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Natalie Lafferty

School of Medicine

College of Medicine, Dentistry & Nursing, University of Dundee

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 2.5 UK: Scotland License.

FREE OPEN ACCESS MEDUCATION: An Introduction AMEE Workshop 27 August 2013, Prague Natalie Lafferty, Annalisa Manca, Ellie Hothersall, Laura-Jane Smith

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This guide provides a brief introduction to Free Open Access Medical Education (FOAMed) a

growing trend in medical education. It includes some examples of FOAMed activities, tools you can

use to create your own FOAMed resources and examples of sites that have resources that you can

use to support your teaching or your own learning.

SETTING THE SCENE

If you want to know how we practiced medicine 5 years ago read a textbook.

If you want to know how we practiced medicine 2 years ago read a journal.

If you want to know how we practice medicine now, go to a (good) conference,

If you want to know how we will practice medicine in the future, listen in the hallways

and use FOAM

- from International EM Education Efforts & eLearning by Joe Lex 20121

Technology has been driving massive change in education and health care. Medical education has

been an early adopter of technology and championed open educational resources (OERs) with many

medical schools sharing learning resources via learning repositories such as MedEd Portal, the

Health Education Assets Library and Jorum. With the emergence of Web 2.0 technologies (also

referred to as the read, write web) it has become easier for individuals to create, share and remix

content using tools such as blogs, wikis and social media sites such as YouTube, Vimeo and Flickr.

that enable individuals not only to consume content but also to participate in the creation, sharing and

remixing of information. These tools are increasingly supporting self-directed and independent

learning and the development of new communities, collectives and networks of interest and learning

both nationally and internationally.

Individuals are no longer restricted to looking for information by asking a local colleague or hunting in

the local library. Those who are digitally connected post questions on Twitter or on their blogs and

get feedback and signposts to what they’re looking for via online conversations with their personal

learning network. By subscribing to RSS feeds information is pushed to individuals making it easier to

keep up to date with research in journals. Using Web 2.0 tools like Twitter and content curation tools,

such as blogs, social bookmarking and social referencing tools, information and resources can easily

be curated, shared and disseminated. Those involved in teaching are discovering a wealth of

resources online and using blogging tools and curation tools to mash-up and weave them into their

own teaching narratives to meet local learning and curriculum objectives. As growing numbers of

healthcare professionals have engaged with these technologies, creating content and making new

connections the free open access medical education (FOAMed2) concept has emerged and

internationally growing numbers of individuals are tagging their content as FOAMed and identifying

themselves as part of this global movement.

EXAMPLES OF FOAMed ACTIVITIES & COMMUNITIES

Key players in the FOAMed movement are Mike Cadogan and Chris Nickson who are based in

Australia and run the Life in the Fast Lane blog. Both Mike and Chris are emergency medicine

specialists and have been blogging for many years sharing clinical cases, quizzes and countless

other resources. Life in the Fast Lane has been an inspiration for many others in emergency

1 http://freeemergencytalks.net/2012/08/joe-lex-international-em-education-efforts-e-learning/

2 Life in the Fast Lane – FOAMed - http://lifeinthefastlane.com/foam/

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medicine and the FOAMed label was coined by this community at the International Conference of

Emergency Medicine in Dublin 2012. If you follow the link in the footnote 1 you’ll find links to

commentaries on FOAMed as well as links to the FOAMed community on Twitter and elsewhere.

One easy way to find examples of FOAMed resources and activities is to take a look at tweets on

Twitter3 that have been tagged #FOAMed, you don’t need a Twitter account to view these. FOAMed

tweets are archived on Symplur4 and you can take a look at analytics here and see who the major

influencers are. Hashtags5 are used on Twitter as a way of categorising tweets allowing conversations

to be followed and searched for – (check the footnote for more information).

