#FOAMtox

Time for Toxicologists to Stop Dogging It

by Meghan Spyres & Jeff Lapoint

Free Open Access Medical Education (FOAM), a term coined by Chris Nickson and Mike Cadogan in 2012, has been defined as a collection of free web-based resources, primarily made up of blogs and podcasts. They also defined it as a community and an ethos, centered around the philosophy that high quality medical educational resources should be free of cost and available to all, and that these resources should be actively shared (Nickson 2014 PMID:24495067). Although materials that could be classified as FOAM existed prior to this defining moment, FOAMs popularity and impact have soared in recent years. It is particularly popular amongst Emergency Medicine and Critical Care (EMCC) learners. In 2015, there were over 275 active EMCC blogs and podcasts, an increase from only 67 in 2010. Of the many EMCC FOAM resources over 86% of these use Twitter as a social media platform for discussion and dissemination (https://lifeinthefastlane.com/emcc-blog-update-2016/). Although toxicology topics are well represented in these blogs and podcasts, the vast majority of the content is created by those without medical toxicology training (Spyres 2018).

Reflected in the rising popularity of podcasts and blogs, is the fact that Emergency Medicine learners love using FOAM resources. In fact, residents now report spending a greater amount of time listening to podcasts than learning from traditional educational materials including textbooks and journals (Riddell 2017, PMID:24556776). FOAM has the unique ability to provide immediate, relevant, and up to date information, a strength not matched by outdated textbooks or even peer reviewed publications. Additionally, with the notable exception of toxicology discussed below, content is often created by experts in the field, which gives all learners an opportunity to learn from nationally recognized educators.

Why should medical toxicologists care?

Whether we like it or not, FOAM is here to stay as an adjunct to medical education. Medical toxicologists currently have a choice: either sit on the sidelines as critical nay-sayers, allowing others to own our specialty, or dive in as active participants in this movement. We, as medical toxicologists and educators, need to embrace FOAM because we are good for it, and even though we don’t realize it, it is good for us.

Toxicology as a subtopic is frequently addressed in FOAM resources, and was one of the first to get its own FOAM hashtag: #FOAMtox. This is not surprising, as death and injury by poisoning are leading causes of morbidity and mortality in the US. Though cyanide and nerve gas poisonings don’t happen every day, pearls of toxicology can be found on every clinical shift in the Emergency Department. We need to bring this mentality to our educational efforts, and FOAM is the perfect medium. Additionally, toxicology, a classically daunting and detail-oriented topic, fits nicely into the strengths of FOAM. A case-based blog demystifying the osmol gap with practical applications, for example, written by an expert, could provide focused information in a more digestible and accessible form than a traditional text. Content delivered in these bite-sized clinically-relevant chunks can help to break down barriers many experience when approaching toxicology. This can be done well while avoiding unnecessary complexity. Our ultrasound colleagues provide a perfect example. They have leveraged FOAM to provide basic skills you can bring to your next shift, yet still internally geek out on right atrial pressure measurements and the physics of piezoelectric crystals. We can do the same.

Worldwide, there are only approximately 600 board-certified Medical Toxicologists. Medical Toxicology services are not ubiquitously present, and many learners do not get any formal toxicology education. High quality #FOAMtox, created by Medical Toxicologists, can fill these educational gaps. Examples of this are already beginning to surface. The American College of Medical Toxicology (ACMT) is now hosting and editing a series on ALiEM: Toxicology Visual Pearls. These posts provide succinct, high quality discussions of focused toxicology topics. The cases center around a visual image, and there is a focus on emergency care management. In doing so, these posts help to educate emergency physicians, who do not always have immediate access to a bedside toxicologist, to provide the best care for toxicology patients. As an added, but important bonus, in creating this content we simultaneously develop an avenue to expose more students and residents to the field of medical toxicology. Particularly when paired with high trafficked FOAM sites, this gives us the potential to reach many that may have otherwise considered toxicology too esoteric or far removed from clinical application. If done well, harnessing the broad reach of FOAM could be a powerful tool to recruit strong candidates into medical toxicology.

Crucial to the above argument, is that toxicology FOAM resources must be high quality and accurate. An abstract to be presented at ACMTs 2018 Annual Scientific Meeting analyzed the quality of toxicology FOAM posts using a modified version of the AIR-Pro Scoring Instrument (Chan 2016 PMID:27033141) developed by the creators of ALiEM. Posts authored by non-medical toxicologists were found to be of lower overall global quality, to be less evidence-based, and to have more factual inaccuracies and inappropriate clinical recommendations than posts authored by medical toxicologists (Spyres 2018). As toxicologists we have but two choices – continue to watch idly from the sidelines, correcting errors we stumble upon after the information has already been consumed by the masses, or to fully embrace this new medium and establish our place in the FOAM world. The former is not a valid option. Even detailed, thoughtful critique on another’s content will have, at best, limited effect. Content creation is the true currency of the FOAM realm and the only way to effect consequential change. Our absence from FOAM has created a palpable cavity, far better to pack it with strong content of our own design than to merely critique how it is filled in our stead.