Time for a FOAM Charter?

The surge of FOAM-related talks just released into the ether from SMACC has led me to re-consider the need for a FOAM charter.

This is how it might work.

Those who sign up can use a logo on their website indicating that they adhere to the principles and conditions for the ethical use and creation of FOAM.

These conditions might include the following:

  • use of a creative commons licence that allows non-commercial sharing, with attribution, of resources and allows others to modify the resources (again with attribution) for educational purposes
  • use of references, wherever possible, to the published scientific literature and to other FOAM — thus allowing others to establish the veracity of FOAM claims and maintain a degree of scholarship and ensure the credibility of FOAM
  • recognition that we are all wrong sometimes, and that creators of FOAM will strive to make corrections as soon as possible, or where there are differences of opinion seek to show, or link to, other perspectives
  • maintain medical professionalism (including patient confidentiality and attention to issues of consent where appropriate) … and be nice!
  • the avoidance of anonymity so that FOAM creators are easily identifiable and are accountable for their actions

An important issue is what should happen if an allegation is made that a FOAM creator has breached the charter. It maybe that we need a committee (perhaps elected?) that screens potential members of the FOAM charter, or at least arbitrates on issues of conduct and has the power to remove the ‘FOAM Charter’ logo / membership from anyone who misuses it. This may require a substantial commitment from those involved.

Please share your thoughts on this idea, including what should be included in the conditions and how to make the logistics happen, in the comments below.

vive la foam blue 700

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Vive la FOAM!

Addendum 29th July 2013

This post has generated a large amount of discussion — I will aim to write a summary of the discussion in early September after letting it all percolate for a while… thanks for taking part!


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  1. Michelle Johnston says

    Completely support. It is the next logical step to improve credibility, accountability and evolution of this fantastic but headstrong movement.

    • says

      Does FOAM even need its own Code versus signing up to HonCode?
      I think there are some differences -- especially in the commitment to free and open-access -- but otherwise the principles are conduct are appropriate
      I agree the HonCode provides a good foundation

      • says

        I like the idea of our own. I would highly recommend sites register with HON as well, but they are very stringent. A FOAM icon would look v. nice next to the HON one.

  2. rfdsdoc says

    Thanks Chris for making first move.
    As we discussed at SMACC2013 , yes this is a step in right direction.
    In fact is already being done by small groups around the world. They are agreeing to link their blog sites, provide prepublication peer review and adhere to some standards of conduct.

    Use of media/images ethically I think is a strong selling point. If the charter lays down the standard of use of images/media on sites then its a powerful message that this is the expectation for conduct.
    I agree with the open access and free aspects should be enshrined in the charter. It is the signature of FOAMEd!

    A universal disclaimer that links to the charter might be another strong selling point. Scott kindly allowed me to adapt his and I think charter and the administrating body/committee can provide this as a useful endorsement of the FOAMEd principles.

    This gets onto which , who and what administrating body/group/committee to govern the charter and deal with process and breaches.

    I suggest we draft the charter proper then publish it for review online and have an open invitation to interested parties to join a foundation committee. There can then be a vote for an administering committee that changes annually

    What happens with conduct breaches etc we need to draft that separately to the charter.
    The final charter and procedures manifest can be an open process of contribution and voting by the FOAMEd community itself.

    • says

      BTW, I don’t think pre-publication peer review should be part of the charter.
      It can be optional.
      One of the purposes of the FOAM charter would be to make post-publication peer review more reliable -- as those who sign up are beholden to respond to commentary on their posts and to correct any errors.

  3. Damian Roland says

    I think a code of practice with which you can associate a FOAM Charter logo is an excellent idea. However in the spirit of open-to-all, but also to avoid the knee-jerk to prove the FOAM is no less rigorous than academia (http://wp.me/p1m0vB-4A), I wouldn’t use a committee. Well at least not initially.

