Skip to content

A Journal of FOAM??

January 18, 2013

Over the past couple of weeks myself and others (Michelle Lin, Todd Raine, Lauren Westafer, Minh Le CongJavier Benítez , Simon Carley, Nadim Lalani, etc!) have tweeted, mused and, in the case of Michelle Lin, even experimented with the idea of peer-review for FOAM. My thoughts are summarized in blog posts here and here. Those posts, along with Todd Raine’s Storified version of the twitter conversation and Michelle Lin’s post on her experiment provide a reasonable overview of the conversation so far.

To summarize briefly in black and white: FOAM skeptics argue that it lacks peer review and therefore has no quality control. FOAM supporters argue that its peer review is crowd-sourced through comments and traffic (good content gets linked to, bad content does not). Michelle Lin created a feedback form for her posts on ALiEM that allowed peer-review of the posts. Unfortunately, while the posts were of high quality (in my opinion) and got view counts that my site daydreams about (as does everything on her high-quality site), few people filled out the forms. While there was much speculation about why this might be (form fatigue, took too much effort, nothing controversial was said, etc), the review mechanism was not as robust as one would hope.

I was disappointed.

Then this conversation happened:

Deirdre Bonnycastle ‏@Bonnycastle
Thinking about Scholarship of Teaching and how contributing to Free Open Access Meducation is not recognized as scholarship #FOAMed #meded

Brent Thoma ‏@BoringEM
I think some bloggers/podcasters are recognized by their institutions for their contributions, yes? @M_Lin @sandnsurf @emcrit

Mike Cadogan ‏@sandnsurf
@bonnycastle @m_lin @emcrit …still fighting, but definitely more tolerated now. Not hospital or Uni supported, but dept support

Michelle Lin ‏@M_Lin
@Bonnycastle @sandnsurf @emcrit I get variable support vs tolerance. Ratio of support to tolerance increasing over yrs. #babysteps

Deirdre Bonnycastle ‏@Bonnycastle
@boringem @m_lin @emcrit I’m griping because uni is pushing for more scholarly work without recognition of SM.

And it got me thinking along another path.

Certainly, the observation that FOAM is not recognized academically is not new. Skeptics would argue that it shouldn’t be recognized using the same refrain they use to criticize it: “It’s not peer-reviewed” they cry. Peer-reviewed medical journals would generally not consider publishing any FOAM content because it is already available freely. However, there are exceptions. For example, Open Medicine and the Public Library of Science, perhaps among others (I didn’t do much of a search), are free, open-access online journals that peer-review their content.

Could FOAM do the same?

During the twitter conversation on this topic Minh Le Cong suggested peer-groups review FOAM content. Why not a peer-review group under the auspices of an online open-access journal? One that, rather than accepting manuscripts and reviewing them, flipped the journal paradigm on its head and picked through the best FOAM published each month and peer-reviewed it. The author could be contacted and asked if they would be interested in having their content reviewed for publication in the currently non-existent Journal of Free Open-Access Medical Education. If they agreed, an editorial team would comb through their contribution (be it a text review, procedural video, podcast or anything else [podcasts might be difficult to edit…]) and provide feedback along with acceptance, suggested changes, or rejection.

Why would this be good?

It would bring peer review to some FOAM content
It would provide the best FOAM to the masses of skeptics with quality control
It would support the academic careers of those creating the best FOAM content by allowing them to cite some of their online work
It would promote publication-worthy FOAM and the authors that produce it
It would utilize the work already done through crowd-sourced review to find the best work. This would also reduce the editorial burden as only great work would be reviewed
It would encourage FOAM content producers to create publication-worthy content
It would maintain the free open-access spirit of FOAM
It is better than what we have now

Why would this be bad?

The journal would be republishing content
I am not academically experienced enough to know for sure, but I suspect open-access journals are less prestigious than other journals, decreasing the benefit to the author
Not enough content could be published to make a difference to the potential academics that put tons of hours into this
Academic rigor would take the fun out of FOAM
We’d be giving in to the critics
Multiple other reasons I’d love you to tell me about


Having written this out I’m not even sure that I want to post it. Creating a FOAM medical journal is out there in a way that could make me the “crazy, unrealistic FOAM resident with stupid dreams that everyone points at and laughs.” Regardless, I look forward to the feedback and the possibility that someone will read this and come up with an idea that helps FOAM to grow in the eyes of the academic world from a rambunctious toddler into a polite teenager.

Please encourage my posting and help to develop this conversation by leaving a comment, tweeting about it, retweeting tweets about it, following me on twitter @boringem, following my blog through e-mail (right column) or following my blog through an RSS feed (top right corner).

Next week I promise to quit posting about the Canadian residency match and FOAM and get back to the boring medical topics that are the original purpose of this site. Thanks so much for reading!

Brent Thoma @boringem


From → EBM & FOAM

  1. “Why not a peer-review group under the auspices of an online open-access journal?
    One that, rather than accepting manuscripts and reviewing them, flipped the journal paradigm on its head and picked through the best FOAM published each month and peer-reviewed it.”

