The open-access nature of commenting on FOAM resources does allow for a uniquely real-time appraisal. This interactive process gathers the insights of multiple practice backgrounds and experiences and is a form of ground-truthing that is not similarly available in print media. On the contrary, for FOAM in general and for comments in particular, users may be left to assess the authenticity of a statement by either the reputation of the author or the perceived accuracy of a post in a manner that is vulnerable to bias and error.

Eminence Versus Evidence

One criticism of FOAM is that it threatens a return to the time of “eminence-based” medicine rather than the evidence-based medicine that underpins modern practice. The validity of this criticism is undermined by the fact that eminent voices continue to have an amplified role in traditional educational venues. The presence of individuals with unique access to platforms and followings that allow dissemination of information is not exclusive to online communities and can be found in academic and scientific circles as well.^11,12 FOAM could be considered, in part, a reaction to the crowded space of traditional medical education and may be an attempt to democratize the process of information generation and dissemination.

Although the gold standard for medical learning remains the personal review of primary source materials, the time in which practitioners could read all of the literature relevant to their practice has long passed. Reliance on trusted sources to summarize and sort the wheat from the chaff is no longer optional. However, like any educational tool, participation in FOAM without a curricular road map can neglect and even create substantial and dangerous knowledge gaps.

There is no equivalent to PubMed for FOAM. Reliance on search engines like Google is not adequate because how search results are generated is opaque, not optimized for this purpose, and easily vulnerable to technical manipulation. A counter to this concern about locating quality information is that FOAM is about community and participation. The idea that all emergency physicians will be active participants in a worldwide community of practice is noble and exciting but improbable, and it makes the “casual” user of FOAM unlikely to reap all of its benefits and more vulnerable to its risks. This problem will only grow as more FOAM content is created.

Knowledge Translation Time

FOAM has the ability to decrease the time from knowledge discovery to knowledge integration into clinical practice, though this process continues to be less regulated than traditional methods.¹ The traditional methods of inquiry and assimilation of research findings into medical practice can take decades, with an estimated lag from time of inception to clinical practice of as much as 17 to 23 years.¹³ Traditional medical journals are incorporating FOAM techniques through partnering strategies. The Annals of Emergency Medicine and ALiEM.com have collaborated on online journal clubs; one such encounter had 1,401 readers and 313,229 Twitter audience impressions.¹⁴ Also, FOAM is by definition free, and eliminating the cost barrier gives it another advantage.