    The beauty of FOAM is the percolation of the higher quality materials via established channels. There is innate peer review from the leading FOAM protagonists anyway. Adherence to the Charter could work in the same way. In addition given virtually all sites have a feedback/comment section why not get the FOAM community to feedback directly. Those sites not responding/deleting comments when not “charter compliant” would I suspect quickly become black listed. There then remains the problem of correctly having a charter and being wrongly maligned. This is where I think holding fire on a ‘committee’ may be sensible. The bureaucracy (although necessary) to respond to these cases could become a distraction and seek to solve problems that don’t exist. Fairly sure Mike Cadogan and colleagues weren’t thinking committee when they formulated FOAM in a Dublin pub and it did pretty well.

    Why not give a charter a shot and go from there.

    • says

      Great comment -- I’d love to avoid a committee if at all possible!
      But I am concerned that non-charter compliant websites could make the rest of FOAM look bad -- then what?

      • Damian Roland says

        They wouldn’t be mentioned, signposted or alluded at all in the FOAM community. I would argue that a list of FOAM charter compliant sites (as decided by you guys at LITFL) are posted on this site. Technically this may not be completely democratic but I think for a short period it would allow a good reference site. It could also act as a focus point for determining whether a committee would be needed.

        • says

          I suspect that will be a pragmatic way forward -- write the charter (FOAM crowd source the content and wording), and get people to sign up.
          Monitor the result -- then decide the need for further regulation (and hope like hell that further regulation is not needed!)

          • says

            I think the idea of a “charter”and Honor Code is a wonderful idea! But, I also agree with holding off on a “committee”. As a Philadelphia native, the concept of letting the community discuss and decide as apposed to a set committee appeals to the Quakerism in me. Perhaps a criterion for using the accepted FOAM logo should be active participation when a controversy comes up….

            The beauty of the FOAM community is that our unity does not demand conformity!

  4. rfdsdoc says

    thanks Damian and Chris
    I am neutral about the prepublication peer review process. It has good and bad points. Certainly the notion that each charter compliant blog post has been reviewed by a peer makes a good selling point. The bad point is that it makes things cumbersome..more akin to the traditional academic journal processes.
    I am interested to hear what my peers think about this!

    As for a committee or not, I personally think we are professionals and need to have some order and structure to set a standard. The charter by itself is not enough.
    The challenges will be when things are disputed..for example when image copyright is disputed between a blog author and a third party. Or the nature of financial disclosures, sponsorship and advertising vs education. What if an antivaccination doctor wanted to become FOAMEd charter compliant..some group needs to decide such matters..it would be unfair to rely upon one or two individuals to handle such challenges. The point is that a group can look out for each other and ensure peer standards and the only way to ensure this is to have an agreed group that has a set of guiding principles to make decisions by and meet regularly to keep house in order.
    This group should be reconstituted regularly to allow fresh ideas and developing standards to grow.

    • says

      RE: “for example when image copyright is disputed between a blog author and a third party.”
      I don’t think that is something for a FOAM committee to arbitrate -- that is down to the individual, and ultimately the law.

    • Damian Roland says

      Perfect practice or passable pragmatism…

      Clearly an well defined governance structure with clear accountability is the optimal solution. My question is whether this would ensure a FOAM charter would never get off the ground.

      Are their volunteers for such a group, would people want to be actively involved, would you have to declare all interests (maybe stop writing foam material…)

      Not averse to change, governance or accountability just think the charter should come first.


  5. rfdsdoc says

    Well Chris, if the blog author is a subscribing member of charter then a complainant might rightly address the committee in addition to the individual

  6. says

    Hi Chris and others,
    I really like the idea in principle, particularly the notion that FOAM creators allow others to use their resources for educational purposes (with acknowledgement of original creator). I think that happens informally anyway but it would be great to have it more widely accepted.

  7. says

    I remind you of wise words from Richard Smith:
    “The editors of the New England Journal of Medicine must think of themselves as superior people (and they are superior to most of us, and certainly to me) capable of distinguishing truth from error, but could they be making a mistake? I urge them to follow the advice of Rudolf Virchow, the great German doctor and intellectual, who insisted that ‘Everybody is free to make a fool of himself in my journal.'”

  8. says

    I feel a little conflicted about this idea. Which seems weird to me given that every other idea you fellas have ever had has turned out to be pure genius.

    On one hand, I see the advantage to a FOAM seal of approval. Guarantees to the reader that this person has met some criteria to publish FOAMed material. Which is awesome, and likely will become more and more important as it seems any dimwit from Kentucky or SC can buy a mic and start publishing crapola.

    On the other hand, it seemingly creates a barrier for others to get involved; which to me, eats at the essence of FOAMed. I don’t want anyone to feel like they can’t create, produce or publish educational material because they have to get a stamp of approval first. In many ways I think the crowd sourced nature of FOAMed is why it has become so successful. It seems the younger generations have less tolerance and patience for the peer-reviewed process, and are invigorated and motivated by the crowd sourcing instead.

    As I write this, I wonder it there is another option. Could we create a way to crowd source the validity of someones FOAMed contribution rather than have a committee review each seal of approval, or each question of validity. Maybe a vote on the site. +1 for good FOAMed, -1 for bad FOAMed practices?

    Just thinking.
    I’m sure Matt came up with something better already.


    • says

      Interesting thoughts Mike
      I can’t see the website idea working -- the last thing I want to do is to go to another website with an arbitrary voting scheme / popularity contest.
      The FOAM Charter would simply be a reassurance that certain standards are strived for by a site.
      People could still make resources and not be signed up to the charter, but if designed correctly, it would be inevitable that anyone who intends to create FOAM as a going concern would sign up. Or if they didn’t a blogpost explaining why, so that readers can see where they stand would be useful for users of that resource.

  9. says

    While I don’t have much to add to the excellent post and discussion that has already taken place, I agree that this is a logical move forward.

    In regard to the pre-publication peer review process: I think it is an excellent quality control measure and have done this on my site for months because I find that 9/10 times it improves the quality of my content. However, I am relatively ‘junior’ in the world of medicine and I suspect the return for people like David Newman, Chris Nickson or Scott Weingart would be minimal

    Perhaps a community-oriented compromise would be a commitment of each member of the community to agree to occasionally (as defined by the member) pre-pub peer review the content of others if asked. This would be beneficial in that it would help to welcome new contributors to the community while hopefully not being too much of a burden for the vets.

    • says

      Would the quality have not also improved if it was peer-reviewed post-publication?

      A couple of months back one of the most published clinician researchers in the world said to me: “One of the problems with peer review is that it is not peer review -- anyone who is seriously into research has very little time to review the work of others, so most of it is done by people with time on their hands” (often non-researchers)

      To me it doesn’t make any difference if the the improvement occurs before or after publication. I often get people to have a look at something before publishing as a quality improvement measure, but that’s not what the journal’s call ‘peer review’.

      I think anyone in the FOAM community would happily pre-review another’s work before publication if asked -- if they have the time!


      • rfdsdoc says

        Chris, fair point from your researcher friend but really we are not talking about reviewing unpublished research articles are we? IN the main its reviewing of blog posts to check accuracy, references, appropriateness of content to theme of the blog etcetcetc.
        Its not checking statistical methods, study designs etc.

        I also take your point that what is the difference between pre and post peer review as in reality, both can occur..they are not mutually exclusive and in fact prepublished review will inevitably still get commented on and amendments surely will be a result.

        I dont think its essential to have FOAMEd prepublication peer review. It makes it seem as if we are emulating the traditional journal review process which might be comforting for some but in reality they are not the same processes.

        I agree with Brent that having a colleague review a draft post can help improve it tremendously, but that is not essential and should be up to the author to decide.
        regardless the Charter should uphold the principle of accuracy and responsibility to check references and correct errors appropriately.

        • says

          Thanks for the responses.

          The problem I see with solely post-pub peer review is that, if other sites are anything like mine, the majority of a post’s impact comes in the first several days after its posted. Certainly, fixing errors at this point is still helpful, but it is nice to catch that kind of stuff before it is up.

