About Michelle Lin, MD

ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco

The Fall of FOAM

Fork in Road Disappearance of FOAM blog podcast

The landscape of emergency medicine and critical care (EM/CC) blogs and podcasts has changed dramatically over the past 20 years. The number of free, open-access EM/CC blogs and podcasts has plummeted. As reported by Lin and colleagues in JMIR Education (2022), these sites decreased in number from 183 in 2014 to just 109 this year– a drop of 40.1% [1].

via GIPHY

This comes after a period of rapid growth of these educational resources in the late 2000’s [2], with expectations that new sites would continue to come online. It is unclear when the combined number of EM/CC blogs and podcasts peaked, or how recently it declined.

Why do we care in these declining numbers?

The FOAM (free open-access medical education) movement has become an important component of EM curricula at many training programs. Online learning resources such as medical blogs and podcasts have all but replaced traditional textbooks, and research suggests that some trainees use these products as their primary study materials [3]. Therefore, the observed decrease in FOAM sites is alarming, as training programs and trainees have come to rely on their availability.

Featured paper

In our JMIR Medical Education paper, Lin et al. sought to identify active EM/CC blogs and podcasts during a 2-week period in May 2022. The authors found a total of 50 blogs, 25 podcasts, and 34 blogs + podcasts (n=109). The age of these FOAM sites ranged from 1-18 years and most were physician-led. Just over half had leadership teams of 5 or more individuals. Support was identified for approximately 75% of the sites and included advertisements, institutional sponsorship, or the sale of goods and services (though site access remained free).

The Christensen Theory of Disruptive Innovation may explain the recent decline in EM/CC blogs and podcasts. Using this lens, FOAM sites are considered ‘disruptors’ in medical education that quickly gained market share previously dominated by ‘incumbents’ such as medical textbooks, journals, and in-person conferences. Rather than cede their influence, incumbent organizations co-opted the disruptive innovation itself, in this case leveraging their assets to create their own online learning resources, blogs, and podcasts. As these incumbent offerings grew, there was less need for new, independent FOAM sites. Concurrently, FOAM sites continue to generate little-to-no revenue and academic value for the creators, making it difficult for the disruptors to challenge the market dominance of incumbents or to create its own unique, sustainable market space. We theorize that older sites likely succumbed to these financial and academic opportunity costs as well as high user expectations for design and functionality.

What is the future of FOAM?

Though EM/CC blogs and podcasts changed the landscape of medical education in fundamental ways, they will likely not endure as independent entities without new business models for sustainability. A recent study suggests that the costs of FOAM might be offset by advertising or other revenues [4]. Based on our observations of current practices on existing FOAM sites, this might include at least incorporating any/all of the following:

  1. Inserting advertisements
  2. Creating products for sale such as books, courses, swag, or consulting services
  3. Developing partnerships
  4. Soliciting for donations

In the meantime, we posit one of 3 potential futures of new and existing blogs and podcasts: hybridization, disappearance, and new-market independence.

future of foam christensen

  1. Hybridization strategy: Incumbents partner with or create their own blogs/podcasts. This loss of independence, which was part of the initial appeal of FOAM grassroots efforts, is traded for more stability and infrastructure. Already 44% of EM blogs are officially affiliated with a sponsoring institution.
  2. Continued disappearance of sites: Progressively fewer independent, free blogs/podcasts because of site demise, merging of sites, or conversion to paid subscription model
  3. Independent sustainability: Growth of independent, free blogs/podcasts as its own new-market endeavor, separate from the incumbent market space, only achievable with better return on investments (academically and financially) for bloggers/podcasters. Once FOAM efforts are no longer a major opportunity cost, educators may even be able to pivot their careers towards this primarily, rather than as a side project.

It remains to be seen whether FOAM can withstand market and academic pressures or whether it is destined to be assimilated by better-resourced incumbent organizations.

What is the future of ALiEM?

We hope to stick around and hope the rest of the FOAM community will evolve with us.

Comments?

Join the interesting discussion on Twitter. We are thrilled to bring this conversation to the forefront.

https://twitter.com/M_Lin/status/1582021848958500864?s=20&t=nBcJtrRvgML2QMRNnZkwwA

References

  1. Lin M, Phipps M, Yilmaz Y, Nash CJ, Gisondi MA, Chan TM. A Fork in the Road: Mapping the Paths of Emergency Medicine and Critical Care Blogs and Podcasts. JMIR Medical Education. 2022 (preprint available: https://doi.org/10.2196/39946)
  2. 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-e77. doi:10.1136/emermed-2013-203502
  3. Branzetti J, Commissaris C, Croteau C, et al. The Best Laid Plans? A Qualitative Investigation of How Resident Physicians Plan Their Learning [published online ahead of print, 2022 May 24]. Acad Med. 2022; doi:10.1097/ACM.0000000000004751
  4. Lee M, Hamilton D, Chan TM. Cost of free open-access medical education (FOAM): An economic analysis of the top 20 FOAM sites. AEM Educ Train. 2022;6(5):e10795. Published 2022 Sep 9. doi:10.1002/aet2.10795

