About Teresa Chan, MD, MHPE

ALiEM Associate Editor
Emergency Physician, Hamilton
Associate Professor, McMaster University
Assistant Dean, Program for Faculty Development, McMaster University Ontario, Canada

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

Education Theory Made Practical (Volumes 4 & 5): An ALiEM Faculty Incubator eBook Series

education theory made practical, volumes 4 and 5 cover book

Back by popular demand and thanks to a generous grant from the Government of Ontario’s eCampus initiative, the ALiEM team is delighted to announce the publication of 2 new eBook publications: Volumes 4 and 5 of the Education Theory Made Practical eBook series [ALiEM Library]. Like all of the others that have come before, these books were a labor of love brought to you by the dedicated Faculty Incubator alumni. On behalf of all the editors of both editions, we are very proud of all our Faculty Incubator alumni who made this happen. 

Their amazing contributions have been compiled in these FREE, peer-reviewed eBooks. We sincerely feel that these will be a useful resource for all the educators out there, wrestling with the issue of integrating theory into practice. Special shout-out to the incredible Dr. Jonathan Sherbino (Volume 4) and Dr. William Bynum (Volume 5) who authored the forewords and provided us with their thoughtful insights on how theory can relate to a clinician educator’s practice.  


Education Theory Made Practical volume 4 ETMP

Brought to you by the ALiEM Faculty Incubator Class of 2019-20

How to Cite This Book
Krzyzaniak, Messman, Robinson, Schnapp, Li-Sauerwine, Gottlieb, Chan (Eds). Education Theory Made Practical, Volume 4. McMaster Office of Continuing Professional Development, Hamilton, ON, Canada. ISBN: 978-1-927565-46-9 Available at: https://books.macpfd.ca/etmp-vol4/


Brought to you by the ALiEM Faculty Incubator Class of 2020-21

How to Cite This Book
Fant, Gottlieb, Li-Sauerwine, Krzyzaniak, Natesan, Schnapp, Chan (Eds). Education Theory Made Practical, Volume 5. McMaster Office of Continuing Professional Development, Hamilton, ON, Canada. ISBN: 978-1-927565-47-6Available at: https://books.macpfd.ca/etmp-vol5/


About the Books

The Education Theory Made Practical series aims to make the theoretical underpinnings of education psychology come alive for health professions teachers who are seeking to use theory to inform their clinical and classroom teaching.

Notes from Dr. Sara Krzyzaniak, the lead editor of Volume 4: I am proud of the authors’ work in writing primers on some of the core theories in medical education. The theories covered in this volume will help educators design (Cognitive Load Theory) and evaluate (Miller’s Pyramid) their curriculum. It will help us understand why our learners behave in a certain way (Maslow’s Hierarchy of Needs) and how we approach and organize abstract concepts in education (Prototype Theory). Check out the 10 chapters in Volume 4 to help you understand how we can use education theory to be more successful educators, learners, and scholars. 

Notes from Dr. Abra Fant, the lead editor of Volume 5: This volume explores 10 new theories which again cover the educational design process from start to finish. The IDEO Design Theory helps educators disrupt while designing, R2C2 provides an exceptional model for delivering feedback and the Logic Model is a wonderful resource for evaluating curricula. We invite you to explore these and other chapters to help provide background and context as you design, enact and evaluate your educational interventions. 

Our Process

As part of the Faculty Incubator program, a 2 -3 person team authored a primer on a key education theory on the International Clinician Educator (ICE) blog. These posts were published serially over a 10-week period. Each post featured a key educationally-relevant theory by starting with a vignette that situated the theory. Following this vignette, there was an explanation and short history of the theory followed by an annotated bibliography for further reading. To ensure high quality, we then asked the #MedEd and #FOAMed online communities to join us in peer-reviewing these posts. After incorporating many of the peer review comments, each blog post was converted into a book chapter within this volume of a series of books for budding clinician-educators – the Education Theory Made Practical series. We believe this will serve as a valuable tool on how to incorporate educational theory into the clinical realm in a practical way.

