How Do You "FOAM," Anyway?

Last fall, I had the honor and opportunity of delivering a lecture about FOAMed to my fellow residents and faculty during our Tuesday didactic conferences. During this lecture, I had about 40 minutes to try my best to give a broad overview of what FOAMed is, how it’s impacting our specialty, and how to incorporate it into one’s practice.

The lecture can be viewed on Vimeo here.

Today, I want to focus on a specific part of the lecture: “How do you ‘FOAM,’ anyway?” For those following along at home, it starts about 15 minutes in, and lasts for about 15 minutes.

In my experience – and I think this sentiment is shared by others – one of the major hurdles faced by those looking to jump in to the FOAMed world is information overload. The sheer number of blogs and podcasts has exploded in recent years and has reached the point of being overwhelming, as seen in this figure from a paper by Mike Cadogan and Brent Thoma chronicling the rise of the FOAM:

From Emerg Med J. 2014 Oct;31(e1):e76-7

For FOAMed to be used as a learning tool, especially for the EM physician in training, I think two important points must be kept in mind. First, learning can only occur in an environment in which there is a positive cognitive margin. Basically, when you have the time, energy, and focus to be able to sit down and really dive into something, retention is maximized. If the environment is not conducive to cognitive functioning – from fatigue, distraction, intoxication, what-have-you – true active learning from a FOAMed resource is going to be very difficult.

Second, while we are in general andragogical learners who want to seek out the information we want and need rather than having it all spoon-fed to us, it is exceptionally inefficient and difficult to wade out into the FOAM world and attempt to “pull in” everything of interest to you. Much more efficient and comprehensive to have everything that’s new “pushed” to you, for your perusal at a time in which you have a positive cognitive margin.

And this is where Chris Nickson’s chosen vernacular comes in. Replace “information overload” with “filter failure” in your lexicon. Particularly when you’re first starting out, you don’t want every new item posted from every FOAMed world pushed to your brain all at once. You need a way to improve the signal-to-noise ratio, to pare down the breadth of content to those things that are highest-yield to you.

Having gone through the painful process of trying to “pull” FOAMed information to me, and then subsequently being drowned in knowledge from filter failure after learning how to “push” information, I’d like to do what I can today to help my fellow EM learners ease their transition to “push” information and filtering.


How To Do It:

1. Familiarize yourself with RSS feeds. This is basically a piece of computer code that indexes all of the posts of a particular blog. They’re usually signified with the following icon:

In and of themselves, they’re useless. If you happened to click on one, your screen would be filled with incomprehensible programming code. BUT, if only there were a piece of software that knew what to do with them…

2. Learn how to use an RSS feed aggregator. This is a program into which you can upload RSS feeds for whatever blogs you want to follow, and then those posts from all of those blogs will be listed out for you in a chronological digest format. I prefer Feedly, which you can download [here]. It integrates into PC & Mac browsers, and I believe there are both Apple & Android apps for mobile devices. Adding blogs to Feedly is pretty simple; I go over it in the video, right at the 19-minute mark.

3. But how do I know which blogs to add? How do I know where to start? Well, this is what I’m going to try to help you with. There is actually another way to add blogs to your Feedly feed, and you can do it en masse. This is via an OPML file, which is just a file cataloging the RSS feeds from whichever blogs you want. Upload the OPML file to Feedly, and *BOOM* all of those blogs are instantly added. Here’s a couple screencaps showing you how to do this in Feedly.

Clicking your e-mail address in the bottom left corner will take you to the "Organize" screen.

Select the appropriate OPML file for import.

Can you feel the power?

There are a variety of options to view and organize posts from your chosen FOAMed resources.

I have created a set of OPML files to help you get started. The file names should be relatively self-explanatory. “Getting Started” includes just a few of the most popular and highest quality resources out there for those just dipping their toes in the FOAMed kiddie pool. “The Basics” adds a few more resources, and it goes up from there. The “Advanced Practice” file includes every blog on my Feedly, which is every active EM-relevant blog I know about. I’m sure I've missed a few, but it should be the lion’s share of what’s out there. You can download these at will and upload them to your Feedly.

I. Getting Started
II. The Basics
III. Intermediate Level
IV. Advanced Practice

If you load “Getting Started” but later want to see more, you can upload one of the other files. Only the new additions will be added to your feed; it won’t duplicate what you already have. Pretty neat.

5. Go get FOAMy! Remember: there’s no “right” or “wrong” way to do this. I still struggle with filter failure. Just remind yourself there’s no possible way to read everything. Find the things that look interesting to you, and bookmark those to read in detail later. Don’t be afraid to let some other things pass you by – if you stay active in the FOAMed Twitter world and keep up with high-quality FOAMed digests like those from Life in the Fast Lane and EM Curious, you’ll catch the most-important, highest-quality stuff. Hopefully the organization of the OPML files will help those of you just getting started, or those of you struggling with “push” information gathering and filter failure.


I’m always open to comments and questions! Feel free to comment here on the blog, or catch me on Twitter: @CSamSmithMD.


Never stop learning,

C. Sam Smith, PGY-3