I’ve been thinking about FOAM since SMACC2013 (Social Media and Critical Care)…thinking a lot and talking to some friends.
I’ve cleared my desk literally and figuratively for a while and intend to read a lot and spend sometime away from computers and in the fresh air. But for good or ill I’m going to share some of my ruminations about FOAM post-SMACC and where it stands:
I thought SMACC was an amazing conference, and I had a fantastic time. I was inspired and challenged by many, especially some icons of the Critical Care world – Cliff Reid, Scott Weingart and Joe Lex. Meeting them, and others, as if I had known them for years, was a surreal experience. I also got a real buzz from speaking among such eminent company and not self-destructing, despite my extreme anxiety about it (or perhaps because of my anxiety – since as Myburg and Weingart say, adrenaline is “God’s own nectar”).
But among all of this enthusiasm, euphoria and exaltation, I have become aware that not everyone felt like I did about SMACC2013. Some people I have the utmost respect for, including several colleagues who I consider to be mentors in my professional life, had what they describe as a “mixed” experience. Rather than trumpet my own overwhelmingly positive experience, I thought it would a be useful exercise to explore the experience of others. So this will be an opinion piece discussing the discomfort of some with how the “Brave New World” of FOAM and #FOAMed is playing out. I think it is important to air and address these views in order to ensure that the “product” we deliver as FOAM is as good as it can be.
FOAM as espoused by SMACC is unfolding with some of the features of a new religion:
- It has a “big idea” at the core.
- It sets out to reject dogma and challenge the status quo.
- It is somewhat anti-establishment.
- It has evangelists. It has an inner circle of disciples, it has zealots and it has converts.
- Thus, it faces the same problems as a religion, and could fall into similar traps, and could eventually leave itself open to some of the same criticisms as religions are.
There are several traps FOAM could fall into, I believe:
- It could lose itself in enthusiasm, evangelism and quasi-religious fervour.
- It risks the criticism that there is a “cult of celebrity” developing (I don’t think this is true, but it is how some see things from the outside).
- It preaches openness and yet some see it as a clique. It can appear somewhat smug to the “uninitiated”
- It risks portraying itself as the “one true path.”
- SMACC spent a lot of time discussing ideas about how we can ensure that FOAM self-polices content and quality, but little time addressing the fact that there is risk that it develops into a “club” which some may not feel they can join.
- Although a version of “peer review” is important, I think this perception of a clique is a bigger threat to FOAM.
The big ideas of SMACC2013 apart from furthering FOAM as an educational movement were: challenging dogma and destroying silos – particularly those separating pre-hospital medicine, ED and ICU. But we MUST be careful that we do not replace these silos with another silo, the FOAM silo. We must not just challenge the dogma that exists and then fall into the trap of creating a replacement dogma (The central message of a certain prophet/son of god/historical figure was love, equality, rejection of dogma and openness – but his followers somehow contrived to develop a new boys club and a new dogma as exclusive and prescriptive as what preceded it).
FOAM, and conferences like SMACC, risk alienating further the slightly more open and curious skeptics precisely BECAUSE they don’t feel part of the evolving club despite taking the courageous step of attending to dip their toes in the water. For those of us who, as Scott Weingart says, “jump in and drink from the stream” it seems self evident that you get out what you put in, but not everyone feels able to commit to that degree, and we risk losing the swinging voter unless we accept and address the perception that FOAM can appear like an exclusive inner circle to the outsider. This may seem crazy to us and is light-years from the intentions and principles of FOAM, but it is definitely how some perceive us. We think we are making it easy because it worked for us, but we need to be rigorous about how open the FOAM movement is. So what can we do?
FOAM must remain truly open and inclusive.
FOAM must listen to and embrace the uncertain and dissenting voices.
Pretty simple, and yet I suspect it will be very difficult.
Specialist Emergency Physician from Ireland currently based in Tasmania, Australia