This handout was produced to support our FOAMed workshop at the AMEE conference in Prague on 27 August 2013.

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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 2012
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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 (FOAMed
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) 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/
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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
Twitter
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that have been tagged #FOAMed, you don’t need a Twitter account to view these. FOAMed
tweets are archived on Symplur
4
and you can take a look at analytics here and see who the major
influencers are. Hashtags
5
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:
#gasclass
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- 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.
#bluejc
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– 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.
#twitfrg
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– 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.
#weNurses
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– 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.
GMEP
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– 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
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Twitter #FOAMed - https://twitter.com/search?q=%23FOAMed
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Symplur FOAMed - http://www.symplur.com/healthcare-hashtags/foamed/
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Twitter hashtags - https://support.twitter.com/articles/49309-using-hashtags-on-twitter
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#gasclass - http://gasclass.wordpress.com/ &
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BlueJC - http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291471-0528/homepage/test.htm
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Twitter Finals Revision Group - http://twitfrg.blogspot.co.uk/ & http://storify.com/twitfrg
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weNurses - http://www.wenurses.com/
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GMEP - https://gmep.org/

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join.
Pediatric Education
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– 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
BlogsReflection/
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 website
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includes more information on its range of licences and there is also
a video
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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 Images
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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 morgueFile
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. 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 reader
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– try Feedly
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– 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/
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Creative Commons video on YouTube - http://www.youtube.com/user/JustinG4000#p/a/u/0/1DKm96Ftfko
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Wellcome Images - http://images.wellcome.ac.uk/indexplus/page/Home.html
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morgueFile - http://www.morguefile.com/archive
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A potted guide to RSS - http://youtu.be/YJinqplM0bY
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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