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I completed my medical school and background EM training from India (Christian Medical College, Vellore and Apollo Hospitals, Hyderabad) where I worked for 4 years. Following this, I devoted (with all my heart) about 1.5 years to do US Medical Licensing Exams. My stint towards an EM Residency in States did not work but it took me to places and it has been quite a journey. I then relocated to London, England to work as a Registrar (Non-Trainee) in A&E. This gave me an opportunity to better understand NHS, EM training pathways and more importantly the EM Mindsets in the United Kingdom. 

Currently, I am pursuing Higher Specialist Training in Emergency Medicine at South East Scotland Deanery where I have the honour and privilege of training under some of the most innovative brains in the field of Emergency Medicine. Over the past few years, I have realised that LEARNING and UNLEARNING (which can be challenging!) is equally important to deliver cutting edge care to our patients.And through this blog, I aspire to disseminate knowledge, assist trainees with exams and stay up to date with contemporary EM literature. I have always been an avid FOAMed supporter because FOAMed has always played an indispensable role during my training. 

Lakshay Chanana
ST4 EM Trainee 
Edinburgh, Scotland

Monday, December 12, 2016

Coaching Residents to use FOAMed in developing EM systems

FOAMed is a revolutionary movement that has spread across the globe in last 5 years. A bulk of online content producers belong to highly developed EM systems who create material that is more pertinent to their own settings. Replicating the exact guidelines, thought processes and protocols in developing systems is not always a feasible option. Therefore, as local educators we need to step ahead and coach EM trainees in the developing world about utilising FOAMed to the acquire the maximum out of it. Also, we need to focus on creating our own resources that fits our needs better. Here are a few suggestions for beginners:

1. Be active on twitter/facebook (preferably twitter)
Social Media plays a key role whenever we discuss about FOAMed. Majority of educators prefer twitter as it imposes a limit (140 characters) on your messages. There are plenty of discussion groups on Facebook and google plus as well. You can converse directly with the experts in a field/topic and get their perspective of looking at things. 

2. Upload a photo and a short bio on twitter
Upload a brief bio about yourself and add your career interests as well to let people know who you are. Nobody likes to connect with a profile devoid of a photograph and personal details.

3. Be inquisitive, participate and ask questions BUT be a professional 
This might be a cultural issue. I reckon that there is a deal of hesitation among physicians  from developing nations especially residents in utilising open access medical educational material. We need to be more open for discussions and sharing our knowledge/tricks. I presume the reason for this reluctance is partly due to pressure from preceptors who are not ready to embrace FOAMed. Residents in developing nations do use online education to enhance their knowledge but there is sheer apprehension when it comes to an open discussion and commenting. Some prefer to be "Anonymous" while commenting on blogposts. Another reason for this behaviour could be fear on being wrong/criticised on a public platform.  

Professionalism: When you come across a anecdotal/baseless information, do not jump to any conclusions but try to understand the other persons's perspective. If you don't get that or disagree with that, state your opinions without being unprofessional in anyway. Remember that people are watching you on social media. Don't be abusive or mean and avoid making any sarcastic remarks, rather try and have an educated and fruitful discussion. It is also recommended to use a different account for your personal and professional use. Try and keep Politics/Celebrities away from your professional account. 

4. Make a list of your favourite podcasts/blogs  (you can't follow everything)
There is a ton of material available on internet. You cannot consume and retain everything. Be selective, use a RSS feeder to get you the desired stuff, subscribe to your favourite resources or use a website like lifteinthefastlane which distributes a weekly summary recommended by the experts. It is very similar to using textbooks. You cannot read every EM textbook and thus end up choosing Tintinalli's or Rosen's. Likewise, pick a few blogs and make the most out of them. 