Reading from the Silver Linings Playbook: The ALiEM Connect Project

ALiEM Connect graduation

It feels like yesterday that we were sheltered-in-place, staring at our computers, wondering, “So now what?” 

As COVID-19 paused all in-person educational sessions, the early morning residency conference we used to begrudgingly join quickly became something that we profoundly missed. While we can now be “present” while wearing sweatpants and a button-down shirt, we miss the human connection. Many of us would gladly even suffer through traffic just to be a part of this morning conference tradition.

As educators and innovators, we know what a disruptive force the COVID-19 pandemic has been to the medical community. It has strained our medical and healthcare systems and has irrevocably altered our day-to-day lives. Without a doubt, the pandemic also changed how we delivered educational content to our learners over the past year.

Scholars have written about how likely this pandemic will likely precipitate the much-needed digital transformation of healthcare and health professions education that many of us have expected and hoped for. But while some of these innovations are born out of necessity, they may also inadvertently isolate us from the experiential aspects of education and human interaction that provide meaning to our work. For the ALiEM team, we cherish the opportunity to be part of some of these significant innovative and positive “disruptions,” further aligning our goal of creating an impactful and fulfilling academic life in emergency medicine. 

The Backstory

As a remote team working across continents, the ALiEM team has thrived on digital connection for over a decade. With excellent collaborators and volunteers representing different parts of the world, our daily operations require us to stay connected and work asynchronously to achieve our goals and deliverables. When the lockdowns hit, we leveraged its impact on physical distancing and leaned into connecting with each other even more! They say “chance favors the prepared mind,” and there we were, already on Slack and yearning for the opportunity to harness the power of teamwork using our shared passions, individual creative strengths, and enthusiastic and supportive emojis. There were moments of creating, moments of celebration, and moments of simply being with each other – often through an evening #WifiAndWine.

By the Ides of March 2020, an auspicious time indeed, we knew we were at a turning point. Our friends and work families had been working on the front lines combating the pandemic locally, gathering PPE, and studying the effects of a virus we knew next to nothing about. New information was coming in daily, and the signal-to-noise ratio was low. In some ways, to escape the disruptions going on all around us, we banded together to focus our unique energies toward creating something as novel as the virus itself in the realm of free open-access medical education.

At a time where everyone was feeling alone, we asked ourselves how we could support the joy of learning from and with each other? In truly whirlwind fashion, the first ALiEM Connect conference went from idea to execution in less than 2 weeks, a record-breaking time even for ALiEM. Thank especially to the American Board of Emergency Medicine for sponsoring these events.

We recently made it to the semi-finals at the CORD/ACEP Innovator of the Year competition, where we shared the below video capturing the fun, collaboration, and innovative outcome of our efforts. Oh, and the familiar ratatat of Slack.

Making this a Multiple Win

The secret sauce of the ALiEM team is that we have a diverse group of people, each of whom brings their own perspective and that we are able to share with one another liberally. Dr. Michelle Lin encouraged an environment that is psychologically safe and supportive since the inception of the ALiEM enterprise. It is out of this space that our diverse team was able to successfully bring a massively successful project to fruition amid a global pandemic. What started as a small brainstorming session blossomed into ALiEM Connect – 3 distinct remote conferences featuring nationally-recognized educators and thought leaders enjoyed by residents across the country.

It’s difficult to express as a linear narrative, but looking back, it seems as though our team divided into unique roles without a second thought. Just like a production company, we had the front and back of the house. Those in the front made sure to help get people in the seats to watch; stage managers and coordinators ensured that every part of each of the ALiEM Connect experiences was phenomenally smooth. We had talented individuals who acted as hosts and speakers to ensure that each of these experiences was top-notch and engaging. In the back, Drs. Mary Haas, Yusuf Yilmaz, and Teresa Chan sprung quickly into action to create a program evaluation strategy for our ALiEM Connect program, including a formal institutional review board exemption! All the while, testing and vetting platforms and methods to distribute the material were ongoing. We built upon each technological skill, learned new platforms, and trialed different features. We had barely decided on an open, free, and accessible platform (which was, in fact, no individual platform but an amalgamation of many!) before sending out the invites.

