There’s been a bit of discussion around about the place lately about FOAM and it’s application in general practice. As a concept, FOAM is gaining momentum all the time and is garnering a huge following all around the world. At its core, it’s clinical education by the people, for the people. The beauty of it is that anyone can create it, and anyone can read it. There’s even a hugely popular conference which has emerged out of this online education world.
As the concept grows, so do the questions and criticisms. The FOAM community, I think, does a pretty good job at being self-reflective and pondering questions of quality, validity and reliability. There have been interesting discussions about the responsibility of FOAM in the case of medical errors, and conversations are ongoing about the possibility of a FOAM charter.
My personal view is this: each practitioner is responsible for their own due diligence when evaluating the reliability of clinical information, whatever the source. Is it from a reputable source? Is it referenced? Does the author have any concerning conflicts of interest? This is no different to the process you would employ when reading a journal article, textbook, listening to a conference presentation or asking a supervisor / colleague for advice.
On of the most common questions is “well what about peer review?”. The thing is, FOAM is not trying to replace peer review literature, but rather to disseminate the information to the masses in an easily digestible format. It’s also useful for experienced practitioners to share their wisdom and tips with the more junior doctors like myself. In the end it is subject to the ultimate in peer review via crowd sourced feedback. If you say something blatantly wrong, it will be very swiftly shot down. But much of medicine is not wrong or right, but shades of grey that can be interpreted or implemented differently in different contexts. I think that the opportunity to debate and discuss issues, rather than just accept them at face value, is one of FOAM’s greatest strengths. See the Broome Docs series on PE prognostication for a great example of interesting, evidence based, clinical debate.
The problem for GPs is articulated well in this recent KIDocs post; that is, FOAM is overwhelmingly dominated by our friends in emergency, critical care, anaesthesia and the like. Similarly, the Australian GP’s who are leading the way in FOAM blogging – namely Broome Docs, ruraldoctors.net and the PHARM blog – are predominantly (and appropriately) focused on the acute care & procedural side of medicine rather than bread and butter primary care. However, these role models, along with up-and-comers like RuralFlyingDoc, GreenGP, Rob Park and others are all making a great contribution and will surely have an increasing role to play in the evolution of primary care FOAM.
Foam4gp.com is the closest we have to a “flagship” GP FOAM resource, and with a recent makeover and some new clinical content it’s starting to live up to it’s name. But I do have to agree with some of the feedback that its impact so far has been diluted by reflective, opinion pieces which are interesting in themselves, but not core business for a FOAM site.
And yet there is a community of GPs and GP registrars, many accomplished bloggers in their own right, who are big supporters of FOAM and social media and want to help spread the word to others. So, how do we enthusiastic GP FOAM evangelists improve the quality of the content and the clarity of the message? How do we help GP FOAM to come of age and fulfill it’s enormous potential?
Firstly, I think FOAM4GP needs to be more focused on high yield, clinical FOAM that’s pertinent to practicing GPs. It would be great to have a mix of evidence based summaries of common conditions, clinical quizzes / cases, debates about controversial topics and updates of “cutting edge” information. If the crowd feels that there is value in having a central repository of the more “fluffy” stuff like reflections, opinion pieces and medico-political comment, perhaps this could be streamlined into a different section of the blog, or even given it’s own, completely separate blog more akin to chats around the clinic tearoom.
Secondly, we just need more content. The problem of course, is that FOAM is created by enthusiastic but unpaid volunteers, who do it on their own time for the benefit of the greater good. Everyone’s busy so it’s a pretty big ask to expect a small number of people to increase their output. But as GP’s we do have strength in numbers, so we need to encourage our peers to get on board not just as consumers but as creators. Imagine if even 0.1% of Australian GP’s contributed on a semi-regular basis … we’d have a pretty rapidly growing repository of information. If our international peers joined us … the sky’s the limit!
Thirdly, we need to keep talking and listening to our target audience of fellow GPs, finding out what works or doesn’t work and taking on feedback so we can continually adapt and improve.
I’m just a humble GP blogger from WA who’s thinking aloud, but I’m certainly interested to be a part of the conversation and see where the future takes us. These are exciting times!
I’d love to hear your thoughts on the matter. Comment below or perhaps tweet your ideas with the #foam4gp hashtag.