
  6. Dr. Smith's ECG Blog: It was created by Dr. Stephen W. Smith to provide online education on Emergency Cardiac Care and ECG (Electrocardiogram)
  7. emDOCs: A group of emerging physicians, providing current information on the Development, Oddities, and Controversies of emergency medicine
  8. First 10 EM: It stands for "First ten minutes in the resuscitation room." It is a FOAMed resource dedicated to critical care, emergency medicine, and evidence-based medicine.
  9. RCEM Learning: It is an e-learning platform of the Royal College of Emergency Medicine that is aimed at providing high-quality medical education resources to the members and the broader international e-learning community
  10. Don't Forget The Bubbles: A popular FOAM resource that provides clinicians with evidence-based erudition on pediatric medicine.

So, these are a few of the FOAM resources; they are intended to provide comprehensive information on learning materials subject to emergency medicine and critical care. To learn more about the resources, refer to this blog on ALiEM.

However, regardless of the multitudinous FOAM resources available, their accuracy and quality are still being questioned. Hence, it is vital to adopt a metric system or the assessment factors to measure the impact of FOAM resources and keep the quality-cognate queries at bay (though not wholly)!

Metric System or the Assessment Factors of FOAM Resources

In contrast to the traditional hierarchy, the grounds of FOAM's free, robust, transparent, and 24/7 accessibility is gaining plaudits worldwide. But the lack of quality metrics challenges the educators in receiving credits and students to identify the authentic resources. Hence, the discovery of assessment factors (SMI, KI, and quality checklists) befell.

Social Media Index (SMI): It measures the website's impact by combining various altmetrics. The variables or altmetrics are Alexa Rank, Twitter Followers, Facebook Likes, Google+ Followers, and Google PageRank. SMI index helped educators and students in gaining scholarly credits and assessing quality resources, respectively.

Kardashian Index (KI): It was proposed by the author Neil Hall and used to measure the scientist or researcher's discrepant social media profile with publication details based on the comparison report of Twitter followers and number of citations. However, many authors and researchers called it a "Joke Metric" or "Ludicrous" for gauging the authors' credibility by measuring the number of Twitter followers with citation indices.


The quality checklists for blogs and podcasts: The checklist was proposed to offset the lack of a standardized metric system in online medical education. According to the study conducted by Chalmers et al., blogs and podcasts (FOAM resources) are measured based on the 3 utmost critical quality indicators, i.e., Credibility, Content, and Design, and designed concerning all the audiences involved in the FOAM viz.

Producers: Use the checklist as a guide to create quality content and label this on their blog or podcasts to confirm the quality checklist being appended.

Editors and Curators: Use the checklist to make necessary improvements while creating the content before publishing it on the page.

Users: Use the checklist to assess the quality of the educational resources and help to engage with the editors and producers.

There are two different sets of checklists created for Blogs and Podcasts, respectively. However, the quality checklist for blogs includes 19 quality indicators (B1-B19), and the quality checklist for podcasts includes 20 quality indicators (P1-P20).

You can refer to this article to learn more about the checklist.

So, these factors help refrain the paradoxical quality assessment impressions on medical, educational resources to an extent.

In the next section, let's discuss how FOAM is considered an educational adjunct.

FOAM as Crowd-sourced Educational Adjunct for Students

FOAM is not the replacement of current medical education. In contrast, it is bridging the learning gap tacitly by providing additional resources via the digital platform. Social media keeps the learners engaged and expedites peer-assisted learnings within the virtual FOAM communities. Thus, researchers, educators, and other organizations are deliberately using FOAM resources to build the connections of research and clinical practice among students. Hence, the FOAM resources are integrated with Reusable Learning Objects(RLOs) within the virtual training programs, and they are made freely accessible for the students. So, it creates an interactive and engaging atmosphere for students to participate actively and helps when they miss out on any face-to-face lecture. Additionally, FOAM acts as the bedside mentor and a crowd-sourced educational adjunct and not as any replacement for actual clinical practice.

They are best suited for "in-time" knowledge sharing, and social media platforms serve as rational data providers' routes. To pick up the thread, Twitter is the most popular and widely used by academicians because of its concise and efficient communication and trending hashtags.


Surprisingly, the reach and the impact of FOAM resources in distributing free knowledge is immense. It is one of the most efficient and effective ways of rapid dissemination of learning resources. FOAM is an inspiring educational adjunct that promotes engagement, builds educational strategies, collaboration, professional networking, and interactive learning. Despite the limitations and challenges, FOAM is evolving and benefiting healthcare professionals and the medical literature.


Dr. Teresa Chan, Associate Professor Medicine, McMaster University

I would like to extend my gratitude to Dr. Teresa Chan, Associate Professor, Medicine at McMaster University, who took her time to review this article and shared valuable insights on the same. She is the Associate Dean, Continuing Professional Development, and previously served as the Assistant Dean, Program for Faculty Development in the Faculty of Health Sciences at McMaster from 2019-2021.

She is a nationally-recognized researcher & educator and the recipient of several prestigious awards, including the Young Educator's Award from the Association of Faculties of Medicine of Canada and Ian Stiell Researcher of the Year award from the Canadian Association of Emergency Physicians. Dr. Chan is well known for online education research and is one of the founding members of the METRIQ Study group. She is a Senior Advisor of the international Faculty Incubator program for the Academic Life in Emergency Medicine (ALiEM) group. She is also interested in developing medical education innovations and evaluating them.