But the fun didn’t stop there! We’re the “academic” life in emergency medicine! How could we not also share our results with the traditional academic community? Within days of finishing our first ALiEM Connect experience, our program evaluation team generated the scaffolding of a manuscript to put together our thoughts and analyze the evaluation data collected. We harnessed the power of metrics from social media platforms (YouTube, Slack, Twitter), website analytics, and end-user experiences. Harnessing all of these analytics and communicating the right message with our academic medicine community was important to inform and help others to replicate similar approaches to their residents. Our team used ready to use metrics which came from YouTube analytics. But we did not stop there as we needed more reports of how the residents and programs interacted during the Connect events in the backchannel, Slack. We developed Python supported software to export and analyze all the messages happening in separate channels. We developed a “Emoji Cloud” to see how the reactions happened, and closely analyzed the messages during the event.

Given the true novelty of the experience, we figured we might as well shoot for the moon, as they say, by submitting our innovation description paper to Academic Medicine. After all, even if they didn’t accept it, we might get some constructive reviews, to say the least. As innovators, we are comfortable with the possibility of failure. We understand the value of the saying, “You miss 100% of the shots you don’t take,” and were prepared to accept “no” as an answer. With that, we took a calculated risk, making use of the same collaborative strategy to craft a manuscript, and clicked submit.

…And we’re glad we took that shot! We are excited to share that what we sent was indeed accepted and express our gratitude for the chance to share our low-cost approach to a large-scale, nationwide residency conference! You may read the Published Ahead-of-Print version of our paper.

Moral of the story…

You might be asking yourself, “What’s the moral of the story here? Of course, with enough academics and experts, yeah, you got a paper published. Cool…” But the papers aren’t the point. In fact, during the COVID-19 pandemic, more papers have been published than ever before – more research is being done, and our whole field is changing. The point is… this is how we got to ENJOY the academic life during a pandemic! We made lemonade (and several other desserts!) out of the lemons we were handed. New knowledge comes from thinking big and trying new things. Turns out, sometimes you also have to write about those experiences and share them with others.

As emergency physicians, we know we’re good in a crisis. But this experience reminded us that by surrounding ourselves with amazing people, we could get a surprising amount of work done (at record speed) and have a fantastically memorable time along the way. The moral of this story is that when you bring great people together and give them a chance to get to know each other, magic happens. ALiEM Connect happens. And we impact more people than we can possibly meet at the touch of our keyboards. We are so grateful for the chance to work alongside all the wonderful people at each of our institutions every day. Still, also, we are indebted to those who are our digital family. Thank you to all of you who make initiatives like ALiEM Connect possible. Academic life in emergency medicine is all about bringing a great team together.

So is the ALiEM team.

Education Theory Made Practical (Volume 3): An ALiEM Faculty Incubator eBook Project

The ALiEM Team is delighted to announce another eBook publication: the third volume in the Education Theory Made Practical series. This book was a labor of love written by the 2018-19 Faculty Incubator class. We are very proud of all our Faculty Incubator alumni who made this happen. Their hard work has been compiled in this FREE, peer-reviewed eBook. We sincerely feel that it will be useful for all the educators out there, wrestling with the issue of integrating theory into practice. Special shout-out to the incredible Dr. David Sklar (former Editor-in-Chief of Academic Medicine) for providing us a thought-provoking foreword.