    I think you’re on to something. Huge issue may be TIME. Who has free time to do this…for free? It’s certainly a worthy cause and will bolster FOAM’s credibility especially with academia but how to get it done? If there were a FOAM association or something with dues….these dues could pay for a core group of peer reviewers. Just some thoughts.

    Or, down the line, FOAM peer reviewing could be built into participating EM residency programs; say as an elective, a resident could contribute for X amount of time for FOAM peer reviewing.

    As someone very new to FOAM, I find this whole discussion exciting. I believe FOAM is in the evolutionary stages of a huge paradigm shift in medical education. See you all along the journey.

    • Good point.

      Who would do this for free? Perhaps nobody.

      But the content is all made for free. And the beauty of the crowdsourced peer-review that FOAM already has is that the best content would be readily apparent. Rather than needing to review everything submitted, an editorial group could focus on a smaller, high-yield number of contributions that have already been recognized for their quality and that they had probably already seen anyways. A review would be a formalization of the criticism/accolades that already occurs in comments and on twitter.

      It may not be the way to go, but I like the idea for its disruptive potential. Rather than trying to convince the academics to give us the time of day, we’d work within their system by creating our own little academic beast (journal).

  2. ambitious. I still think that Michelle’s idea & culture of commentary on blogs is the way to go … Just have to create the culture. It seems we’re all excited about sharing what we know. We need to be equally motivated to comment – especially when there’s controversy and disagreement. I liked MIchelle Lin’s ALIEM, but survey fatigue is a reality. Why don’t we start a trend of commenting on all posts we read? It may work if some of the big names in #FOAM start this?

  3. as an afterthought … ER docs also have adhd and so are itching to read the next tidbit of #FOAM rather than scroll through commentary. Maybe Twitter can serve a role in the “view the conversation” portions I already see good back-and-forth

    • True, tons of discussion!
      I’ll definitely try to comment/tweet about more of the things I’m reading, even if I am offering more support than criticism/suggestions.
      It’s nice to see ALiEM continuing with the project.

  4. Who says that any Journal of FOAMed needs to be a written account? THere are other scientific journals that exist only as video podcasts. Could we not do a SMART EM/EM-Rap -style audio reviewer commentary. All those ADHD ED docs could then listen while sky-diving and jumping into ravines.

    • ellebellucci permalink

      Like your idea of using audio/video. Have you heard of JOVE (Journal of Visualized Experiments)?

      Some interesting stuff going on here too via UC Irvine:

      Digital Media and Learning:the power of participation

    • There’d certainly be no reason to restrict it to one media. It would be a different kind of journal if it ever happened.
      Seems to be pretty controversial. Interesting discussion though.

  5. msrebekahjane permalink

    I like it.

  6. Vince permalink

    There’s a rogue feeling about FOAM that’s utterly attractive to me. Having been a General Surgery resident for a number of years, I appreciate most the proudly unconventional culture of Emergency Medicine.

    We go by first names, all of us. Some wear jeans to work. We clock out. We have less dogma. So it’s always bothered me when an old establishment like ABEM comes around and details the importance of the Oral Boards. Why have a test that 99% of people pass? I think the answer, more than anything else, is conformity and acceptance / legitimacy.

    Then comes FOAM, a grassroots effort that sprung from a necessity to supplement ED docs learning. For me, emgoogle has replaced PubMed when I need an answer on whether NIPPV will benefit my ED patient. Radecki’s and Newman’s opinions help me more than Steill’s and Wells’.

    But FOAM has grown, and now in order to gain acceptance and more legitimacy it has to conform. Or does it? There’s efforts to rate posts, there’s talk of a FOAM journal? But will FOAM then lose it’s participants and subsequently, it’s appeal?

    FOAM is kinda messy, and it’s kinda disorganized, but it’s still a young movement. Should we be in such a hurry to make it grow up?

    Vince @himynameisvince

    On a related note, I dig your work.

    Vincent Nguyen
    Jacobi / Montefiore Medical Centers
    Emergency Medicine
    Chief Resident 2012-2013

    • Thanks for the great comment!

      Its a huge endorsement of FOAM to note that it’s become the go-to resource (I’m a combo of googleem followed by google scholar myself, PubMed’s pretty much lost to me).

      Also some great questions. It looks like the twittersphere is trending towards the negative on the idea, but I find the conversation extremely interesting.

  7. Fascinating where this conversation is going!

  8. I love the idea of not giving into the critics, with time things will change, and the skeptics will change. Soon it will be obvious how FOAM gets peer reviewed, its just not obvious yet!

  9. chrislipp permalink

    Great food for thought.

    I’d agree that returning the responsibility and initiative back to those in the trenches is awesome. Lets bring medicine back to what it was like in the beginning: discussion, debate, and discoveries by scientist clinicians asking questions.

    I’m all for the grassroots movement.

    That being said, peer-reviewed content would be helpful especially for those of us who still have so much to learn (namely me). It would be nice to know that what I’m reading isn’t just one person’s thoughts.

    Chris Lipp.
    Med student UofC

Trackbacks & Pingbacks

  1. A Note to Conference Organizers Everywhere | emimdoc

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: