We don’t need no FOAM Curriculum

The past few months have seen enthusiastic discussions of the need for a FOAM curriculum among users of free open access med(ical e)ducation. This topic was also in the spotlight at SMACC during the education plenary and the SMACC Q&A panel.

See discussions and commentary by BoringEM and KI Docs.

It will come as no surprise given the title of this post that I don’t think creating a curriculum for FOAM is needed, or even makes sense. For me ‘curriculum’ is a dirty word used by those who subject others to the necessary evil of examinations — what Osler called ‘stumbling blocks… in the pathway of the true student‘ — for me, FOAM is about following that pathway wherever it leads.

A curriculum is the content or set of courses that are prescribed by an organization in order to complete a training course or an exam. The curriculum is what must be passed in order to reach a defined level of education. It is related to, but different from, the syllabus. The syllabus describes the objectives, content, grading schemes and other administrative aspects of a course. For example, the curriculum for my training in emergency medicine was prescribed by the Australasian College for Emergency Medicine (ACEM). I had a detailed list of topics, that I was expected to attain the specified level of expertise in, in order to pass the Fellowship exam and complete the other requirements needed for recognition as a Fellow of the College.

So, clearly FOAM can not have a curriculum in the true sense. The amorphous and anarchic emergency medicine and critical care FOAM community does not confer diplomas or other qualifications, nor recognize specified levels of FOAMy expertise. There is no organization to create such a thing.

But should there be?

I think not.

FOAM is just an adjunct to learning. FOAM is blogs, tweets, podcasts, screencasts, videos, Google Hangouts, open access journal publications and more but most importantly it is conversations and ideas exchanged between people. People using FOAM already have their own curricula as prescribed by their medical schools, universities and specialty organizations. FOAM is merely another way of helping people to achieve the learning objectives set by their curricula.

Perhaps I am being too pedantic (it wouldn’t be for the first time!).

Perhaps it would be useful to create a general guide or ‘curriculum’ for people to follow as they explore the world of FOAM?

Some might find it useful, but I wouldn’t.

I already have the curricula of my Colleges (ACEM and the College of Intensive Care Medicine (CICM) of Australia and New Zealand) and beyond that my learning needs are specific to me. What I need to learn depends on my own strengths and deficiencies and the foreground knowledge needs (what we need for real time flesh-and-blood decision-making) of the medicine I practice day-to-day. Different people work in different systems, see different patients and diagnose and treat different conditions and have different learning priorities as a result. This, coupled with the devastating reality that no one person can know everything (yes, it is true), means that we each have to prescribe ourselves our own personalised ‘curricula’ so that we each reach the standard set by our own internal examination boards. Indeed, if your own ‘internal curriculum’ does not go beyond that prescribed by your College then you are doing something seriously wrong. A physical manifestation of following the path set by my ‘internal curriculum’, fused with that prescribed by CICM, is gradually evolving into LITFL’s Critical Care Compendium (feel free to use whatever you find is helpful). Yet my own knowledge needs have varied greatly over the course of the past eighteen months, depending on whether I was working in an emergency department in Australia’s remote Red Center or one of the world’s most high tech ICUs in Melbourne, and so my ‘internal curriculum’ is constantly evolving.

If you are lost in the world of FOAM, try following The LITFL Review each week (here is last week’s edition), searching googleFOAM.com, following the collated FOAM EM RSS blog and learn how to deal with information overload. On LITFL you can search free databases of podcasts, procedure videos, physical examination videos, blogs, case-based Q&As (including toxicology), the ECG Library, past exam questions and more — just enough to get you started… ;-)

What about FOAM users in overseas countries that do not have prescribed College curricula?

I don’t think it is the place of the FOAM community to dictate this. These curricula need to be created by those in the trenches, those who are best placed to know what is required, perhaps by adapting and refining the curricula used by other colleges around the world. FOAM, again, would merely be an adjunct to help achieve these learning objectives.

So, I say ‘no’ to the creation of a FOAM curriculum. The creation of curricula is the job of Colleges and training programs, not FOAM.

I will leave you with the words of the Master, who I suspect would have approved of looking past set curricula as we march along the long and arduous path to insanity mastery with no end in sight:

“More clearly than others the physician should illustrate the truth of Plato’s saying that education is a life-long process.”
— William Osler, from ‘The Importance of Post-graduate Study.’ Lancet. 1900 (2):73-75.

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  1. says

    Here here Dr Nickson

    Put simply. To do your job, wherever or whatever it may be. To provide the best possible care for your patients you need to know what you need to know.
    FOAM provides access to a healthy, growing set of learning resources one can use in order to achieve excellent knowledge ( and hopefully care)

    Curricula and syllabi are arbitrary lines in the desert of medical knowledge.
    As a generalist it is daunting to march into the desert -- but you must.
    FOAM provides signposts and oases within the desert. We all must make our own path to the other side -- of course we never get there. But the ride is more fun with like-minded travellers to accompany us.

    I sat my exams 11 years ago. Completely irrelevant to my current practice -- without FOAM I would be wandering without a compass on my own. I now make my own curriculum -- either for here and now, or for the future.

    Agree. Curriculum is a naughty c word

  2. says

    I agree. There seems to be a move to make FOAM the same as other sources of information. What makes it special is how it is different, flexible and organic. Let’s not constrain it with rules, lets not replace dogma with dogma…let FOAM breathe!

  3. Casey says

    Ok another analogy

    Foam is a rainforest -- curriculum is a zoo
    Evolution don’t happen in zoos
    They are places you see the results -- but to grow and stay up you need a system that can learn, evolve and autoselect

  4. Duncan says

    Agree with sentiments, but there would be no reason that an individual or organisation couldn’t augment an existing curriculum with FOAM links -- the curriculum would remain relevant to the administering organisation but the content source might be less traditional (e.g. go through the ACEM syllabus, identify FOAM resources for each topic and stick in some hyperlinks, and you’re ready to go. Repeat with other organisations (medical school, colleges, voluntary organisations, specialties, whatever) and repeat as necessary. Anyone following those should have access to the whole curriculum.

    Some problems exist with this -- mainly that certain institutions (rightly or wrongly) expect certain questions to be answered in a certain format, or that the questions may be closely related to prescribed texts, so you could certainly disadvantage yourself if you follow it. Another is that the content might not be there -- dead links, expired websites, defunct organisations.

    • says

      Spot on Duncan.
      I envisage ACEM and CICM outsourcing online resources that can be plugged into their curriculum framework.
      The cheapest and most efficient way for them to do this will be to have (a select group of?) Fellows recommending links for each component of the curriculum. Because FOAM is free and can be modified for educational use it is ideal for this sort outsourcing. The recommendations would have to be periodically reviewed, added to and replaced.
      Will the Colleges do this? Or will they pay huge amounts to content creators to create what is already out there?
      Time will tell.
      Ultimately though I think it will be the role of the Colleges, or at least teaching programs, to do this for their trainees -- as they are the ones creating the exams and setting the standards.
      We (i.e. the FOAM community) could create our own suggested FOAM resources based on different College curricula, but unless they were adopted/ sanctioned it would potentially be a big waste of time and effort.

      • amcunningham says

        Completely agree- #foamed should be curated by those leading and learners within individual courses. That would fix the issue.

  5. Chris says

    I know it can be dull, but while trawling the ACEM website I came up with this… http://www.acem.org.au/sitedocument.aspx?docId=1273 … it would be great if more of the FOAM community could get involved with this. If commonly used FOAM resources are “sanctioned” on a college website and linked to a colleges curriculum it may well help many trainees!

    • says

      ACEM BOW is in principle a good project.
      The local ACEM membership will benefit from peer reviewed content being added to a framework to assist study and research.
      The main issue I have, from a FOAM perspective, is that it is purely local, behind a login firewall and feels a tad subjective. Looking forward to seeing how it looks on the new website when completed, but for now concentrating on defining useful resources in a multi-lingual, open access, global network