However, the increased speed of knowledge translation raises the question, How fast is too fast? Significant changes in clinical practice could occur before further study can verify and confirm exciting new findings.15 Future important directions for FOAM are to establish the real-time ability to publish and discuss not only new ideas but also the structure necessary to evaluate them in standardized trials with subsequent peer review.
Distinguishing FOAM from Crowdsourcing
Crowdsourcing is the solicitation of real-time clinical input from others over an electronic platform. Distinguishing crowdsourcing from FOAM can be difficult because crowdsourcing isn’t FOAM, but it may occur in the same space as FOAM activities. For example, a Twitter discussion about the best agent for blood pressure control in aortic dissection is likely FOAM, whereas tweeting, “Help!!! What should I do for my patient with an aortic dissection?” is crowdsourcing. The social media platform SERMO advertises crowdsourcing as a benefit of its network.
Crowdsourcing is a seductively appealing modern combination of informal, or “curbside,” consultation and telemedicine. There is the potential benefit to provide practitioners easy access to colleagues or specialists. However, crowdsourcing lacks the robustness of telemedical consultation in terms of the amount of information shared, accountability of the consulting provider, and a mechanism to document it in the medical record. In addition, while curbside consultation (informally requesting patient management information or advice from a medical colleague) is a common practice, it has been criticized due to its greater risk of inaccurate recommendations compared to traditional consultation.16,17 Online crowdsourcing through FOAM platforms increases these risks because the identity and credentials of those providing advice cannot be independently verified. Crowdsourcing through FOAM resources shares the appeal of FOAM itself to harness “the wisdom of crowds.” However, without established processes to vet those providing input and a validated structure to balance differing views, crowdsourcing places patients at unacceptable risk.
Over the last two decades, the Internet has transformed how we access information and how we learn and practice medicine. The FOAM movement has created collaborative communities capable of ultra-rapid dissemination of information and remote interaction between learners and educators. These pioneering advancements must be coupled with new responsibilities for both educators and learners. The flood of available information must be consciously processed and methodically vetted by those learning through FOAM to maintain the peer-review process and promote evidence over eminence. In addition to this responsibility, FOAM contributors also must keep patient confidentiality paramount and disclose commercial interests or involvement. FOAM will likely continue to grow and expand over time, and attention and research are needed to focus on how FOAM can best integrate with, augment, or supplant more traditional existing resources. Emergency physicians are forerunners in medical education and should continue this leadership role to ensure FOAM evolves responsibly.