We don’t need no FOAM Curriculum

The past few months have seen enthusiastic discussions of the need for a FOAM curriculum among users of free open access med(ical e)ducation. This topic was also in the spotlight at SMACC during the education plenary and the SMACC Q&A panel.

See discussions and commentary by BoringEM and KI Docs.

It will come as no surprise given the title of this post that I don’t think creating a curriculum for FOAM is needed, or even makes sense. For me ‘curriculum’ is a dirty word used by those who subject others to the necessary evil of examinations — what Osler called ‘stumbling blocks… in the pathway of the true student‘ — for me, FOAM is about following that pathway wherever it leads.

A curriculum is the content or set of courses that are prescribed by an organization in order to complete a training course or an exam. The curriculum is what must be passed in order to reach a defined level of education. It is related to, but different from, the syllabus. The syllabus describes the objectives, content, grading schemes and other administrative aspects of a course. For example, the curriculum for my training in emergency medicine was prescribed by the Australasian College for Emergency Medicine (ACEM). I had a detailed list of topics, that I was expected to attain the specified level of expertise in, in order to pass the Fellowship exam and complete the other requirements needed for recognition as a Fellow of the College.

So, clearly FOAM can not have a curriculum in the true sense. The amorphous and anarchic emergency medicine and critical care FOAM community does not confer diplomas or other qualifications, nor recognize specified levels of FOAMy expertise. There is no organization to create such a thing.

But should there be?

I think not.

FOAM is just an adjunct to learning. FOAM is blogs, tweets, podcasts, screencasts, videos, Google Hangouts, open access journal publications and more but most importantly it is conversations and ideas exchanged between people. People using FOAM already have their own curricula as prescribed by their medical schools, universities and specialty organizations. FOAM is merely another way of helping people to achieve the learning objectives set by their curricula.

Perhaps I am being too pedantic (it wouldn’t be for the first time!).

Perhaps it would be useful to create a general guide or ‘curriculum’ for people to follow as they explore the world of FOAM?

Some might find it useful, but I wouldn’t.

I already have the curricula of my Colleges (ACEM and the College of Intensive Care Medicine (CICM) of Australia and New Zealand) and beyond that my learning needs are specific to me. What I need to learn depends on my own strengths and deficiencies and the foreground knowledge needs (what we need for real time flesh-and-blood decision-making) of the medicine I practice day-to-day.

Different people work in different systems, see different patients and diagnose and treat different conditions and have different learning priorities as a result. This, coupled with the devastating reality that no one person can know everything (yes, it is true), means that we each have to prescribe ourselves our own personalised ‘curricula’ so that we each reach the standard set by our own internal examination boards. Indeed, if your own ‘internal curriculum’ does not go beyond that prescribed by your College then you are doing something seriously wrong.

A physical manifestation of following the path set by my ‘internal curriculum’, fused with that prescribed by CICM, is gradually evolving into LITFL’s Critical Care Compendium (feel free to use whatever you find is helpful). Yet my own knowledge needs have varied greatly over the course of the past eighteen months, depending on whether I was working in an emergency department in Australia’s remote Red Center or one of the world’s most high tech ICUs in Melbourne, and so my ‘internal curriculum’ is constantly evolving.

If you are lost in the world of FOAM, try following The LITFL Review each week, searching googleFOAM.com, following the collated RSS blogs and learn how to deal with information overload. On LITFL you can search free databases of podcasts, procedure videos, physical examination videos, blogs, case-based Q&As (including toxicology), the ECG Library, past exam questions and more — just enough to get you started… 😉

What about FOAM users in overseas countries that do not have prescribed College curricula?

I don’t think it is the place of the FOAM community to dictate this. These curricula need to be created by those in the trenches, those who are best placed to know what is required, perhaps by adapting and refining the curricula used by other colleges around the world. FOAM, again, would merely be an adjunct to help achieve these learning objectives.

So, I say ‘no’ to the creation of a FOAM curriculum. The creation of curricula is the job of Colleges and training programs, not FOAM.

I will leave you with the words of the Master, who I suspect would have approved of looking past set curricula as we march along the long and arduous path to insanity mastery with no end in sight:

More clearly than others the physician should illustrate the truth of Plato’s saying that education is a life-long process.

William Osler on ‘The Importance of Post-graduate Study.’ Lancet. 1900; 156(4011): 73-75.

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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