Wednesday, July 30, 2014

Seduction, Hype, and the Tradition - FOAM as Effective Learning

I had the phenomenal opportunity to present at SMACC in Australia and it's now out there on the SMACC podcast or here
 So, here are some of the references/resources I promised.  This fantastic conference will be held in Chicago, June 2015 - book your leave!

The Gist - Whether Free Open Access Medical Education (FOAM) represents gizmo idolatry or effective learning depends - not on the resource, but on the user.  Consider treating FOAM like a parachute, for which there are also no human randomized controlled trials - perform safety checks, examining FOAM closely for holes and actively identify and repair these before they become unsafe, start with “tandem jumps," guided through FOAM, directed by teachers, a curator, or role model and teach others the necessary critical thinking and skills needed for successful solo jumps.  Like any educational resource, FOAM can be gizmo idolatry or powerfully effective learning, so let's use FOAM effectively.

Gizmo Idolatry 
Gizmo idolatry, coined by Leff and Finucane, is our intrinsic preference for a technologically advanced approach than one that is less technological.  We're seduced by new technologies/innovations because we like to be on the cutting edge and because they "make sense," are sexy and full of hype.  Often this occurs before the evidence is in, which may show that these interventions don't pan out.  Recent clinical examples revolve around robotic surgery and coronary CT.  Some argue that, as a "new" and popular educational intervention without significant evidentiary basis, FOAM can be gizmo idolatry for the following reasons:
  • Superficial learning/absorption of information (See post: "But I heard it on a podcast..")
  • Over reliance on multi-tasking, which is not as effective as we like to believe [1]
  • Lack of focus on core content and over-emphasis on the fun parts of medicine like airway and memes  (Note: This was one motivation behind co-founding FOAMcast)
  • Sometimes FOAM can even be wrong, as evidenced by one of my own experiences in which I placed part of an algorithm from a peer reviewed journal in this blog post, only to be corrected within hours in post-publication peer review (the individual caught the error in the peer-reviewed journal as well).
Note: it's important to realize that superficial learning, inaccurate information, idolatry, and enjoyment of the fun parts of medicine are not unique to FOAM, rather part of human nature and can be present in classrooms, conferences, peer-reviewed literature, etc.

Effective Learning

While the evidence for the efficacy of FOAM is currently lacking, there is an evidentiary underpinning behind some ways in which we can use FOAM.  Used smartly, FOAM can naturally harness some of the most evidence based learning modalities, spaced repetition and practice testing, and encourage learners to engage in learning and critical thinking[2].  

Spaced Repetition - We learn better in small aliquots over time because we tend to forget things over time, but when we're reminded repeatedly, or "beaten over the head" with a fact, we retain the information better [2].  This learning theory, which has been born out in medical education RCTs, happens naturally in FOAM, as contributors cover the same topic repeatedly, particularly when information is pushed to the learner (RSS feeds, Twitter).  See this post:  "Drinking From the Firehose - One Sip of FOAM at a Time"
Practice Testing - One of the most highly effective learning interventions as it provides learners with immediate feedback in an often non-threatening way [4-5].  FOAM examples include the repository at Life in the Fast Lane and the Detroit Receiving EM blog.

The Pause Principle - Pausing during lectures can allow learners to think and assess what they're learning as it can allow time for clarification and collaboration during an otherwise passive absorption of content [6,7].  This is one appeal of podcasts.

Highlighting the Things We Don't Know that We Don't Know- We often overestimate our abilities or knowledge, especially as novices.  When pushed to us in RSS feeds, podcasts, or tweets, FOAM can expose us things that we would otherwise never seek out, particularly things we think we're good at or know well. This is detailed in this blog post "We Don't Know What We Don't Know, which highlights the


1.Kirschner P a., van MerriĆ«nboer JJG. Do Learners Really Know Best? Urban Legends in Education. Educ Psychol. 2013;48(3):169–183.  
2.  Dunlosky J, Rawson K, Marsh EJ, Nathan MJ, Willingham DT. Improving Students’ Learning With Effective Learning Techniques: Promising Directions From Cognitive and Educational Psychology. Psychol Sci Public Interes. 2013;14(1):4–58. 
3  Larsen DP, Butler AC, Roediger HL. Comparative effects of test-enhanced learning and self-explanation on long-term retention. Med Educ. 2013;47(7):674–82. 
4.  Chan JC, McDermott KB, Roediger HL. Retrieval-induced facilitation: initially nontested material can benefit from prior testing of related material.  J Exp Psychol Gen. 2006 Nov;135(4):553-71.
5.Larsen DP1, Butler AC, Roediger HL.  Repeated testing improves long-term retention relative to repeated study: a randomised controlled trial. Med Educ. 2009 Dec;43(12):1174-81.
6. Ruhl KL, Hughes C a., Schloss PJ. Using the Pause Procedure to Enhance Lecture Recall. Teach Educ Spec Educ J Teach Educ Div Counc Except Child. 1987;10(1):14–18. 
7.  Di Vesta FJ, Smith D a. The pausing principle: Increasing the efficiency of memory for ongoing events. Contemp Educ Psychol. 1979;4(3):288–296. 


  1. Great presentation! Can't wait for Chicago 2015.

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