 

Download or View the Book Now

The book is available in 2 formats:

iBook format via the iTunes bookstore 

PDF format via ResearchGate

 

About the Book 

The Education Theory Made Practical series aims to make the theoretical underpinnings of education psychology come alive for health professions teachers, who are seeking to use theory to inform their clinical and classroom teaching.

 

Table of Contents

Chapter 1: Six Steps Model of Curriculum Development

Chris Lloyd, DO; Simiao Li-Sauerwine, MD, MS; Shannon McNamara, MD

 

Chapter 2: The Kirkpatrick Model

Christoper Fowler, DO; Lisa Hoffman, DO; Shreya Trivedi, MD; Amanda Young, MD

 

Chapter 3: Realist Evaluation

Jason An, MD; Christine Stehman, MD; Randy Sorge, MD

 

Chapter 4: Mastery Learning

Michael Barrie, MD; Shawn Dowling, MD, FRCPC; Nicole Rocca, MD, FRCPC

 

Chapter 5: Cognitive Theory of Multimedia Learning

Laurie Mazurik, MD; Elissa Moore, DO; Megan Stobart-Gallagher, DO; Quinn Wicks, MD

 

Chapter 6: Validity

Rebecca Shaw, MBBS; Carly Silvester, MBBS

 

Chapter 7: Programmatic Assessment

Elizabeth Dubey, MD; Christian Jones, MD; Annahieta Kalantari, DO

 

Chapter 8: Self-Assessment Seeking

Nilantha Lenora, MD; Layla Abubshait, MD; Manu Ayyan, MBBS

 

Chapter 9: Bolman and Deal Four-Frame Model

Lexie Mannix, MD; Shawn Mondoux, MD; David Story, MD

 

Chapter 10: Kotter’s Stages of Change

Dallas Holladay, DO; Melissa Parsons, MD; Gannon Sungar, DO

 

About our Process

As part of the 2018-19 Faculty Incubator program, each 2 or 3-person team authored a primer on a key education theory on the International Clinician Educator (ICE) blog. These posts were published serially over a 10-week period. Each post featured a key educationally-relevant theory by starting with a vignette that situated the theory. Following this vignette, there was an explanation, a short history of the theory, and an annotated bibliography for further reading. To ensure high quality, we then asked the #MedEd and #FOAMed online communities to join us in peer-reviewing these posts. After incorporating many of the peer review comments, each blog post was converted into a book chapter within this first volume of a series of books for budding clinician-educators – the Education Theory Made Practical series.

 

How to Cite This Book

Robinson D, Chan TM, Krzyzaniak S, Gottlieb M, Schnapp B, Spector J, Papanagnou D (eds). Education Theory Made Practical: Volume 3. 1st ed. Digital File. San Francisco, CA: Academic Life in Emergency Medicine; 2020. ISBN: 978-0-9992825-7-1. Available at: https://books.apple.com/us/book/education-theory-made-practical/id1534232421?ls=1

 

Education Theory Made Practical home page

By |2020-11-06T04:41:47-08:00Nov 6, 2020|Academic, Book Club|

Silence is not an option: Addressing structural racism in medical education

racismThe year 2020 has been a year of upheaval. The COVID pandemic revealed disparities in healthcare and its effects on marginalized groups such as the Black community. The pervasive effects of structural racism affect all of us, including in medical education. We cannot and must not remain silent. As we honor Juneteenth, #BlackLivesMatter, and #WhiteCoatsforBlackLives, let us reflect on ways we can address racial injustice in our direct environment.

(more…)

By |2020-06-19T08:37:15-07:00Jun 19, 2020|Academic, Emergency Medicine, Life|

Teaching in the age of COVID-19: The learning management system

learning management systemGiven the epidemiological data from China and Italy, educators should be prepared for the likelihood that online learning will continue to be the norm for many weeks to months. Simply running disconnected weekly educational sessions without an overall organization will hinder educational success for learners. Learning Management Systems (LMS) are a tool that can support educational leaders with the delivery, assessment, and organization of learning.

(more…)

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