Arguments against Free Open Access Medical Education

I have always been an avid supporter of FOAMed as much of whatever I have learned (besides textbook), came through the use of social media. I recently participated in a panel discussion at the Developing EM Conference on the Pros and Cons of FOAMed. In this whole process I also realised that there are certain critical issues with FOAMed that need to be tackled to streamline things and make these resources more credible. 


Argument 1 - FOAMed Lacks Peer Review

Many are of the opinion that Peer Review itself is a flawed process. Some the the editors who review the articles are self-declared experts. This raises questions on this whole process of peer review. I would argue in favour of FOAMed here as you get an instantaneous post-post peer review by readers across the world (some of those are really the experts). A recent example is PESIT study published in NEJM. This paper grossly overestimated the prevalence of PE in patients presenting with syncope. 

Moreover, material is far more easily accessible to readers via social media rather than paper published journals. Peer reviewed is often nothing but an expert stating that `The paper looks all right to me'. A peer review that asks for raw data, repeated analyses, checks all the references, and making detailed suggestions for improvement is rare. To understand more about the drawbacks of peer review - click here



Argument 2 - Violation of Patient Rights

When using internet for online education, patient privacy comes under threat. There have been cases when Physicians were dismissed following a privacy violation on social media. There are two ways to sort this out - either take a written consent or change the personal details of the patient. Also, we need to sensitise students regarding this.

Argument 3 - Professionalism and your digital foot print

There have been a few altercations on FOAMed in the recent past due to highly polarised opinions. We need to remember that social cues are completely lost when we interact through social media. In addition, as educators we must lay strong principles on professionalism right from the beginning of the medical school from a social media standpoint. Medical Schools and Residency programs now have people assigned to handle this particular task. 

By the time, a student enters the medical school, he/she may already have a digital footprint that may not suit a physician's persona. Whatever we post on social media (Facebook, twitter, google plus and even whatsapp) should be considered accessible to everyone (including your patients and employer as well). Residency programs may google the name of an applicant to look at his/her digital footprint before a formal interview is conducted. 

Argument 4 - Information Overload

Read about how to manage information overload here. I personally use the weekly life in the fast lane review and read whatever interests me. 


Argument 5 - Confuses Learners (esp Medical Students)

This issue deserves serious attention as junior trainees and medical students often find themselves lost between two strikingly different opinions between their core content textbook and a recently FOAMed article published by an expert. For instance, some texts still mention Loop Diuretics as the first drug of choice for a crashing pulmonary edema while in practise many Emergency Physicians use high dose boluses of NTG for these patients. 

A possible solution is having a discussion with the trainee and probing for the evidence behind the use of diuretics and NTG. Educators need to spare a few minutes to explain about the best available evidence and rationale behind a particular treatment. However, some treatments are just based on a clinician's past experiences and anecdotes. It would be appropriate to let the trainee know whenever a treatment is based on a clinician's personal opinion rather than EBM, There are often many ways to treat a disease with none of them being absolutely right or wrong. 


Argument 6 -  FOAMed = Partial or Swiss Cheese Knowledge

FOAMed is not meant to replace a textbook or get rid of bedside teaching. Medicine is best learned by role modelling and observing our mentors while on shift. None of the FOAMed supporters say that students need not read the textbooks. A textbook is still the foundation and FOAMed is a SUPPLEMENT to solidify the foundation. 

Author:

              

     Lakshay Chanana

     

     Speciality Doctor

     Northwick Park Hospital

     Department of Emergency Medicine

     England

     @EMDidactic