          I would agree that what I’m referring to is more of a ‘quality improvement measure’ than peer review in the classic sense. It’s definitely not essential (especially for vets), but I’d argue it should be encouraged :)


  10. Tessa Davis (@tessardavis) says

    Thought I’d weigh in too, although the discussion so far has been pretty comprehensive.

    I tend to agree with Mike in his reservations and I think it boils down to what the aim of the charter/committee actually is.

    Is it for sites to declare their educational intentions (i.e. trying to produce high quality content, reference where we can) and copyright sharing goals?
    Or is it for regulating these sites?
    i.e. is it intention to adhere or actual adherence to the standards?

    If it is INTENTION, then that’s fine, a simple stamp summarises your intentions without having to print them out in a whole page (and it will look nice on your website too). The stamp can link to a page on LITFL saying what the principles are.

    If it is ACTUAL ADHERANCE then I do think this becomes more problematic. Is the FOAM Charter Committee (or whoever) going to mediate in disputes about referencing, accuracy and copyright? This seems unnecessary. Chris has already pointed out that laws exist to ensure we stick to these rules anyway, and we are pretty much all under professional regulation of our conduct online too. Essentially all the points laid out in the charter are already in existence and we are all bound by them anyway (with the exception of CC license). So I’m not sure what a FOAM Charter Committee would add.

    We need to avoid committees for the sake of committees

  11. says

    Sorry to be late to the discussion. I’ve been reading and mulling over all the great points above. To me, a “charter” is essentially a formal organization with an official governance structure which would be accountable for all those included/approved under the charter. Without such a structure, in the eyes of a novice FOAM consumer, what is the validity and value of the charter’s stamp of approval? That being said, what I do like about the charter includes:
    -- FOAM branding concept
    -- Builds stronger FOAM community

    Stepping back a bit, it sounds like the purpose of this FOAM Charter discussion is to objectively inform readers about the quality of content that they are reading. For me, the ideal process is one which does not rely on self-reporting of charter/code-adherence and does not require a lot more work by the FOAM content producer (it’s already an unpaid full time job!).

    So in summary, I think I’ve just talked myself in a circle. I’m happy to try out the FOAM Charter idea. No harm in testing this out. Not sure who quoted this: “There is no such thing as failure, just results.” My 2 cents.

    • says

      Thanks Michelle,
      Without a committee, I think the charter would simply be a description of the fundamental principles of those who choose to be part of the FOAM community.
      Without a committee we would rely on crowd forces within the FOAM community to maintain standards -- I actually suspect that would be quite powerful.

  12. ScottyDoc says

    Here’s my two-cents as a very peripheral, unknown, non-contributing consumer of FOAM resources (so make of this what you will!).

    I feel the FOAM community leaders need to be careful to avoid the appearance of over-regulating or dictating to the world of FOAM unnecessarily. As an ‘outsider’, the whole process appears driven by a relatively small, intelligent, committed and yet exclusive group of enthusiasts, and I can’t help feel any move to give further power or authority to a small group in the form if committees and charters is at risk of alienating potential consumers like me, who might bristle at thought of a small group being the arbiter of what is and isn’t FOAM.

    In essence, this whole debate is about quality control. As a FOAM consumer, I’m aware of what resources are out there (or where I might look for them if I’m after something new), and a natural and important part if the process is an appraisal of what I find -- I like to think I’d recognise FOAM that may not be reliable or decent quality, and I move on. That’s part of my professional mindset and approach: investigation, examination, appraisal and evaluation. I can’t see how a charter or FOAM committee would improve this process (which I hope we all do?), other than to make me think a small group is having an increasingly powerful choice over what they think I should or shouldn’t have access to. (And then FOAM starts to look like a textbook or a journal…!)

