Is it time for GP FOAM to come of age?

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, GreenGPRob 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.

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22 thoughts on “Is it time for GP FOAM to come of age?

  1. Hi penny
    Great summation and dare I say reflection on the GP foam as it stands.
    I am making a concerted effort to do a lot more “GP” content. (I think it is all knowable – but may be delusional !!)
    So as one of the early adopters I am calling my cyber-mates out – let’s do it!
    A good place to start – look at the curriculum of any GP training provider, divide it into small topics and start producing smart, catchy and digest able content ASAP
    C

    • Casey you are doing a great job in leading the way for us amateurs! Broome Docs is awesome and I take a lot of inspiration from your work.

      Great idea to map out topics and that will help to identify gaps, too.

  2. Thanks Penny, great post. Indeed a few great posts lately on FOMA4GP! I just posted this comment about the FOAM4GP site on Tim’s blog (where Casey suggested to make better use of categories):

    The current categories (‘about & disclaimer’, ‘blog feedback’ etc) on FOMA4GP are probably not really categories, but more pages. I would replace the current categories at the top with the categories currently filed under FOAM4GP Maps: ‘cardiovascular’, ‘paediatrics’, ‘dermatology’ etc. In addition, the drop-down category widget would then help to find posts filed under the different categories.

    And if I may, perhaps for those of us who like the ‘MedEd fluff’ a few non-clinical categories could be added – like practice management, leadership and health politics? I acknowledge it’s not hardcore scientific FOAMed stuff but hey, all scientific magazines have a few non-clinical pages. Plus, it would perhaps appeal to a wider audience? (I wont tell Mike Cadogan)

    I am yet to contribute my first clinical piece and would love a page with tips & tricks for FOAM4GP newbies including how to write a contribution!

  3. Agree, bugbear of mine has been the ED-Crit Care emphasis from FOAMed over past year or so – whilst intersects with a portion of my practice (and the stuff I find teresting as a clinician), it doesnt appeal to many in primary care.

    Great new content coming out, viz Robin parks recent blogs….

    Need good summaries, use lf EBM and journal club (which means reading papers, not just NICE guidelines)…

    Interspersed with a dollop of reflection on life as a doctor – like it or not, thoughts on training, dealing with politics and Medicare/funding have impact value too…

    So….drum up support from within the ranks – students, trainees, established docs.

    And as Britney says “get to work *****!”

  4. Thanks for the great thoughts Penny! FOAM for Australian General Practice will hopefully also highlight areas which are deficient in good evidence at the moment so by highlighting what is currently out there, and what is not, might interest people into doing more GP specific, Australia specific, research.

  5. I also think it’d be great if foam4gp content was posted directly on there, rather than being reblogged. It’d be have much slicker appearance, then. Identical posts could then be posted on the author’s own blog if they wanted anyway.

  6. As one of the authors diluting foam4gp.com with ‘reflective, opinion pieces which are interesting in themselves, but not core business for a FOAM site’, I’d like to point out that these posts are normally reflagged from my own site, which doesn’t ever pretend to be a FOAM resource…

    • Thanks, David. Agree absolutely. I mean absolutely no criticism towards the non-clinical posts or their authors. After all, I too am responsible for a chunk of it! As you know I’m a huge fan of notjustagp.com.

      Out of interest, do you prefer your posts just to be reblogged? Or would you prefer to chose which posts appear on foam4gp?

      I personally would prefer to give-the-ok regarding which of mine are reblogged

      • Agree Penny
        I like the blogs out there – great writing. My point is that we need better curation in a central repository eg. foam4gp.com

        That way as a supervisor I can direct my Regs at specific content, share with more academic types and make it work for all.
        David- I am very selective about which content I share from my blog – I try to keep it as focused as I can on clinical stuff that will one day be part of an online “textbook”.

        Maybe we need to have an admin meeting to decide how this curation will work?
        C

      • Casey – I think you’ve really hit the nail on the head there. A variety of different types of content is good but it needs to be carefully curated for the particular audience. I’m happy to have my clinical or work-related posts on foam4gp but probably not as keen to have my more personal blog-diary type entries about my locum trips there (which makes up a sizeable chunk of my blog!). I’m sure the nomadicgp readers are a completely different target audience to foam4gp and it’s appropriate that the content gets filtered.

        Great idea to have a team meeting re: curation and content. Seeing as how I’m being opinionated about it I supposed I’d better put my hand up for being involved with it!

        Huge appreciation to the founders of foam4gp though, you guys have done heaps of work and made it the start of something great. Look forward to seeing how things evolve.

  7. So if the FOAM4GP is heading in the direction of categories and sections, then is that going to be similar to the likes of australian doctor, medicine today and the like? They have excellent articles which I use regularly. Also has a blog section, practice issues etc too.

  8. I had never heard of FOAM until stumbling upon this blog. Absolutely fascinating. After some 20 yrs of practice, so much of what I do is what I simply just know from experience, without always being able to tell the whys and wherefores (usually because of time restraints) I can see FOAM discussions reopening this classic field of research into experience, by simply asking why is it so? Thanks for the article

    • Fantastic! It really is a whole new world out there once you get to know about it. I’d encourage you to have a look around and check out all the blogs and websites, or maybe even think about creating some FOAM yourself… ? 🙂

  9. One very efficient way to postpublication review articles would be by creating a database with reviews that have already refuted claims, so that critics can postpublication review by posting links to those articles wherever the refuted nonsense arguments crop up (no need to write the refutation as a new comment each time). New refutations can constantly be added to the database, including refutations that expose flaws in previous refutations. This may be the way to replace expensive, slow and partly arbitrary prepublication review that refuses to touch theories/hypotheses just because where they happened to be initially published. Some of the theories/hypotheses that have already been published in the supposedly “wrong” places may be true.

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