FOAMed & Primary Care Research

It is no secret that I am a huge fan of FOAMed. I’ve probably learnt more in the past two years via FOAMed than I ever would have via the traditional routes of attending courses & conferences, even those ostensibly aimed at rural proceduralists.

I’ve tried to collate stuff that I find useful (mostly rural GP, EM and Anaes focus) over at www.ruraldoctors.net – preserving the KIdocs.org as a more idiosyncratic collection of thoughts and commentary on issues that affect the practice of medicine locally.

As a consequence, KIdocs.org is more of a stream-of-consciousness whinge about bureaucracy, deficits in training and commentary on (mostly) airway related issues.

But it’s not FOAMed.

In fact, despite the increasing numbers of primary care doctors on twitter and the blog-o-sphere, there’s still a paucity of decent primary care FOAMed.

That’s in no way a reflection on those (self included) who are currently contributing…and indeed there are some excellent nuggets of clinical info out there. But they are interspersed with more reflective pieces – many of which I really enjoy as they relate to the day-to-day matters of working in medicine, running a business or dealing with the PCEHR etc. There have also been some epic wins using the tools of social media – the #scrapthecap and #savetelederm campaigns in particular.

But a lot of it isn’t FOAMed.

Whilst many GP blogs are excellently written and often discuss quirky or interesting facets of work as a GP, this is often old hat to those who have been doing it for years. It’s also very hard to showcase this to educators who are ‘FOAMed-curious’ – wondering what all the fuss is about – and possibly underwhelmed with the academic rigeur of FOAMed resources in primary care. In contrast the EM and prehospital crowd have taken FOAMed and run with it – sure, there are some reflective pieces, but there’s a LOT of hardcore clinical commentary on the way. Some of this is relative to rural docs (think Casey Parker’s BroomeDocs and Minh le Cong’s PHARM) – but it may not be content that mainstream GPs identify with.

I received an interesting email from a colleague who reported that some of the more conservative GPs being turned off by recent presentations on FOAMed and SoMe at GP conferences. Their comments:

“If we want to engage the masses, we need to do the topics / core content that GPs are interested in well and with an edge – some panache – hat makes it readable / watchable and memorable. We need a focus somewhere as a purely clinical repository where we could direct teachers and learners of primary care – with a broad base of contributors.  

“I just scrolled through some of last months content from GPs  – and a lot of it was what I would class as “MedEd fluff” –  not a lot of clinical content, very little EBM, lots of musings around teaching and politics – even the PCEHR got a few spots”

“In short, a lot of us felt that it was more about the blogger than the content”

Again I ENJOY reading a lot of these reflective pieces (and freely admit that KIDocs.org is along those lines, tinged with a lot of jaundice and antipathy to bureaucracy)…but I think this contributor is spot on. We need to raise the bar if FOAMed is going to be taken seriously by medical educators and frontline GPs.

I must admit that I have a healthy scepticism of some of the “meducationalista” – my background before medicine (believe it or not) was in pure science, with higher postgraduate degrees in medical research. I’ve been out of the research field for a decade or more, but on return have been increasingly frustrated with some of the ‘research’ presented at GP conferences – there seems to be a LOT of emphasis on topics such as rural retention, workforce planning, registrar training pathways, training medical students, educational theory & telehealth. What I’d consider as ’lite’ topics. Not much quality research on clinical conditions or critical appraisal of contentious issues relevant to clinical primary care.

Kudos then to the FOAM4GP.com website which has undergone a makeover – and some excellent recent posts of relevance to all GPs. In particular, credit to GP registrar Robin Park (@robapark) whose series of FOAM4GP Maps is a clear leader in terms of quality primary care FOAMed … check out ‘Paediatric Fever Phobia‘ and ‘To Statin or Not to Statin, That is the Question‘ as examples. This is the sort of medical educator I can take seriously.

These are topics that those of us who use FOAMed have already figured out for ourselves – but articulated nicely for the masses and easy to digest. It’s good stuff and good advertisement for FOAMed as “about the content – not the messenger“.

Stay-tuned, Robin promises that there’s more to follow. It looks like he and like-minded colleagues will turn primary care medical education on it’s head, which I applaud.