    Maybe I’ve misunderstood the argument, and I’m certainly not au fait with the complex inner workings of putting FOAM on the web. But in summary, I think viva la FOAM and all that -- but perhaps not viva la over-regulation. Just keep allowing people to put great (medical) content out there, and let us -- the anonymous, uninitiated amorphous mass of FOAM consumers -- decide what to do with it!

    • says

      Great comment Scotty
      I completely agree with your perspective that all physicians and medical learners need to skeptical, critical thinkers capable of appraisal -- indeed I have argued this at conferences and online.
      However one of the constant criticisms of FOAM -- particularly from established academics -- is that it lacks quality control.
      As is probably clear from my previous comments here -- and also at SMACC -- I am not in favour of a committee or regulation.
      I do however see merit in FOAM creators waving a standard, a flag that demonstrates our ideals and commitment, that also gives some credibility to what we do.

  13. Mike Jasumback says

    Ok, haven’t slept in a while so bear with me. While in the past I have commented on the nature of FOAM as wtihout peer review and suspect to some degreee. I believe that the huge benefit of FOAM is that it is, to some degree, self correcting. I view FOAM as a crowd source of PERSPECTIVE! I believe that the most profound benefit of FOAM occurs when we DISAGREE!

    From a Standards point of view, I think we can lift from other areas in this. FOAM participants have, in my experience, been remarkably professional in their behavior. That doesn’t seem to be an issue. I do believe that useful FOAM is highly referenced, peer-discussed, batted around, criticized and re-spit out in a much more powerful form than where it started.

    If any standards need to be developed it is the fact that we need to use professional standards of referencing.

    The beauty of FOAM is that it allows for rapid commentary, discussion and recapitulation. It is Hegelian in its nature. The quality control is US!

    Michael A. Jasumback, MD, Advocatus Diaboli
    Half asleep at the keyboard!

  14. Mike Jasumback says

    Minimally more awake now and have read through all the previous comments.

    As I published about a year ago, I think the whole prinicple of FOAM is that it’s purveyors subscribe to a code of Honor. In my mind this code holds them to publish the most accurate information they possible can, with their perspective being as honestly put forth as possible.

    A code of Honor, cannot, by definition, be regulated. It can be codified however. Perhaps this is what you are looking for.

    By subscribing to a code of Honor, providing the highest quality, most accurate information possible, FOAM will succeed without formal regulation.

    The marketplace will ultimately be the arbiter of whether someone’s FOAM product will be succesful.

    Michael A. Jasumback, MD Advocatus Diaboli

  15. says

    I am late to this having spent the weekend climbing mountains (it was great, but it’s amazing what can happen in such a short space of time). I suppose it gives me the opportunity to stand on the shoulders of giants and sound wise…….I will manage the first and fail the second!


    1. A set of FOAM principles/charter/code that defines what makes a blog site #FOAM positive has an appeal. However, there are dangers in defining things too tightly. For an example I refer you to the case of the French Lovers and the summary of Justice Potter http://en.wikipedia.org/wiki/Jacobellis_v._Ohio

    Whilst the topic here is not as racy, I too find #FOAM a little to define at times, but I sure as hell know it when I see it (or rather when I don’t see it).

    This should not prevent a set of principles being produced, but they would need to be just that -- principles.

    2. If one sets a standard then by implication there needs to be a judgement. That’s tricky as no-one wants to set up a committee to arbitrate on matters that might turn out to be rather trivial.
    Much has been said already on this which I agree with. I’m not a big fan of committees, particularly the self elected ones.

    3. I am happy with Chris’s original suggestions as to what might be in the principles. I might also add.
    something around PHARM sponsorship (not a good thing), and independence (or strict declaration of other interests).

    Lastly, I could see a process that looks a bit like this……

    1. Blog declares that it adheres to #FOAM principles.
    2. Puts #FOAM logo on site
    3. Click on the logo to endorse/refute agreement that it adheres to #FOAM principles.
    4. Ask Mike Cadogan to make above happen in code (should be step 1 probably).
    5. Time limit endorsements to 3 years.

    That way you have declaration of agreement to principles, crowd sourcing of views, some QA.

