Free Open Access Medical Education (FOAM) — An Open Knowledge resource for Health Care Professionals during the COVID19 Pandemic.
The use of educational technologies are widely embraced within the healthcare profession and the Department of Health’s technology enhanced learning framework encourage the use of such technology where it will enhance learning and support key objectives such as improving patient’s experience, outcomes and safety. Internationally there are well established repositories that share open educational resources (OERs) in medicine such as the Medical Education Portal (MedEd Portal) and Health, Education, Advocacy, Linkage (HEAL).
Over the past decade Free Open Access Medical Education (FOAM), has become an integral part of online education in emergency medicine, critical care within the healthcare profession as a whole. FOAM encompasses an array of free online educational resources and discussion forums which are aimed at breaking down traditional barriers to knowledge translation but also encourage online dialogue between healthcare professionals where previously they may not have been able to interact.
The rapid spread of the COVID-19 pandemic urged healthcare professionals to search for accurate and up-to-date information online. This however challenged conventional methods of scientific knowledge such as peer reviewed journals which are not always published on rapid timelines. Hence the FOAM community worldwide turned to social media using twitter hash-tag #FOAMed to share COVID-19 learned experiences, crowd-sourced advice, online resources, research and to discuss the emotional impact of COVID-19. Twitter is the most widely used social media platform within the FOAM community and has become a valuable resource for healthcare and medical learners.
During this pandemic optimizing knowledge translation is key as critical decisions need to be made often with limited evidence. During the early stages of the COVID19 pandemic many tweets pertained to the diagnosis of COVID19 infection, airway management, ultrasound use, personal protective equipment and mechanical ventilation. Being able to share images, website links, educational material, asking for advice, emotional impact and documents has been a valuable asset during this pandemic such as:
“Free critical care training modules @SCCM for non-clinicians to prepare” #medtwitter, #COVID19, #covid4MDs
Asking for advice — Primary care doctor
“How do we treat patients with mid respiratory symptoms who have not had contact with known COVID19 cases?” #medtwitter, #COVID19,
“Reminder that how you take OFF PPE. Clutch gown at chest, pulls down over glove, pull off with gloves, wash hands, pull off mask and goggles straight away from face (NOT UP); wash hands” #medtwitter, #COVID19, #coviddoc
“As the world is shaken, it turns to us. We can’t be shaken. We have an opportunity to be the beacon that guides the world. That’s rare and wonderful. In the midst of uncertainty/fear, there is no other place I’d rather be. Proud to be in healthcare.” #medtwitter, #COVID19, #healthcare, #intensivist
The publication and editorial processes of FOAM resources vary compared to traditional publication peer reviews. FOAM relies on complete transparency and open post-publication where other contributors can discuss, critique or contribute to resources such as the Internet Book of Critical Care (IBCC) chapter on COVID19. The IBCC received over 2.1 million reviews, over 180 comments contributing to post-publication peer review. This resulted in numerous revisions of the chapter to incorporate new evidence. Having the opportunity to consolidate and share vast amounts of information attained during the pandemic allowed open post publication peer review to balance the dissemination of content ensuring accuracy and quality.
Contributing to and participating in the FOAM community particularly within the social media platform is not without risk. The potential for receiving false, misleading information is quite significant. In a study by Prager et al; 2021, 19 contributors contributed blatantly false or misleading information:
“#CoronaVirus is a bio-weapon experiment gone wrong, suspect global experts. #breakingnews, #medtwitter, #covid19, #wuhan, #china”.
However, this only represented approximately 0.2% of the overall study.
Although misleading tweets are relatively easy to identify there is concern when a reader is misled either through misrepresentation of opinion or fact, sensational anecdotes or providing content without context. Misleading or incorrect information proves more challenging to interpret and is a serious concern when using open-sourced information. A further study by Kouzy et al; 2020, also found that one in four tweets in relation to COVID19 contained misinformation.
Being part of the FOAM community there is the potential to reduce the knowledge translation gap during the COVID19 pandemic, but the resources available may be of variable quality. It is the readers responsibility to critically appraise online content and locate high quality and accurate resources. The Social Media Index (SMI) does provide FOAM websites that are high quality and impactful. The Academic Life in Emergency Medicine (ALiEM) AIR tool or the revised Medical Education Translational Resources: Impact and Quality (METRIQ) tool both have been validated to help readers better appraise and determine the quality and accuracy of content of online resources.
Despite there being some pitfalls within the FOAM community, during this pandemic it has offered and contributed to the timely dissemination and medical knowledge translation throughout the world. It has proven to be capable of rapidly sharing information, crowdsourcing advice and providing new articles and FOAM resources discussing COVID19 within several days of online publication. In situations such as the COVID19 pandemic where efficient communication is essential that FOAM resources are available to all healthcare professionals. The benefits certainly outweigh the possibility of misleading information. Twitter certainly has allowed for tailored advice to individuals by having the ability to share their personal experiences, ask specific questions or by sharing and discussing the emotional impact that COVID19 is having on their day-to-day challenges and even their mental health.
In conclusion, the use of social media like twitter during the COVID19 pandemic has united the healthcare profession around the world. This has enabled effective strategies for sharing resources, thoughts and new ideas, accurate and high-quality medical information with the goal to improve patient’s care, outcomes and safety.