I alluded to the need for more quality FOAMed last month and point readers to the excellent ‘top 20 research studies of 2012 for primary care’ which is well worth a read.

Bottomline, FOAMed has the potential to shape our practice as we evolve. It’s a great form of CPD (although not currently recognised) and makes us better doctors. What’s not to like?

Of course, if we are serious about FOAMed, we need to be able to keep up to date with the literature (not just read various blogs) and critically appraise topics for ourselves.

I wasn’t able to make it to RMA2013, but tried to make the point via twitter that, without access to online journals, any pretence of ‘research’ in rural medicine is doomed to failure – unless we stick to surveys, reflective pieces or yet more papers on teaching medical students and registrars.

All useful stuff, but shouldn’t be the “be all and end all” of primary care research. Getting neck deep into the literature – heck, even publishing some yourself – should be the aspiration of GPs and educators.

Who knows, some of you may even come along to smaccGOLD?

More on barriers to effective research in another post…

5 Comments

  1. Hi Tim,

    Good post. Good points re scientific content. Just a critical note re the comments about “MedEd fluff”.

    I love MedEd fluff! We have a small but awesome group of Australian GPs, registrars and medical students interested in GP who blog about a wide range of important topics in their work/life. I’m surprised to hear (and don’t believe) that medical educators are turned off by posts about non-clinical/EBM content – isn’t this part of GP training as well? I doubt that these ‘more conservative GPs’ you refer to only read the scientific content in the NEJM or the Lancet, so why do they expect this on FOAM4GP?

    Delivering new GPs who can quote the latest statin trials is great, but if they don’t know how to deal with eg challenging situations or a demanding work-life balance we’ve got a problem. We also need engaged GPs showing leadership about where to take our profession in the future – or others will decide this for us.

    Blogs are a great way of sharing all sorts of experiences, and FOMA4GP is becoming the mother of them all, which is great if you ask me. Most of the posts are Free, Open Access, and part of Meducation or, in other words: FOAM!

    GP educators are of course free to contribute more EBM related material, but I’m sure that even then there will be critics who feel FOAM is not scientific enough etc etc

    I personally enjoy the wide range of topics on FOAM4GP, even the PCEHR got a few spots, woohoo! 🙂 I also know that many supervisors have signed up for SoMe accounts & several GPs are contemplating a blog since the recent presentations on FOAMed and SoMe at GP conferences.

    Ps Love the makeover of FOAM4GP!

    Reply
  2. Thanks Tim
    Maybe the best way around the debate – hardcore clinical Ed vs softer stuff is through the new-look blog.
    The foam4gp.com site could be more clearly divided into categories so that consumers can read what they like and suit their own needs.
    I know when I started broomedocs.com with Mike Cadogan’s not so soft guiding hand – he made it really clear that search ability and categorisation / search engine optimisation were crucial in the longer term.
    No point in having a huge repository of Med Ed data if it is all clunked together…. we need to make it as easy as possible for the “old dogs” to benefit from our new tricks?
    Thoughts
    Casey

    Reply
    • Apologies for the late response…. I agree Casey, my thoughts: the current categories (‘about & disclaimer’, ‘blog feedback’ etc) are probably not really categories, but more pages. I would replace the current categories at the top with the categories currently filed under FOAM4GP Maps: ‘cardiovascular’, ‘paediatrics’, ‘dermatology’ etc. In addition, the drop-down category widget would then help to find posts filed under the different categories.

      And if I may, perhaps for those of us who like the ‘MedEd fluff’ a few non-clinical categories could be added – like practice management, leadership and health politics? I acknowledge it’s not hardcore scientific FOAMed stuff but hey, all scientific magazines have a few non-clinical pages. Plus, it would perhaps appeal to a wider audience? (I wont tell Mike Cadogan)

      I am yet to contribute my first clinical piece and would love a page with tips & tricks for FOAM4GP newbies including how to write a contribution!

      Keep up the great work!

      Reply
  3. Pingback: Is it time for GP FOAM to come of age? | Nomadic GP

  4. Great post. I am new to twitter and the FOAMed movement and see great potential in it. Dr Vin @ gpexamsupport.com.au

    Reply

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