There are FOAMed resources, communities and activities across many of the medical specialties and

also amongst paramedics and nurses. These typically have formed around blogs and Twitter

hashtags and chats, some focusing on case discussions, others running as journal clubs or

discussing topics of interest identified by the community. Some examples include:

#gasclass6 - A case based discussion blog aimed at trainee anaesthetists which covers

anaesthetics and critical care. Cases are posted on the blog and discussed on Twitter with

the #gasclass hashtag. Gasclass has attracted an international audience to its weekly case

discussion.

#bluejc7 – A Twitter journal club supported by the British Journal of Obstetrics and

Gynaecology (BJOG). Each month the BJOC makes a paper available as open access to

support this journal club, questions are posted ahead of the club and the discussion takes

place on Twitter with the #bluejc hashtag. A summary of the discussion on Twitter is

published in a subsequent edition of the BJOC. The Royal College of Obstetricians and

Gynaecologists have recognised participation in #bluejc for CPD if evidence of a copy of

tweets accompanied by a reflection on the discussion is submitted.

#twitfrg8 – The Twitter finals revision group was set up by Sophie Bishton whilst a final year

medical student as an online revision tool to support medical school finals. Along with a small

team of other students Sophie prepares case discussions and these are discussed on Twitter

with the #twitfrg hashtag at 20.00hrs (UK) on Thursday evenings. The #twitfrg blog posts

revision notes and transcripts of the weekly cases discussions are archived on Storify (see

footnote 7). Whilst aimed at medical students these case discussions regularly attract

participation from medics.

#weNurses9 – This blog serves as a hub for connecting nurses and runs a weekly twitter chat

for nurses covering a wide range of topics. This community also supports Twitter chats for

pharmacists and paramedics and provides access to archives of these chats.

GMEP10

– The Global Medical Education Project set up by Mike Cadogan of Life in the Fast

Lane fame is a burgeoning hub where individuals can share FOAMed resources. The site is

currently in beta version and a state of evolution but already hosts many reusable clinical

images, clinical cases, anatomy illustrations and assessment questions. The site is free to

3 Twitter #FOAMed - https://twitter.com/search?q=%23FOAMed

4 Symplur FOAMed - http://www.symplur.com/healthcare-hashtags/foamed/

5 Twitter hashtags - https://support.twitter.com/articles/49309-using-hashtags-on-twitter

6 #gasclass - http://gasclass.wordpress.com/ &

7 BlueJC - http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291471-0528/homepage/test.htm

8 Twitter Finals Revision Group - http://twitfrg.blogspot.co.uk/ & http://storify.com/twitfrg

9 weNurses - http://www.wenurses.com/

10 GMEP - https://gmep.org/

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join.

Pediatric Education11

– An extensive collection of paediatric cases created over several

years by Donna D’Alessandro. Each case highlights key learning points, links to the latest

research and images relating to the case.

FOAMed TOOLKIT

There are a raft of Web 2.0 and social media tools that can be used to support participation in

FOAMed learning activities and the development and hosting of FOAMed resources. Some examples

are detailed below, but the list if by no means exhaustive.

1. Video sharing sites - YouTube; YouTube.edu; Vimeo; BlipTV

Teaching and training resources are increasingly being shared on social media sites as many

organisations, institutions and individuals use these sites to host their video resources. These

videos can be viewed directly on these sites but can also be embedded on any web page and are

common features on blogs and wikis.

2. Presentation sharing sites - Slideshare, Prezi, Sliderocket, Google Drive, Haiku Deck

Increasingly conferences and meetings post PowerPoint slides on presentation sharing sites such

as Slideshare to support sharing with delegates and the wider community. Here presentations

can be viewed and downloaded directly from Slideshare but can also commonly be embedded on

other web pages such as blogs. There is also growing interest in other presentation tools such as

Prezi, Sliderocket and Haiku Deck, which also support online viewing and mobile accessibility.

3. Image sharing sites - Flickr, Picasa, Wellcome Images

Photo sharing sites are a rich source of images that can be reused under Creative Commons

licences. Images can be downloaded and reused in presentations and publications where

appropriate attribution is provided. Some academic and research conferences also share poster

presentations on sites such as Flickr to support the wider dissemination of these communications.

