Issue 5 / 15 February 2016

YOU might be familiar with foam. It’s an aerated liquid, bubbly. You might not be so familiar with FOAM, or Free Open Access Meducation.

It’s an online movement that has gone global ever since the name was coined by Dr Mike Cadogan, an emergency physician promoting online medical education via social media networks.

He was meeting resistance to this concept and while at a medical conference in Dublin, staring into a tall glass of frothy Guinness, he had an Archimedes moment and so FOAM was born.

Free open access education is nothing new. In fact, it is enshrined in the traditional Hippocratic oath taken by all physicians: “I will teach them my art without reward or agreement”.

What is new and novel with 21st century FOAM is a dual techno-social phenomenon.

Technically, an individual now has the ability, even with modest income or budget, to establish their own personal media outlet, combining online website, podcasting and social media identities.

It’s even easier now with internet-based free resources to learn and copy how to become your own home publisher.

Socially, altruism is making a comeback among medical professionals. Medical educators, paid or voluntary, are creating content and making it freely available online and promoting it globally via social media platforms like Twitter, Facebook and Google.

In their own time, often using personal finances, the community of online FOAM producers and authors extols the virtues of altruism in the sense that everyone who can access online material has the opportunity to benefit, without barriers of journal paywalls or a need to attend expensive commercial courses and conferences.

Why produce content for free, then make it available for free online, when this costs money to perform? Altruism! The desire to do good for the sake of making a better world.

Romantic, naive nonsense? Perhaps, but we are not alone. Wikipedia, Linux, Apache OpenOffice, Gmail, GoogleDocs – are all open access, free resources with no charge to the consumer/end user.

Recently, when the Ebola virus epidemic was sweeping through parts of Africa, many traditional commercial scientific journals waived paywalls and expensive pay-per-article costs to allow scientists to collaborate and share research to defeat an emerging serious threat to global health.

Why should life-saving medical knowledge and research be bought at a dollar cost? Should research and knowledge that save lives be hidden behind a paywall?

The FOAM ethos is that it should not. Ethical education requires we share our knowledge and learning with all, without fee or reward.

You may question quality and standards if things are produced for free, when it’s an open market to publish.

That’s a fair question and yet the answer is in the consumption. If you use Gmail, you don’t question its quality or standard. It works, it’s free, it’s that simple.

Similarly, with FOAM, you can see and follow what the majority are doing and consuming, and judge for yourself.

Also, just because you use Gmail doesn’t mean you stop paying to enjoy other things. So it is with FOAM. It’s not all or nothing and as in life in general, a middle ground is often the best balance.

Finally, the democratisation of medical education via FOAM allows greater participation by all, rather than elite professional educators.

It crosses professional disciplinary boundaries in a way that fosters creativity and sharing. It brings colleagues together globally and negates the isolation of rural and remote health care.

While working in the outback, I remain engaged, connected, and learning and teaching with colleagues in New York City, London, Norway and Fiji. In real time!

Vive la FOAM!

Dr Minh Le Cong is a rural trained general practitioner who currently works for the Royal Flying Doctor Service, based in Mount Isa, in northwest Queensland. His clinical and research interests are in emergency airway management, retrieval medicine and prehospital care.

7 thoughts on “FOAM, altruism and medicine

  1. Dr Brian Stoffell says:

    Dr Le Cong’s enthusiasm is heartening but there are two cautionary notes to sound here.

    His Hippocratic reference states in full:

    I will reverence my master who taught me the art. Equally with my parents, will I allow him things necessary for his support, and will consider his sons as brothers. I will teach them my art without reward or agreement; and I will impart all my acquirement, instructions, and whatever I know, to my master’s children, as to my own; and likewise to all my pupils, who shall bind and tie themselves by a professional oath, but to none else.

    Those with whom the doctor is exhorted to share information freely are his or her students, that is, those with whom they share a tutelary relationship, or perhaps by entesniuon a medical-collegial relationship. The ethical imperative is not to educate the world at large.

    On-line sources for health information and self-diagnosis have proliferated. Quality control is hard if not impossible to establish, so there is every chance that well considered medical information will be lost in the swirl.

    Secondly, there is an increasing tendency in health practitioner education to put weight on the term ’empathy’ and design topic or course modules that are intended to increase its presence in students. Again, this, like the desire to better inform the publc, is well intentioned. But perhaps someone should scan the pedagocial literature to find out what the outcomes of this teaching strategy are. My current feeling is that we can proliferate moral terminology and better equip health professionals to pepper their rationales with the terms of moral sensitivity, but rachmones might be a little harder to teach.