EM Match Advice 38: Our 2 Cents | The Revamped Standardized Letter of Evaluation (SLOE) is here

EM Match Advice 2 cents episode on SLOE Standardized Letter of Evaluation

This is the 38th episode of EM Match Advice but the inaugural episode for new podcast series host, Dr. Sara Krzyzaniak (program director at Stanford EM residency program)! This quick podcast episode was recorded to coincide with the new, much-anticipated release of the Standardized Letter of Evaluation (SLOE 2.0). We address questions of why the changes, and what is different. In this podcast, Dr. Krzyzaniak and Dr. Michelle Lin speak with 2 key faculty who helped lead the multi-year development of this key piece of the residency application puzzle:

  • Dr. Sharon Bord (Johns Hopkins EM Clerkship Director, 2022-23 President of the Clerkship Directors in Emergency Medicine)
  • Dr. Doug Franzen (Washington University Associate Program Director)

EM Match Advice Podcast: Our 2 Cents about the new SLOE

 

 

View the ESLOE template

 

Read and Listen to the Other EM Match Advice Episodes

Blog posts: https://www.aliem.com/em-match-advice-series/

 

References and Additional Reading

  1. SLOE 2.0, CORD EM website, July 2021
  2. A Path Forward–practical consensus on 2021-2022 EM advising. CORD EM website, April 2021.
     

 

By |2022-07-19T08:52:30-07:00Jul 19, 2022|EM Match Advice, Podcasts|

EM Match Advice 37: EM Program Directors Reflect on the 2022 Match

EM Match Advice 10 year table residency match

In this 37th episode of EM Match Advice, we discuss the results of the 2021-22 EM Residency Match with lots of shocking numbers and surprises to review. The table above lists the trends and data since 2014, extracted from the National Resident Matching Program (NRMP) site [1]. Could this have been foreseen? What does this mean for the 2022-23 EM Match season? In this podcast, Dr. Mike Gisondi and Dr. Michelle Lin host the following esteemed panel of 3 program directors to review this juicy table and discuss the future:

  • Dr. Abra Fant (Northwestern University)
  • Dr. Sara Krzyzaniak (Stanford University)
  • Dr. Bonnie Kaplan (Denver Health)

More Numbers from ERAS/AAMC by Program

emergency medicine EM Match Advice ERAS table

EM Match Advice Podcast

 

Read and Listen to the Other EM Match Advice Episodes

Blog posts: https://www.aliem.com/em-match-advice-series/

 

References and Additional Reading

  1. National Residency Match Program: Data and Reports
  2. Pelletier-Bui AE, Schnapp BH, Smith LG, et al. Making Our Preference Known: Preference Signaling in the Emergency Medicine Residency Application. West J Emerg Med. 2021;23(1):72-75. Published 2021 Dec 17. doi:10.5811/westjem.2021.10.53996. PMID 35060866
  3. Preference/Program Signaling (PS) in Emergency Medicine. CORD website, 2022.
By |2022-05-28T09:30:51-07:00May 11, 2022|EM Match Advice, Podcasts|

Need your help: A master list of free EM and Critical Care blog and podcast sites

Calling all who read or listen to emergency medicine/critical care (EM/CC) blogs or podcasts. In 2014, we helped to publish the master inventory of free open-access medical education (FOAMed) resources spanning the period of 2002-2013 [1]. In that publication, we demonstrated an exponential rise of both blogs and podcasts with 141 blogs and 42 podcasts (total 183 sites). In 2019, the Life in the Fast Lane (LITFL) team identified 251 active sites. But where are we at now?

Why create an EM/CC master list of sites?

Most of the time, we encounter new resources by word-of-mouth or through Google search engines. There are, however, so many more quality sites that are available for teaching and learning. We aim to find them all. Are the numbers like 50 or more like 500? So far, we have reviewed the 2019 LITFL list and identified 119 and 9 still-active blog and podcast sites, respectively. But we likely have missed some, especially those sites launched after 2019.

Why the rush on updating the master list now?

Since 2014, we have prided ourselves in running the Approved Instructional Resources (AIR) Series, which identifies quality blog posts and podcast episodes, specifically to help residency programs award asynchronous learning credit to their residents [2]. Posts and episodes are identified from the top 50 sites, based on our validated Social Media Index (SMI) score [3] and are selected from a modified version of the 2019 LITFL list. The SMI formula incorporates the Alexa rank, which unfortunately just retired on May 1, 2022. So we are working towards an updated SMI score, using Ahref’s Domain Rating as well as new platform followerships that includes not only Twitter and Facebook but also Pinterest, Reddit, YouTube, Instagram, and LinkedIn.