5. Take everything with a grain of salt
Big Point - Do not trust everything that you read on the internet. It is recommended to go through the references by yourself and also with your consultants prior to changing your practise. Occasionally, a given opinion might be based on an anecdote or something which is done only at a well equipped tertiary care hospital. Read the evidence yourself and think what are the possible issues that can possibly arise at your shop with use of novel therapy. 

For instance, if you perform a resuscitative thoracotomy then you must have the ability to quickly mobilise the resources and arrange for definitive care. When you plan a Peri-Mortem LSCS, you must have OBGYN and Neonatology support ready within minutes. 

Educators on FOAMed world do appreciate this issue and explicitly mention this as on their website disclaimer as well. It is important to stick to local protocols and go by the clinical acumen of a physician when making life-changing decisions. 

6. Discuss with local mentors/senior physicians about their opinions
You may not able to practise what you hear on every single podcast. What is practised at a particular centre in the United States or England, may not be completely applicable in developing EM nation like India, for reasons such as lack of such high standards of EM training, infrastructure and equipment related issues or simply due to lack of expertise and poor allied speciality support. It is crucial to discuss with a consultant beforehand if you intend to use information gathered through FOAMed for patient care. 

My advice - Before you start using some sort of intervention that you recently heard on a podcast, have a discussion with your consultants outside the clinical shifts. In the midst of a busy shift, it can be hard to convince people for obvious reasons. It is extremely rare to find a mentor who trusts your acumen as a junior physician and is open to an immediate change. However, I have been fortunate to work with physicians who were always open for a conversation. 

Here I recall when I first used ketamine as an induction agent for a septic hypotensive patient, despite my consultant being unfamiliar with it. He was brave enough to say "I have never used ketamine before for RSI" and allowed me to use my choice of RSI drugs. More importantly stood at the bedside and said - go ahead and I am going to stay around to handle any mishaps. To my surprise, the very next day I noticed ketamine employed in our choice of RSI meds. He could have easily ridiculed me and moved on with traditional Midazolam and Sux. 

7. Get filtered FOAMed resources 
If your faculty is not on board with FOAMed, then it is a good idea to introduce them to the FOAMed world. Once they are accustomed with this concept, they can filter information and give you selected high quality weekly podcasts/ blogs which can then be directly applied to patient care. 

8. Don't forget the textbook
You won't find everything on FOAMed. Your EM textbook is still your best bet. Use FOAMed to enhance your knowledge and understanding as FOAMed often talks only about the controversial and hot topics. Read a topic from a textbook and then use FOAMed as a supplement. 

FOAMed questions our current practise and dissects the evidence behind a treatment/ intervention which is what makes many of us uncomfortable. As medical students and residents, the importance of having a solid foundation cannot be emphasised enough. 

Before doing a Delayed Sequence Intubation, familiaze yourself with a Rapid Sequence Intubation. 

9. Find virtual mentors
FOAMed gives us an opportunity to find virtual mentors. Trainees from developing EM systems can obtain invaluable  guidance. Weekly meetings, teaching sessions can be arranged to disseminate knowledge. 

Take Home: FOAMed appears to be paramount for developing EM systems. It is here to stay and we need to get comfortable with it. In this era of technology, it is hard to escape FOAMed and teaching residents about how to incorporate this into their curriculum seems to be the way out rather than going into a completely aversive mode towards it.

A list of my favourite FOAMed resources:


  • Nickson, Christopher P., and Michael D. Cadogan. "Free Open Access Medical education (FOAM) for the emergency physician." Emergency Medicine Australasia 26.1 (2014): 76-83.
  • Cadogan M, Thoma B, Chan TM, et al. Free open access meducation (FOAM): the rise of emergency medicine and critical care blogs and podcasts (2002-2013). Emerg Med J. 2014
  • Thoma, Brent, et al. "Five strategies to effectively use online resources in emergency medicine." Annals of emergency medicine 64.4 (2014). 


     Lakshay Chanana
     Speciality Doctor
     Northwick Park Hospital
     Department of Emergency Medicine


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