    If really clever you could restrict endorsement to those whose content has already been declared as #FOAM compliant. That would allow a self perpetuating cycle of endorsement.

    Just thinking -- probably a rubbish idea from sun burn, frostbite, immersion injury and dehydration from a typical weekend in the Lakes (British weather).



  16. says

    Some great comments from Mike Jasumback and ScottyDoc -- the threads emerging here

    i) a small bit of publication review discussion (probably best dealt with elsewhere)
    ii) the concept of a charter
    iii) the need/ability to regulate

    The jury seems to be out on (iii) and as I hold a strong opinion against (at least initially) won’t deal with this.

    The charter itself seems to have found some traction. I like Michelle’s comments about branding and community and Tessa’s observation in may promote intention.

    A charter may be useful for just being able to tell the world what FOAM is, a formal stake in the sand. Something I suspect could be agreed upon which might benefit those outside of FOAM more than inside it…

    (and from a selfish perspective a charter would be really useful as a definition for what is and isn’t FOAM material for evaluation purposes…)


  17. rfdsdoc says

    I suggest Vic Brazil’s comments on journalistic analogy to FOAMEd need to be considered. Journalists are bound by a formal association with charter of conduct. They are not a bunch of individuals doing the same thing. They hold meetings , reward the best in their field with formal recognition, promote best practice and seek to nurture/promote the next generation.

    I see some comments look at the negative aspects of formal organisation/committee/association . Yes it involves extra work. Yes it can stifle creativity but so can many other things that as individuals we have much harder challenge to strive but collectively we have greater voice.

    At the moment FOAMEd is choose your own adventure, medical journalism by individuals. It is mainly an amateur pursuit. Some proponents have pushed it into the realms of professional activity with some academic recognition and reward. So we are in this transition period that will decide how the FOAMEd community will progress ..or stagnate.
    Leave it as it is for now..even add a voluntary charter ..and it will remain the realm of amateurs/hobbyists/enthusiasts. Thats fine..nothing wrong with that. But to me when SMACC 2013 conference became reality and was way more successful than we had ever forsaw..I believe it signals progress into the next stage :becoming professional and organised.

    To deny the need to improve FOAMEd, to establish good pathways to assist novices, to assist established proponents in unique challenges like intellectual property issues, ethical behaviour, IT dilemmas, to recognise best practice/standards and reward them,
    I am not proposing we become FOAMEd Inc.
    But answer this: how do we improve FOAMEd now?

    • says

      Thanks Minh,
      I know you feel strongly about the need for some form of organising FOAM body. Based on the comments so far it seems you are part of a very small minority on this point.
      A big difference is that we -- as doctors -- already belong to a professional body, that already sets standards for how we should behave. I think that is ultimately what we abide by, and ultimately I am a doctor -- not a ‘FOAM professional’.
      FOAM is just another educational activity -- as Victoria Brazil said at SMACC (to paraphrase), ‘Do we need a professional body for Powerpoint too?’.
      I don’t think so.
      Intellectual property issues and ethical behaviour fall in the realm of the law or our existing professional standards -- whether we make a powerpoint presentation, write a paper or create FOAM it is all the same.
      As for pathways to assist with FOAM -- I think that exists… Have you not been the recipient yourself? 😉
      The pathway is clear -- if you want help, ask for it!

  18. says

    Was a condition referring to conflict of interest disclosure considered?

    I think one of FOAM’s biggest assets is that it is generally created by people without any CoI’s. However, if someone has or develops one then disclosure would be important.

  19. says

    First we should be clear that not participating in this charter and not putting the icon on your site doesn’t make your site not FOAM. The icon should prob. say something akin to: I adhere to the FOAM Charter and then link to the actual charter. No icon, still may be FOAM, but less instant trust.

    I see no need for a committee, the community will enforce the charter 4chan style. May want an organizing group who will cultivate and host community discussion about possible changes like we are doing now. I have no problem with LITFL being that forum.