Call to action: What sites did we miss?

We want to get as comprehensive a list as possible. If you don’t see a blog or podcast on these lists, fill out the Google form below! Thank you for your help.

Blogs

Podcasts

Submission Form

References

  1. 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-e77. doi:10.1136/emermed-2013-203502. PMID 24554447
  2. Lin M, Joshi N, Grock A, et al. Approved Instructional Resources Series: A National Initiative to Identify Quality Emergency Medicine Blog and Podcast Content for Resident Education. J Grad Med Educ. 2016;8(2):219-225. doi:10.4300/JGME-D-15-00388.1. PMID 27168891
  3. Thoma B, Sanders JL, Lin M, Paterson QS, Steeg J, Chan TM. The social media index: measuring the impact of emergency medicine and critical care websites. West J Emerg Med. 2015;16(2):242-249. doi:10.5811/westjem.2015.1.24860. PMID 25834664
By |2022-05-03T17:04:12-07:00May 4, 2022|Academic, Social Media & Tech|

Dear emergency physicians: We see you

The COVID-19 pandemic has placed incredible stress and strain on the personal work lives of emergency physicians. We have endured these almost 2 years of misinformation, PPE shortages, fear, frustration, grief, and death. So much going on in the world politically and socioeconomically, we at ALiEM wanted to share a message that WE SEE YOU. We’re with you, and we’re in this together.

Credits

Thank you for the tireless work on this video by animator Spencer Evans, who is a soon-to-be-emergency physician attending medical school currently at the University of Colorado. Also thanks to the entire ALiEM team for contributing to the message and storyboard, especially Drs. Al’ai Alvarez, Andy Little, Carl Preiksaitis, Chris Belcher, Christian Rose, Felix Ankel, Jason Woods, and Teresa Chan.

EM Match Advice 36: It’s Time to Make Your Rank List

Now that interview season for residency match has concluded, our residency director panel tackles the hot topic of making your rank list, which includes “love letters” to programs and second look visits. In this podcast, Dr. Mike Gisondi and Dr. Michelle Lin host an esteemed panel of 3 program directors, Dr. Emily Fisher (University of Oklahoma), Dr. William Paolo (SUNY Upstate), and Dr. Michael Van Meter (University of Texas Health Science Center at Houston) to discuss these issues. Good luck to everyone in the match this year!

EM Match Advice Podcast

Read and Listen to the Other EM Match Advice Episodes

Blog posts: https://www.aliem.com/em-match-advice-series/

By |2022-04-26T16:24:10-07:00Feb 9, 2022|EM Match Advice, Podcasts|

Holiday Gift Guide for ALiEM Readers: Top 5 Favorite Tech Tools

Technology continues to integrate with our life — for better and worse. Our team felt that the following 5 tech tools added value and joy to our lives, and so we are sharing with you. These also make great gifts for the emergency physician or healthcare provider in your life this holiday season.

holiday tech tools blinkist

Blinkist is a professional book summary subscription service that condenses key points from non-fiction books into 15-minute reads. This is an efficient way to catch with all those books that you have been putting off.

holiday tech tools headspace app

The Headspace app is one of the frequently used mindfulness app in the world. Working in Emergency Medicine was already extremely stressful before the pandemic began. Being more intentional about self-care is as critical as ever for our personal and professional well-being.

holiday tech tools headphones

Noise-cancelling headphones, such as the Anker Soundcore Life Q20 Noise Canceling Headphones are essential, especially if need some quality time working alone or just need some “me time”. With potentially many people in our house conducting virtual meetings, doing work, and performing chores, this over-the-ear headphone does the trick.

holiday tech tools speaker

The Anker Soundcore Bluetooth Speaker is a compact, quality wireless speaker that you can take with you to your favorite “office” (such as your backyard), on your night shift to boost team morale, or play in the background for your patients as you are suturing their lacerations.

holiday tech tools blinkist camo

Reincubate’s Camo is a software that turns your iPhone into your computer’s webcam. Without needing to buy fancy videocamera equipment, you can upgrade your videoconferencing and video recordings by using your iPhone’s high-resolution camera. While the free version provides 720p video resolution, Camo Pro allows for 1080p resolution, portrait mode, and manual control of the camera features. Note: Nonprofits and educators can contact them for a discount off of the $39.99 annual subscription.

Check out our other holiday gift lists:

Disclosure: Although we do not have an official partnership with Amazon, we belong to their Amazon Affiliates program which allows us to be paid a few pennies with books purchased from our links.

By |2021-11-17T15:14:01-08:00Nov 19, 2021|Academic, Social Media & Tech|
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