Many of the participating doctors have taken to posting a daily "pearl" (as in, pearl of wisdom), a practice Mallemat has adopted. "Often I'll send out a picture of an X-ray and all I'll say is 'What is the diagnosis?' and later answer with bullet points. In that sense, it is pure education." Social networking among physicians is also an extension of what they do at conferences, where the focus is on "going beyond the textbook" to interacting directly with experts -- but now they can do it all year long, any hour of the day. In yet other cases, Mallemat may encounter a clinical problem he doesn't know how to solve, share it with his network (without patient identifiers), and "instantaneously get responses from around the globe."
"Is that classical medical education? Maybe not, but it's a new way of learning," Mallemat said.
"It's education in the broadest possible sense -- idea dissemination and discussion," said Ryan Patrick Radecki, an assistant professor at the University of Texas Medical School, whose specialties include emergency medicine and informatics. As an educational resource, FOAM materials may be particularly useful to physicians around the world whose hospitals may not have the budget to subscribe to all the relevant journals, he said.
Partly because it was first promoted at an emergency medical conference by an emergency medical physician, FOAM's center of gravity is very much in emergency medicine, although Cadogan said he also sees it taking off among general practitioners, pediatricians and others. Urology and cancer physicians are also starting to pay attention. One reason emergency physicians have a strong interest might have to do with their "short attention span and need to have answers quickly, with a large number of topics covered." An emergency room doctor needs to understand a little of all specialties, never knowing who might come in the door, he said. "They're also willing to discuss things far more openly and far more open to being wrong" and accepting new evidence that there is a better way to do something, he said.
FOAM has just advanced to the point where practitioners are starting to ask more serious questions, such as who is to blame for medical errors inspired by unreliable information from an online source, Cadogan said. Yet information in professional journals can be just as unreliable, or even fraudulent, he said, and doctors need to hone their critical thinking skills for all the information they consume.
As a polymath who writes software code in addition to practicing medicine and teaching, Cadogan is working on a new website that would correlate the best medical information available in social media. His first cut at that problem was the Global Medical Education Project (GMEP) website. He is particularly interested in organizing medical images that can be used for teaching purposes. Medical privacy rules have complicated the process of obtaining images to write about, and procedures for obtaining proper consent from patients are just now being solidified, he said. A library of images obtained in keeping with the rules and available under Creative Commons licensing would help solve that problem, he said.
Meanwhile, he sees FOAM as an "initial foray into collaborative education." Some of the trends sweeping through the rest of higher education are starting to make their way into medical school, such as the concept of a "flipped classroom" where students view video lectures and do most of their studying online, shifting the emphasis in classroom time from lecturing to discussing the material. Even though this approach is not officially sanctioned by the medical schools where he teaches, probably 90 out of 100 students in the lecture hall will have studied in advance.
"Now it's not two minutes of question time at the end of the lecture -- they want 20 minutes lecture time -- and that change has become wildly apparent over last 12-18 months," Cadogan said. "If you're sitting in a lecture hall to learn, you're not doing it right anymore."