4. iTunes/iBooks/AppStore

iTunes is a free application that helps to organise music, podcasts, iBooks and apps from the

Apple store. Content can be viewed and listened to on a PC or Mac and on hand held devices

such as iPhones, iPads and iPods. Many universities are now distributing recordings of lectures,

podcasts, videos and iBooks to students via iTunes-U. There are also growing numbers of health

related apps that can be downloaded from the iTunes App store, whilst some are paid for apps,

there are many that are free. Growing numbers of medical related apps are also now available

for other android mobile devices.

5. Blogging tools

Blogging tools such as Wordpress, Blogger, Typepad and Tumblr offer an easy way to set up a

website and have become central to many FOAMed resources and activities. Individuals can

subscribe to RSS feeds from these sites to keep up to date with new posts and information

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http://www.pediatriceducation.org/

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updates or subscribe by email. Commenting features support community engagement and

conversations.

Wiki tools such as PB Works and Wiki Spaces also serve similar functions as blogging tools and

support information sharing around specific subject areas and disciplines.

Examples of ways in which blogs can support to educational activities are illustrated in the figure

below.

6. Social networking tools

Sites here include Facebook, Twitter, Google+, LinkedIn. These networking sites can support

collaboration and discussion amongst individuals with common interests and support communities

of practice.

7. Social bookmarking tools

Social bookmarking tools such as Delicious, Diigo and Zootool allow individuals to save and

access bookmarks via any web browser building shareable and searchable collections of online

resources. These can be shared with colleagues and others via email and RSS feed

subscriptions.

8. Rapid learning asset development tools

There’s a wide range of tools that can be used to support open content creation. Some students

will be aware of these but not all and so here too you may want to highlight tools appropriate for

their project. Free tools include:

Audacity and Garageband for recording and editing audio

Screenr.com, Screencastomatic for recording screencasts

Pixlr.com for editing images

Skitch for annotating and labeling images

Prezi for creating presentations

Blogs Reflection/ Portfolio

Reviews of research

News & views

Formative assessment

Just-in-time learning

Teaching – guide on the side

Patient experiences

Supporting communities

Comments support audience engagement

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Haiku Deck – a free iPad app for creating visual presentations

iBooks author for creating iBooks for ipads

Xerte for developing online tutorials

Google Drive for creating documents and presentations

GoAnimate for developing animations

Commercial tools such as Articulate and Articulate Storyline are quite expensive, however you

can download 30 day free trials of these tools to see if you think it’s worthwhile your institution

investing in them

9. Collaborative working

Tools that support collaborative working include Google Drive, Microsoft 365 and wikis. File

storage sites such as Dropbox and SugarSync also support file sharing. Google Hangouts and

Skype can also support virtual meetings, desktop sharing and Google Drive allows synchronous

editing of documents all of which can be used to support learning activities.

10. Reference tools

Sites such as CiteULike, Mendeley, Zotero and Colwiz support reference management but also

have social aspects to them with the ability to create groups around specific interests to share and

discuss articles. These tools can support research collaboration and local and national research

networks.

11. Content aggregator and curation tools

Tools here include Netvibes, Yahoo Pipes, Scoop.it, Pinterest and they offer a way to aggregate

and curate content which can signpost students to learning opportunities. Collections can be

created around different topics and areas of interest to support both personal learning and to

serve as a guide to others.

DON’T FORGET ABOUT COPYRIGHT AND PATIENT CONFIDENTIALITY

If you start to develop and share your own FOAMed resources it’s important to think about copyright

issues and whether you have patient consent to reuse clinical images and recordings. Many

individuals seem to think that if you find an image or resource via a Google search you can download

it and reuse wherever you want. It’s important to remember that copyright law applies to online

content in the same way that it does with paper-based resources. Make sure your students (and

colleagues) know about copyright issues and how they can re-use content shared via Creative

Commons Licences.

