FOAMed & Research for GPs – Which College?

OK, last post I mentioned the need to bring more academic rigeur to the exciting world of FOAMed for GPs. There are some people doing great stuff out there using social media- but I feel that as a group, primary care research tends to be biased towards either ‘research lite’ topics (such as workforce planning, telehealth or different ways of educating registrars/students) or towards blog posts on life as a GP  (interesting, but not exactly FOAMed).

Scott Weingart gave a great lecture at smacc2013 – entitled ‘The Path to Insanity’, he really made me think about pathways to achieving excellence rather than competence. Key to this was the need to READ more.

For me, FOAMed is a way to inch closer to mastery. It’s always a challenge for the rural GP as a ‘jack of all trades, master of none’.  That said, rural medicine IS our specialty and the rural generalist is ‘oft times better, than master of one’. Like a swiss army knife, we are adaptable to a variety of situations – and we owe it to our patients to be the best we can, especially when critical illness intervenes.

I have collated the useful FOAMed for rural procedural doctors over at RuralDoctors.Net

It’s a delight to read other’s appraisals of the literature via FOAMed. Promiscuous blogger Minh le Cong seems to tweet out a never-ending deluge of ‘interesting papers’ to read. But here’s the irony – despite being embroiled in FOAMed via blogs & twitter, as a rural GP I can’t access the literature.

Membership of my college doesn’t offer online journal access. It’s great when someone else does the work for you…but sometimes it’s nice to actually read a paper yourself. In fact, Weingart would argue it’s essential. I am sure other advocates of FOAMed would agree – we need to question & to be sceptical of research, if we are to develop expertise. More so if we are to explore rural research issues.

In Australia, there are two Colleges with remits for primary care – RACGP and ACRRM. When I trained it was fairly easy to get Fellowship in both – it’s a bit harder now, but not impossible to get FACRRM and FRACGP.

Registrars have a choice as to which Fellowship to attain. I’ve always advocated FACRRM as the more robust qualification. I think it’s important to align oneself philosophically with a like-minded mob of clinicians – and ACRRM ticks the boxes for me as a rural doctor. They also offer access to excellent online learning via RRMEO as well as tallying up my CPD points every triennium. So I was delighted to receive my FACRRM a few years ago – so much so that I sent the board of both colleges a short video of me wiping my hairy arse with my FRACGP certificate. One College thought it was funny, the other not so…

Cost wise there’s not much in it between ACRRM and RACGP. But here’s the thing that is beginning to grate – the more I use FOAMed, the more interest I have in reading the literature and appraising it for myself. Indeed, I am beginning to think that I have something to contribute back to the field – and whilst one can bash out a quick post via the blog-o-sphere, it’s nice to have publications in peer-reviewed journals.

So I am surprised that membership of RACGP allows access to online libraries – yet membership of ACRRM does not. There was a research forum at ACRRMs conference, RMA2013 – I couldn’t attend in person, but asked some questions on this via twitter. The response? Well, the considered answer of the research panel was that access to the literature wasn’t necessary. If rural doctors want access to online libraries, then they could

  •  get honorary academic status via the local University ‘if you teach medical students’
  • do a Masters
  • find a Mentor

Seriously? That’s it?

The first option I have achieved. I am apparently an Adjunct Senior Lecturer in the Department of ‘innovations in clinical education’. Awesome. It took six months and was only granted because I teach medical students affiliated to that university. I don’t think many of my colleagues could be bothered to fill in the forms and hassle the university hierarchy to achieve this. It also came with a requirement that any research I published was explicit that my affiliation was with them. Other than library access, I can’t think of any support I received for my last paper.

This means there is no access for rural doctors even if teaching ACRRM registrars or ACRRM John Flynn students. Basically no recognition if you are a teacher with ACRRM, only if you teach with a university.

The second option? Well, been there done that (and more). Certainly not going to spend $10K just to do another higher degree…and access to online libraries ceases once the award is achieved. Not exactly a committment to lifelong learning.

The third? Well, it’s possible to get someone else to do the work for you. I will keep hitting up Minh le Cong to send me journal articles, but it’s going to be tiresome for us both. Especially when I am supposed to be debating against him on ‘real airway doctors need checklists’ in a few months time. Can he be trusted to feed me the correct papers? Of course he can…but….

Yes, there’s always GoogleScholar. But it’s not exactly Ovid, is it?

I will lay my cards on the line here – if ACRRM is serious about research in rural medicine, then it needs to help enable access to the literature. Otherwise the research that is presented at conferences will continue to remain that done by the current meducationalista – either those already in academic appointments or from wishy-washy backgrounds (like the RTPs). There may be a few who have access through their employ (RFDS, or State-funded hospital appointments). The frontline clinicians who are self-employed? Nope, there is no access unless their work intersects with another agency that is not ACRRM.

Seems ironic that ACRRM has a research committee – yet members cannot read or engage in research unless they belong to another agency – University or Employer.

So – my challenge question to those of you who use FOAMed and are serious about training doctors and keeping up-to-date yourself – is access to the literature a ‘must have’ or a luxury?

Can we learn enough through FOAMed alone? Or do we need to get stuck into the literature, particularly if we’re going to contribute to FOAMed not just consume it?

I’m with Weingart on this one.

3 Comments

  1. Hear, Hear!

    We absolutely need access to journals to be able to engage in analysis of research and fully practice evidence based medicine.

    Those contributing to FOAM definitely need to be able to access it, but even non-FOAMers need it for journal clubs etc.

    Having said that – I have some degree of access through my FRACGP.

    Reply
  2. Thanks

    Ain’t nothing wrong with the FRACGP … but I am bias towards FACRRM as the better training for rural docs ! I say po-tay-to, you say po-taa-to.

    More important than a piece of paper is a commitment to lifelong learning. FOAMed helps – but as Weingart says, we still need to READ.

    I am hoping ACRRM will revise their policy. It costs money, but when comparing ongoing membership of ACRRM vs RACGP, it’s important to make sure that there is a quality product.

    FOAMed via blogs or twitter is a ‘digest’ – if we are going to produce useful resources or even contribute, then the College’s research committee needs to consider this

    Relying on backdoor access through employers or tenuous academic links is not available to all.

    Time will tell…

    Reply

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