Production and use of free open access medical education resources (FOAM) has had a meteoric rise over the last decade.​1–4​ ALiEM works hard to produce content, disseminate knowledge, and consolidate resources in a democratic and accessible way. However, we recognize that FOAM comes with its own limitations:

  1. Blogs are distinct, individual, and decentralized. How can we search for topic-specific content?
  2. FOAM doesn’t often have peer review. How can we assess quality and accuracy?
  3. FOAM is produced on an as-needed basis. How do we achieve curricular comprehensiveness?

We recently published a project in Academic Emergency Medicine Education and Training that tries to address the above limitations, using the renal and genitourinary organ system as a “focus group”.​5​

Limitation 1: Distinct, individual, and decentralized blogs. How can we search for topic-specific content?

We developed search terms specific to the renal and genitourinary organ system from the American Board of Emergency Medicine’s Model of the Clinical Practice of Emergency Medicine. We then performed a systematic search of both FOAMSearch as well as each site within the social media index top 100.​6,7​Unlike the AIR series, which collects content published within the last 12 months, our search included any relevant resources regardless of publication date.​8​

Limitation 2: No peer review. How can we assess quality and accuracy?

Of the 13,058 resources identified, 12,717 were found to be journal articles, duplicates, not relevant to emergency medicine or renal, or not FOAM. These were excluded. The 341 remaining articles underwent quality assessment using the revised METRIQ score and were categorized based on subtopic within renal and genitourinary, recommended use of the resource, and recommended learner level for the resource.​9​

Calculus of the urinary tract (17.6% of total) led the subtopics with more than twice as many FOAM posts as the next topic, acute and chronic renal failure (7.6%). Most commonly, posts were appropriate for personalized reading followed by post-shift reading assignment. Few posts were appropriate for on-shift learning or as an adjunct to a journal club. Lastly, junior residents were found to be an appropriate audience most often (76.3%), followed by interns (64.2%), senior residents (56.4%), clerks (i.e., third- or fourth-year medical students, 52.1%), attendings (40%), and pre-clerks (i.e., first- or second-year medical students, 29.0%).

Interestingly, only 35 posts met our criteria for high quality. This table below can serve as a curated, categorized centralized list of renal and genitourinary FOAM resources.

SubtopicName of First AuthorName of Blog PostLevel of Trainee
(Starred = author; unstarred = team’s recommendation)
Calculus of urinary tract (renal colic)Helman, AntonJournal Jam 3 – Ultrasound vs CT for Renal ColicJunior, Senior, Attending
Calculus of urinary tract (renal colic)Chartier, LucasEpisode 5: Renal Colic, Toxicology Update & Body PackersClerk, Intern, Junior, Senior, Attending
Calculus of urinary tract (renal colic)Swaminathan, AnandOptimal First Line Analgesia in Ureteric ColicIntern, Junior, Senior, Attending
Topic not on list (foley catheter problems)Schneider, AaronFoley Catheter Patients: Common ED Presentations / Management / Pearls & PitfallsIntern, Junior, Senior
Calculus of urinary tract (renal colic)Firestone, DanielTop 10 reasons NOT to order a CT scan for suspected renal colicIntern, Junior, Senior, Attending
CystitisSahsi, RupinderDiagnosing Pediatric Urinary Tract InfectionsClerk, Intern, Junior, Senior, Attending
Hemolytic uremic syndromeSwartz, JordanHemolytic Uremic Syndrome (HUS)Intern, Junior, Senior
Urinary retentionBenitez, JavierFirst ALiEM journal article: Trial of void for acute urinary retentionClerk, Intern, Junior, Senior, Attending
Calculus of urinary tract (renal colic)Shih, JeffreyUltrasound For The Win: 46F with Right Abdominal and Flank Pain #US4TWClerk, Intern, Junior, Senior
Calculus of urinary tract (renal colic)Swaminathan, AnandMedical Expulsion Therapy with Tamsulosin in Ureteral ColicJunior, Senior, Attending
Calculus of urinary tract (renal colic)Swaminathan, AnandMedical Expulsion Therapy in Ureteral Colic: An UpdateJunior, Senior, Attending
Calculus of urinary tract (renal colic)Swaminathan, AnandMedical Expulsive Therapy (MET) in Renal ColicJunior, Senior, Attending
Calculus of urinary tract (renal colic)Chitnis, SubhanirNephrolithiasis: Diagnosis and Management in the EDJunior, Senior, Attending
PyelonephritisNickson, ChrisUrosepsisClerk, Intern, Junior
DysuriaLin, MichellePaucis Verbis card: Urinary tract infectionIntern, Junior, Senior
CystitisShenvi, ChristinaUncomplicated Urinary Tract Infection in Older Adults: Diagnosis and Treatment (Part 1)Preclerk, Clerk, Intern, Junior, Senior
CystitisShenvi, ChristinaUncomplicated Urinary Tract Infections in Older Adults: Diagnosis and Treatment (Part 2)Preclerk, Clerk, Intern, Junior, Senior, Attending
Acute and chronic renal failureHayes, BryanPiperacillin/Tazobactam and Risk of Acute Kidney Injury with VancomycinJunior, Senior
Calculus of urinary tract (renal colic)LaPietra, AlexisIntravenous lidocaine for renal colicIntern, Junior, Senior, Attending
HematuriaSaunders, FionaInvestigating microscopic haematuria in blunt abdominal traumaJunior, Senior, Attending
Urinary retentionRezaie, SalimUrinary Retention: Rapid Drainage or Gradual Drainage to Avoid Complications?Junior, Senior, Attending
Calculus of urinary tract (renal colic)Milne, KenSGEM#202: Lidocaine for Renal Colic?Intern, Junior, Senior, Attending
Calculus of urinary tract (renal colic)Wightman, RachelUltrasonography vs CT in Renal ColicIntern, Junior, Senior, Attending
Hemolytic uremic syndromeLong, Brit[email protected] – Hemolytic Uremic SyndromeJunior, Senior, Attending
Gangrene of the scrotum (Fournier’s gangrene)Cohen, PaulHow do we misdiagnose and mismanage necrotizing fasciitis?Junior, Senior, Attending
Gangrene of the scrotum (Fournier’s gangrene)Santistevan, AmieNecrotizing Fasciitis: Pearls & PitfallsPreclerk, Clerk, Intern, Junior, Senior, Attending
Urinary retentionFox, SeanUrinary Retention in KidsJunior
TorsionShih, JeffreyUltrasound For The Win: 22M with crotal Pain #US4TWSJunior, Senior, Attending
Genital lesionsLin, MichellePaucis Verbis: Genital UlcersClerk, Intern, Junior, Senior
PyelonephritisLong, BritPyelonephritis: It’s not always so straightforward…Preclerk, Clerk, Intern, Junior, Senior, Attending
Topic not on listSparks, MattRenal Fellow Network: Top nephrology-related stories of 2016Junior, Senior, Attending
Epididymitis/OrchitisShih, JeffreyUltrasound For The Win! Case – 64M with Fever and Scrotal Pain #US4TWIntern, Junior, Senior, Attending
Calculus of urinary tract (renal colic)Lin, MichelleAuthor Insight: Ultrasonography versus CT for suspected nephrolithiasis | NEJMJunior, Senior, Attending
Calculus of urinary tract (renal colic)Swaminathan, AnandAlpha Blockers in Renal Colic: A systematic reviewJunior, Senior, Attending
Table 1: High-quality posts