    I would not be part of any charter that includes prepublication review; I think Chris’s idea of committing to open reply to review is the way to go. Most current FOAM prepub peer review is even worse than journal peer review as it gives the illusion of peer review, without the depth or some assurance that the peer reviewers are actual experts.

    See no reason to get into copyrighted image issue; that’s between you and your lawyer.

    Also the creative commons sharing requirement doesn’t make sense to me. If an author chooses to allow sharing by permission rather than sharing by attribution is their stuff not FOAM?

    • says

      RE: Creative commons

      True -- doesn’t have to be sharing with attribution -- could simply be creative commons licence with non-commercial sharing.

      However I think attribution is a common courtesy. It has the advantage allowing FOAM resources to be traceable, and will help spread the idea of FOAM when people who indirectly receive its benefits trace it back to its origins. It also removes any uncertainty about how it can be used. Of course, if someone wants to use FOAM in some other way (e.g. for a commercial purpose) they could negotiate that with the FOAM creator, who would have right of refusal.

      For these reasons I think stating that FOAM can be reused non-commercially with attribution should be included. Doesn’t have to actually state Creative Commons licence, but could be used as an example.


      • says

        I must not have stated clearly enough, the intent of my comment was not that sharing should be without attribution; quite the contrary, it was that some FOAM providers would not want their stuff shared without permission. What if Steve Smith decided he doesn’t want his actual ekgs used unless you ask first, would his site no longer be FOAM?

        • says

          I see what you mean now.
          To me, if it is not free and open-access it isn’t FOAM.
          I may be in a hardline minority here -- I’m not sure -- but for me the spirit of FOAM is that it can be used by anyone for education in anyway. To me that should mean it can be reused and modified without permission, but with attribution.
          By being FOAM, permission is already granted.

          • says

            Since EMCrit is creative commons, I obviously don’t disagree with your feelings on the matter, but is this really a point that kicks someone out of the FOAM club?

  20. rfdsdoc says

    thanks Simon, Chris, Damian and Scott for comments.

    Ok I am in the minority on the committee aspect!
    Its paradoxical but no need to dwell on it. The fact this post has been written and the question asked : “Does FOAMEd need a charter?” already answers the question of ” Does FOAMEd need to be improved and how to do it?”

    Right now consumers have the option to not trust what they are reading. They vote with their devices and mouse buttons. Adding in a self regulated endorsement icon on your website may add some trust to consumers..but I suspect not much and is it worth it in and of itself. HON code already exists so that would a FOAMEd code add per se.

    If we are going to go ahead with a charter why not make a significant advance to truly value add to FOAMEd resources rather than adding window dressing…because the question may equally be answered ” Whats wrong with FOAMEd right now? Isnt it right for now?”

    Imagine at SMACC GOLD (2014) we unveil the new FOAMEd charter to show how we have improved the community and resources. Someone like Holley ( the beautiful conscientous objector he is no less!) stands up and asks ” So this new charter is self regulated, voluntary and you dont need it to create a FOAMEd site…how is it better than last year?”

    I would suggest dont create a charter for the sake of having one. It needs more than that for the next step..in my view anyway!
    I would rather as Scott suggests in regard to pre publication peer review..leave things as they are and let consumers vote. That is the current state of play now and it works ok. To truly improve on it..well you know my thoughts!

  21. says

    +1 to @EMManchester -- I like the concept of an agreed set of principles that a site/blog/contributor could state they support and promote by their activities. Though it’s growth has been chaotic and anarchic, FOAM isn’t broken enough to need “fixing” by a committee or charter just yet IMHO. Perhaps dissemination and trial of agreed principles might be a first step that could then evolve via vox populi and tincture of time…?

  22. says

    Great to get this out for discussion again Chris.

    I feel divided here.

    On one hand the concept of committees, charters, regulations and the inevitable exclusivity and hierarchy that this brings seems to go against the essence of FOAM. With committees there is the inevitable slowing down of processes and an onus on the committee to constantly monitor the sites involved. A committee could not take responsibility for everything that’s published and keeping up with the mass of FOAM media that’s coming out is a phenomenal task.