  2. Dr. Balaji Bikshandi says:

    Congratulations Dr Minh Le Cong. Freeing medical knowledge from the clutches of copyright is the need of the hour. It is unclear to where this ‘copyright paranoia’ will spiral down to! Even medical definitions have become copyright by the virtue of the author getting the definition ‘published’ in a journal! I wish the ‘Wikibooks’ project of Wikimedia foundation was listed in your article because it is very much in-tune with the aspirations of FOAM. Wikibooks aims to create copyright free textbooks that can be authored by anyone anytime. I had initiated a reference textbook on Intensive Care at . Good luck!

  3. John Johnston says:

    Unfortunately, we live in an era with increasing threats to traditional professional values –  job insecurity, KPI’s/targets, litigation, public hospital budgetary constraints and an increasing reliance on privatised medicine for timely access to care. With an increasing focus on medicine run along corporate principles for profit, I think payment for univeristy training, as well as the trend towards “for profit” conferences and short courses as part of medical education, will further risk changing the mindset of the medical profession away from true altruism.

    In this world moving away from traditional free, open access education values, towards education for a fee, I see some in the FOAM world are already exploiting and leveraging their involvement for profit and personal gain!  

    FOAM: a great concept for the truly autruisitc and those not seeking reward. 

  4. Casey Parker says:

    Thanks Dr le Cong

    I would add that the benefits of FOAM Education resources are best appreciated in remote and rural areas where access to more traditional or intercollegial education is difficult to access and of variable quality.  The key concept here is timely Knowledge Translation – something tht has been lacking in non-metroplitan areas in the past.

    IN response to the Anonymous commentors here:  one of the central principles of the FOAM community is the idea of non-anonymity – transparency and full disclosure.  The reader / consumer of information is given full access to the author’s position, references etc.  Quality control is a common criticism of the FOAM education resources – however the social nature of the dissemination allows for rapid and vigourous post-publication peer-review. This is a process that is sorely lacking in more traditional edcuational models.

    Finally – it is free.  So the consumer spends nothing and has choice to ignore whatever they choose.  We are all professionals and must decide what is best for our patients.  There is nothing new in FOAM that subverts this basic principle.  This is just a new, and more democratic means to achieve the same ends.


  5. Sue Ieraci says:

    Thanks to Dr Le Cong for the article. The benefits of FOAM are far-reaching, including to medical trainees and post-graduates in other, less privileged parts of the world.

    The comments by “Anonymous” suggest that he or she has not accessed FOAM. These resources are clearly targetted at a medical audience, with evidence reviews, discussion of diagnostic dilemmas, interesting or difficult ECGs and imaging. It is highly unlikely that they could be misused by the general public – as opposed to the huge mountain of misinformation available on general websites posted by ideologues and interest groups.

    I gave a talk about on-line learning resources at an Emergency Medicine conference in Kathmandu just before the recent earthquake. Although he venue was fairly basic (by our standards) almost 100% of the audience had some sort of a smart device. These people and the institutions that employ them cannot afford to maintain full sets of journal subscriptions of text books, but they are certainly connected through the digital world.

  6. Mario Rugna says:

    Thanks Dr. Le Cong

    the great impact of freely available medical education is already a reality and make possible to share information from one (Australia) to the other (Italy in my case) part of the world in an interactive and instantly way. This is a giant step in the direction of “democratic” spreading of good quality informations but make also possible the raising of a more aware sense of criticism in health professionals. If in the past we were more prone to passively accept medical information coming through conventional (but not always pure from biases) sources, nowadays the great quantities of sources and the greater chance of low quality, contributed and stimulates every medical professional to build his own sense of criticism and to freely choose what is good and what isn’t for his own clinical environment. This permits a more customised (and so higher in quality) medical education. Cause is not good what is good in general but what is clinically feasible in the place and in the setting where I work. Just a free open acces medical education can do that!

  7. Simon Carley says:

    Hi Minh. I agree with all that you say and will add that the ability to engage and learn from practitioners such as yourself through #FOAMed has really influenced and enhanced the care I give to my patients here in Manchester.

    It really makes a difference and makes me a better clinician.

    Vive la #FOAMed


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