Limitation 3: FOAM is produced as needed. How do we achieve curricular comprehensiveness?

As you can see in our publication’s table 2 below, numerous topics exist with no-to-limited coverage and even less topic coverage among highly rated posts. This is important to note. For FOAM producers, this can serve as a call to produce less frequently covered topics to fill these curricular holes. For learners, be aware that the following subtopics are less often covered in FOAM and refer to a textbook or other resource to identify gaps in your own content review. For educators seeking to ensure their learners learn comprehensively, this breakdown may serve to help them emphasize different topics in recommended resources or in classroom learning to ensure a well-rounded emergency medicine education.

Table 2: Renal and Genitourinary SOAR Review Subtopic Analysis

References:

Special thanks to SOAR coauthors Theresa Chan, Anuja Bhalerao, Brent Thoma, Annie Wescott, and Seth Trueger.

  1. Scott K, Hsu C, Johnson N, Mamtani M, Conlon L, DeRoos F. Integration of social media in emergency medicine residency curriculum. Ann Emerg Med. 2014;64(4):396-404. doi:10.1016/j.annemergmed.2014.05.030
  2. Purdy E, Thoma B, Bednarczyk J, Migneault D, Sherbino J. The use of free online educational resources by Canadian emergency medicine residents and program directors. CJEM. 2015;17(2):101-106. doi:10.1017/cem.2014.73
  3. Pantaleoni M. [Benedetto Schiassi and peripheral anesthesia]. Minerva Anestesiol. 1967;33(3):196-200. https://www.ncbi.nlm.nih.gov/pubmed/4885578.
  4. Cadogan M, Thoma B, Chan T, 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. doi:10.1136/emermed-2013-203502
  5. Grock A, Bhalerao A, Chan T, Thoma B, Wescott A, Trueger N. Systematic Online Academic Resource (SOAR) Review: Renal and Genitourinary. AEM Educ Train. 2019;3(4):375-386. doi:10.1002/aet2.10351
  6. Raine T, Thoma B, Chan T, Lin M. FOAMSearch.net: A custom search engine for emergency medicine and critical care. Emerg Med Australas. 2015;27(4):363-365. doi:10.1111/1742-6723.12404
  7. Thoma B, Sanders J, Lin M, Paterson Q, Steeg J, Chan T. 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
  8. 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
  9. Colmers-Gray I, Krishnan K, Chan T, et al. The Revised METRIQ Score: A Quality Evaluation Tool for Online Educational Resources. AEM Educ Train. 2019;3(4):387-392. doi:10.1002/aet2.10376

Andrew Grock, MD

Andrew Grock, MD

Lead Editor/Co-Founder of ALiEM Approved Instructional Resources (AIR)
Faculty Physician, Greater Los Angeles VA Healthcare System
Assistant Professor of Emergency Medicine
UCLA Emergency Medicine Department