There are different types of Creative Commons (CC) licence with differing levels of restriction. These

are

Attribution

The rights holder lets others copy, distribute, display, and perform their copyrighted work

- and derivative works based upon it - but only if you give them credit.

Noncommercial

The rights holder lets others copy, distribute, display, and perform their work - and

derivative works based upon it - but for noncommercial purposes only.

No Derivative Works

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the rights holder lets others copy, distribute, display, and perform only verbatim copies of

their work, not derivative works based upon it.

Share Alike

The rights holder allows others to distribute derivative works only under a licence

identical to the licence that governs their work.

The Creative Commons website12

includes more information on its range of licences and there is also

a video13

on YouTube, which gives a summary of Creative Commons.

You can find reusable images via a Google image search if you use the advanced search function,

the same applies to images on Flickr. Wellcome Images14

has a rich collection CC images and again

Xpert is a good site to search for images and you can download them as PowerPoint slides which

include the appropriate attribution. Another site with CC images is morgueFile15

. Also remember

GMEP, which was mentioned previously and includes clinical images, which can be reused.

When it comes to using clinical images or using patient cases, it’s essential that you have permission

to reuse and share these openly on the web, if in doubt don’t publish. You should never include any

patient identifiable information in resources that you publish online. Many medical regulatory bodies

have guidance on the use of clinical recordings so if in doubt refer to your local guidelines.

SOME FINAL TIPS

Keep it simple – follow a handful of people on Twitter, be selective, read what they are saying,

evaluate how useful the information they share is for you and your own learning and teaching

needs. Dip into conversations if you feel conformable doing so. Follow a Twitter chat or a

hashtag. Lurking is totally acceptable! Take a look for a few minutes each day, when you’re

on the bus, standing in the queue for a sandwich, you can take part in FOAMed anytime,

anywhere, anyplace.

Start a blog – write a post – ask for comments and feedback – reply to comments – keep the

conversation flowing!

Get a good RSS reader16

– try Feedly17

– save time and make information come to you – read

blog posts, listen to podcasts, watch YouTube videos, follow Twitter chats.

Use bookmarking or curation tools to help you store and archive things that you find useful,

use tags so that you can find them again when you need to.

Try a few solutions – see what works, what you are comfortable with – it’s all about

personalisation. Over time you’ll see what works for you and develop your own learning cycle

supported by Web 2.0 and social media tools like the one illustrated below.

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Creative Commons website - http://creativecommons.org/ 13

Creative Commons video on YouTube - http://www.youtube.com/user/JustinG4000#p/a/u/0/1DKm96Ftfko 14

Wellcome Images - http://images.wellcome.ac.uk/indexplus/page/Home.html 15

morgueFile - http://www.morguefile.com/archive 16

A potted guide to RSS - http://youtu.be/YJinqplM0bY 17

Feedly - http://cloud.feedly.com/#welcome

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Source: Mike Cadogan - http://lifeinthefastlane.com/2011/11/essentials-of-em-talk-2/

Take a look at this blog post for more tips from members of the FOAMed community -

http://mededelearning.wordpress.com/2013/07/09/what-are-your-top-tips-on-foamed/

FOAMed HELP

If you get stuck or need advice or more tips, email or tweet us!

Natalie Lafferty - Twitter - @nlafferty - Email – n.t.lafferty@dundee.ac.uk

Annalisa Manca - Twitter - @annalisamanca - Email – a.manca@dundee.ac.uk

Dr Ellie Hothersall - Twitter - @e_hothersall - Email – e.hothersall@dundee.ac.uk

Dr Laura-Jane Smith - Twitter - @drlaurajane - Email - laura-jane.smith@ucl.ac.uk

…. AND FINALLY

Remember: it’s all about connections, people, ideas… Sharing the knowledge, being inquisitive and

open to dialogue … keep #FOAMed alive and join the conversation.

SOCIAL LEARNING CYCLE