Written jointly by Teresa Chan & Tessa Davis (Guest writer from “DontForgetTheBubbles.com“)

A Brief Background: It seemed like an average Thursday at first. But then, on November 21 (November 22 to some in Australia) controversy struck our little online #FOAMed world. With the launch of the Social Media Index on the ALiEM website, something had existed for almost six months at BoringEM.org suddenly became a point of contention.

This blog post is about the Twitter discussion that ensued. Really, it is more of a Twitter discourse analysis of FOAM Bloggers (from the night of Nov 21 2013), but we think that the power of what we ended up saying to each other (140 characters at a time) was actually amazing. So, albeit a bit tongue and cheek, we have called this an ‘Impromptu Consensus Conference’ because after much debate and discussion, that’s more or less what ended up happening. Consensus.



Without a doubt, the primary aim of creating FOAM content is to provide high-quality online education with a view to improving patient care. But there are secondary aims too – engaging more people in online education, getting people to want to come back to your site, making reading your posts enjoyable/readable. Time has to be spent on these secondary aims to create a great overall site, and in many ways, they are the means to an end – namely the education of your end-users. This end-user orientation is the same with any project: educational, web-based or otherwise. Attention has to be paid to other elements in order to make the primary aim a success.

Here are a few points where we were able to agree.  These ‘consensus points’ are a great place to start if you’re looking to get into the FOAM game:

Consensus point #1: The importance of quality content

One concept that everyone was able to get behind was the idea of great content. There was some disagreement about how far you might need to go to optimize and deliver that content, but in the end all participants seemed to endorse the idea that the core essence of FOAM is the excellent content that we all aspire to produce in a free and open manner.

Consensus point #2: People have to be able to find your stuff

It’s all very well to create the content, but in a world of infinitely increasing number of websites, there’s no point in it being there unless people can actually find it.

If your target audience is on Twitter/Facebook/Gooogle+, then posting about your site on these social media channels is a great way to spread the word.

However, we are now seeing FOAM spread out to other specialties (paediatrics, general practice) – these specialties have far less social media engagement. Therefore, bloggers also want to make their site findable through search engines. Even when searching amongst FOAM content on GoogleFOAM – your site first has to be indexed on Google for it to show up in the search results.

There was some mention in the Twitter chat about clickthroughs, spamming and shifty search engine optimization (SEO). Nobody thinks this is a good idea. Google does not like black hat (dodgy) SEO tactics. We all want people to visit our site, but what’s more important is that they want to come back – quality content is needed for this.

But simple SEO is necessary, especially for new sites. This can be just metatags, a good website structure (e.g. having coherency between your blog post title and its content), posting regular content, and linking to other sites. It does take time to work out how to do this, but if it’s done well at the beginning then that eases the ongoing SEO burden. If you’re using WordPress there are some great plugins (like Yoast SEO) that help with this.

Nowadays, with blog aggregators like Feedly, people need only find your site that first time, and then they can add you to their custom RSS feed and you’ll continue to be on their radar.

Consensus point #3: Design enhances uptake and learning

There was a bit of a semantic debate about what constitutes aesthetics versus design, but in the end, most discussants were able to agree that good design is important for a great educational blog.  Many terms surrounding of this concept were bandied around:

  • Connection with users

  • Crawlable, fast, and good architecture

  • Enagement

  • Readability

  • Usability

Lessons learned can be gleaned by reading around some educational theories on cognitive load [Pubmed reference in Medical Education 2010]. Suffice it to say, most participants in our discussion felt that making sure your blog was readable and approachable to the end-user was of critical importance. It is more important than just making something that looks pretty. Good educational design must flow from the needs of the content which is derived from your initial core purpose. And yet all of it needs to integrate so that the message is effectively conveyed to the end user so that they may learn.

That said, for bloggers there are a number of good platforms that can enhance the form and function of your education platform.

  1. WordPress – functional and designable. Look for HTML5-compliant scalable WordPress sites (@SandnSurf)

  2. Squarespace – an alternative that provides author and end-user platforms (@EMCrit, @BobStuntz)

  3. Blogger – less functionality, but approachable for beginning users

  4. Tumblr – same as for Blogger

The Consensus Tweet

Take Home Points

There are 3 ‘rules’ the emerged from the Twitter discussions that we think are important to share. Tessa summarized it in her tweet above, but we’d like to refine it a bit now for this blog post.

Three Simple Rules for FOAMing

Rule 1) Make good content.

Rule 2) Make sure people can find it. (At least initially…)

Rule 3) Design it to be readable/usable/functional for the end-user.

THEN … Return to Rule 1 because that is at the core the reason you got into this educational endeavor. And if you do Rule 1 well time and time again, the rest may very well follow.

A collection of links suggested on Thursday, November 21, 2013

On Optimizing your reach as an Online Educator

  1. What would you like to see from Webmaster Tools in 2014?
  2. YouTube: SEO / Spam introduction by Google
  3. YouTube: Winning the Story Wars

On Design & Education

  1. ZenHabits: An Example of Clean, Simple Minimalist Design That Still Works
  2. Anatomy of learning: Instructional design principles for the anatomical sciences
  3. Cognitive load theory in health professional education: design principles and strategies

A Very Special thanks goes out to all the participants of the excellent conversation:

@ALittleMedic, @bobstuntz, @Brent_Thoma, @EBMGoneWild, @emcrit, @emlitofnote, @EMtogether, @EMTogether, @HumanFact0rz, @jvrbntz, @M_Lin, @movingmeat, @precordialthump, @sandnsurf, @umanamd for their unique contributions to the conversations

Here is the link to the collection of Tweets:


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


ERDoc. #meded #FOAMed Own views expressed. Contributor to @ALiEMteam, @WeAreCanadiEM, ICE Blog, #FeminEM. @MedEdLIFE founder. Works @McMasterU & @HamHealthSci