    There’s also the fact that the structure and organisation that may be required already exists in various colleges and organisations that we’re all members of, and to create and maintain these takes substantial effort and cash.

    But I do also see the necessity to legitimise this form of resource and prove it’s worth to any doubters.

    This is the tricky bit!

    A charter may be a starting point, with high ideals to which we can at least encourage FOAM creators to strive towards, but the quality is always going to vary. The NEJM is the NEJM because they have incredibly smart people working for them and editing for them and have built a brand that attracts the best people to want to publish with them. FOAM is a completely different resource.

  23. rob mac sweeney says

    I’m hesitant about a FOAM charter for several reasons, most of which have already been excellently covered. I’ll focus on just two.

    Firstly, if the problem is one of perceived low quality, then it shouldn’t be too hard to match the standard of most journals. Have pre-publication peer review, including stating on the article/blog that the article has been peer reviewed, and provide full in text citation for any scientific claims.

    Secondly, producing a charter to sign up to potentially creates a divide; those who are in favour, who sign up and are in the official club, and those who don’t, and are excluded. Both groups would continue to offer free, open access medical education, which should be sole standard -- the differences between how a site/group provide their material is a real strength and encourages diversity and innovation. If a site is poor, and provides low quality material, it won’t be successful.

    Natural selection will prevail. Let’s not split a wonderfully successful movement.

  24. haney says

    Wow! How late am I to this party…for what it’s worth, here are my two (tiny) cents….

    I think a charter is a good idea as we move forward for the longstanding FOAM community but also as it grows into a respectable academic body. A charter also allows us to create a mission statement that we all inherently know and understand but will give framework to newbies who are just joining and may save all of us some breath explaining.

    I personally believe we should use caution not to become so exclusive as to have a set group of people who sit on a tribunal or committee, but keep FOAM open for everyone as a free flowing organism.

    Finally, I believe anything put out there on FOAM should be shared and used freely, however there must be some encouragement to give recognition if something is used for personal use. I have seen many people’s hard work on FOAM re-posted as other people’s tweets and on other blogs…while I feel having rules against this are too formal there should be open discouragement of this stuff.

    I think it would be very cool to unveil this at SMACC gold, but if not completed by then certainly continue the discussion in person there.

    Haney (@criticalcarenow)

  25. says

    New to the website and the specifics of FOAMed, but a very old follower of the concept.

    In order to really gel and move forward not just as a purely academic but more widespread movement, some formalities will be necessary. So long as they’re built on the concepts we all agree on as the important core of what we want to do, I believe this would work; and, could be developed in such a way as to not be onerous for those involved.

    I would be happy to be involved.

  26. says

    I think a loose outline of what we mean by FOAM would be useful as a reference point for those on the outside wanting to know what the hell we’re talking about.

    I’m against the idea of a formal committee vetting posts for compliance. If we believe in post-publication peer review (which we may not of course…) then we can also allow people to make up their own mind if a post fits with the general FOAM ethos.

  27. ostermayer says

    A great FOAM resource that we have been developing at Harbor-UCLA is WikEM.org. In the spirit of open source and FOAM it is free, completely open and supported by the community. With thousands of users worldwide we are very interested in helping out the FOAM community.

  28. @Cannulator says

    I only just found this post.
    Are, by forming committees and branding removing the very things that make FOAM attractive?
    Committees signify ownership, and FOAM is for all, not for committee. It takes it out of the hands of those who give freely. FOAM should be like the net; no one owns it. The diversity of professions freely sharing information, education and research is what makes it special. Those that wouldn’t normally get to share, do.

    Will we one day have an Australian College of FOAM? I hope not.
    What could transpire is that bloggers/ contributors could include a charter paragraph/ disclaimer on their sites.

    Please don’t brand FOAM from it’s current format; the diversity and free open source content is what I can only access for now. I think I have enough nous to separate fact from fiction.