AcademiaWelcome back to season 3 of the ALiEM MEdIC series! The MEdIC team (Brent Thoma, Sarah Luckett-Gatopoulos, Tamara McColl, Eve Purdy, and Teresa Chan) are very excited to kick off the ‘school year’ again with another online discussion within the ALiEM Medical Education in Cases series.

Join us now to discuss the case of the FOAM (Free Open Access Meducation) promotion wherein Chris, the assistant professor, finds himself reflecting about whether he should incorporate his online and FOAM works into his promotions package.

MEdIC Series: The Concept

Inspired by the Harvard Business Review Cases and initially led by Dr. Teresa Chan (@TChanMD) and Dr. Brent Thoma (@Brent_Thoma), the Medical Education In Cases (MEdIC) series puts difficult medical education cases under a microscope. On the fourth Friday of the month, we pose a challenging hypothetical dilemma, moderate a discussion on potential approaches, and recruit medical education experts to provide “Gold Standard” responses. Cases and responses are be made available for download in PDF format – feel free to use them! If you’re a medical educator with a pedagogical problem, we want to get you a MEdIC. Send us your most difficult dilemmas (guidelines) and help the rest of us bring our teaching to the next level.

The Case of the FOAM promotion

by Anand Swaminathan (@EMSwami)

It was the end of another long overnight shift, and Chris was feeling good after successfully resuscitating a patient with septic shock patient and another with a gunshot wound to the chest. Sign-out was wrapping up. Looking up from his pile of completed charting, Chris noticed that his colleague and mentor Dr. John Siu was walking up towards him.

“Hey, Chris. I have a meeting in an hour, but want to grab a post-shift bite before you go home? John was one of the faculty members and had been a mentor to Chris throughout his first few years of being an attending. John was also on the university Promotion and Tenure (P&T) committee, and Chris has been thinking a lot about advancing his faculty career recently.

“Sure, why not.” Chris responds.

Walking over to the hospital café, the pair chatted and caught up about life, family, and their recent vacations. However, as they sat down, Chris stirred up the courage to chat about a dilemma that was weighing on his mind.

“So… John, I’ve been thinking a lot about getting my application together for promotion to Associate Professor. Can I pick your brain a bit?”

“Of course. Always happy to help. What have you done so far?”

“Well, I’ve been keeping my CV updated and I think it’s filling up nicely. My concern is that a lot of what I’ve worked on is non-traditional from the university’s perspective. I’ve been very active in resident- and medical student-education, and I’ve had the opportunity to publish a few peer-reviewed publications. I’m also on the hospital sepsis care committee, so that means I’m displaying some clinical involvement. Most of my non-clinical work, however, has been spent on a number of free open access medical education projects…”

“Is that the FOAM stuff?” asked John. “I’ve been noticing a lot of your stuff popping up everywhere! It seems you really enjoy it, no?”

Chris nodded. Chris had been relatively productive online and written a bunch of blog posts. He’d also participated in a couple of podcasts. More recently, he’d taken on an editorial role on a major FOAM website.

“Clearly, you’ve been busy with everything you’ve been doing but I’m not sure this is going to be enough for the P&T committee to move you up,” stated John, furrowing his brow. “It’s not that your work has not been fantastic and impactful, but our P&T committee… Well, they’re pretty old school in their perspective, and I think they’re going to want more of the standard publications and research. The truth is, I don’t know if anyone has gone up before the committee since these non-traditional forms of scholarship have been around so I don’t know how they’re going to respond.

Breakfast is served, and Chris mulled over what John was saying. Frankly, he was a bit discouraged, but as a rather disruptive and enthusiastic guy, Chris wasn’t afraid to fight an uphill battle. Chris reflected that perhaps promotion might not be daunting as John anticipated. John had no idea how his work would be received because it was quite different from the work that other people had previously done. Moreover, as there was no precedent at his institution, it did appear that he needed to think about how best to represent his work to the committee since there was no obvious pre-packaged way to present FOAM for the P&T committee.


Key Questions

  1. Given the lack of precedent with using FOAM for promotion in his institution, where should Chris go to get further advice on putting his application together?
  2. What metrics can Chris use to show his P&T committee the impact of the work he has done?
  3. Should Chris put the focus on his work in FOAM or direct attention in his promotion packet towards the traditional work (journal publications, clinical teaching, hospital committee participation) that he’s done?

Weekly Wrap Up

As always, we posted the expert responses and a curated commentary derived from the community responses one week after the case was published. This time the two experts were:

  • Damian Roland (@Damian_Roland) – Pediatric Emergency Medicine staff physician at the University Hospitals of Leicester NHS Trust. He has a special research interest in quality and process improvement, Identification of serious illness in children and medical education evaluation. Have a look at his blog and reflect on “what I learned this week” (#WILTW)!  Dr. Roland also encourages readers to check out and “pledge to do something better together”!
  • Daniel Cabrera (@cabreraERDR)- Consultant in Emergency Medicine at the Mayo Clinic in Rochester, MN, where he has been since 2005. A native of Chile, he obtained his medical degree from Pontificia Universidad Catolica de Chile where he was also part of an experimental training program in EM. He then completed an Emergency Medicine residency at Mayo Clinic. He holds the academic rank of Assistant Professor of Emergency Medicine. He is the editor- in-chief for the Mayo Clinic EM Blog and is the co-director of Mayo Hootsuite Healthcare in Social Media course. His academic interests include knowledge management, clinical decision-making, graduate education, orphan diseases, and Open Knowledge.
  • Bryan Judge – Attending emergency physician and Program Director of the Grand Rapids Michigan Emergency Medicine program. He is also the Chair of his local University P&T Committee.

On October 2, 2015 we will post the Expert Responses and Curated Community Commentary for the Case of the Backroom Blunder.  After that date, you may continue to comment below, but your commentary will no longer be integrated into the curated commentary which was released on October 2, 2015.  That said, we’d love to hear from you, so please comment below!

All characters in this case are fictitious. Any resemblance to real persons, living or dead, is purely coincidental. Also, as always, we will generate a curated community commentary based on your participation below and on Twitter. We will try to attribute names, but if you choose to comment anonymously, you will be referred to as your pseudonym in our writing.

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