News & Features — 1 August 2014 at 9:00 am

Bubbles in the Wilderness: All About FOAM

Natasha Pirie-Burley / Senior Retrieval Registrar, Queensland

Tash is a Senior Retrieval Registrar for Careflight Medical Services in Queensland, Australia. For the past 4 years she has roamed across the continents as an adventure medic, working on Mt Ruapehu, New Zealand as a ski field doctor, volunteering in Nepal, landing up in Queensland and working on various choppers and planes in between. Looking for inspiration that she’d found lacking in hospital corridors, she recently stumbled upon FOAM. Here she explains more about this free, online cosmos, and gives us some enthusiastic insight into how as a medic frequently working in isolation, it’s rocked her world.

What is FOAM?

Free online access medical education, or “FOAM” as it’s affectionately called, is essentially free medical learning anytime, anywhere, for anyone. Which is perfect for adventure medics like us; no longer do we need to worry about falling completely behind in our specialty as we jet off into the horizon. FOAM allows you to learn on the move and gives you the forum in which to learn. I am hoping to give you the inspiration to roam. Movement boosts brain power and wild places are probably more conducive to absorption than any lecture hall we’ve ever encountered in our lives.

Within FOAM all opinions are entertained, whether you’re a Professor at the Royal London or an unwashed medic who has just emerged from the jungle. Speaking for myself, it is also good to remember that most of the information in these resources have been distilled and condensed by someone a lot more academic and brainy than me. FOAM is based upon asynchronous learning, using online resources to facilitate information-sharing outside the constraints of time and place, among a huge network of people.

“If you want to know how we practised medicine 5 years ago, read a textbook.
If you want to know how we practised medicine 2 years ago, read a journal.
If you want to know how we practise medicine now, go to a (good) conference.
If you want to know how we will practise medicine in the future, listen in the hallways and use FOAM”

– Joe Lex, legendary ED doctor and ‘Godfather of FOAM’

So while we are out there travelling there is a possibility that our knowledge may actually be cutting edge! But best of all, like the memories we store, FOAM is free. If it isn’t free it isn’t FOAM: the best escapades don’t cost a penny.

So where can we find this free brain fuel to digest on the move? Like the basis of any good education it is available in many formats. Blogs, Google Hangouts, videos on Vimeo or Youtube, Facebook groups, photographs, essays, musings, and great websites like this. Independent blogs such as or more ‘Jack of all trades’ blogs like Kidocs or Broome Docs are a good place to start. They contain real-life musings from people on the shop floor. They are candid, sometimes emotive, and importantly provide a neutral territory in which clinical dogma can be challenged.

There are also numerous free podcasts on forums like iTunes such as “Pre-Hospital and Retrieval Medicine” by Minh Le Cong, “EMCRIT” by the energetic Dr Scott Weingart, and my favourite “RAGE” – The Resuscitationists Awesome Guide to Everything. The latter is hosted by a panel of Intensivists, Retrievalists and Emergency Physicians from around the planet. They serve up lovely distillations of current medical research, controversies and core topics in a well-rounded, unpretentious, and often amusing manner. Most podcasts are linked to fantastic websites bursting with relevant references in case you need to explore a little more. In the main, you will find them palatable, upbeat, punchy a great asset to any enquiring brain.

Better still, start recording a podcast yourself. It’s not as hard as you may think. There are many extremely helpful people who have tested the waters before you such as Andy Neill or Rob Rogers who are more than happy to give you top tips on how to rock, rock, rock the microphone. It’s not expensive and it’s not complicated. Furthermore, podcasts targeting our brand of wild and exploratory medicine is definitely a genre that’s notably missing.

And then there’s Twitter: A cheeky, chirpy invention that contrary to popular belief isn’t just occupied by Justin Bieber. Instead it is a valuable resource where pressing questions can be answered and nice sentiments, pictures, or documents can be exchanged. It really is a world of opinion sitting right at the end of your thumbs that can provide you with a consensus from around the globe within hours. Statements and declarations in Twitter are limited to 147 characters so beware that content can be misconstrued. But idea progression and knowledge accumulation can be exponential. I liken it to rapid fire email with an “ask the audience” kind of twist and I just love it.

So can we trust FOAM? I think on the whole, yes. The caveat being to keep your mind open and not regurgitate everything you have seen or heard verbatim without questioning it first. The ethos of FOAM is to encourage you to question medical hand-me-downs, not accept without query. FOAM is an open and organic think tank where a global conversation and collaborations are evolving all the time. It strays away from the competitive nature of medicine and knowledge is disseminated selflessly.

Tangible FOAM: heading to SMACC

FOAM didn’t really enter my world until last year. Sure, I had a smartphone within a 10cm radius at all times, but really I knew little of the “Twittersphere” or this effervescent revolution. Instead I stumbled upon some Emergency Medicine podcasts whilst looking for some acoustic company on my regular two hour commute to a rural ED in New Zealand. From that day forward, my commute ceased to be daily vacuum of unhealthy snacks and diet coke. Instead my car teemed with medical goodness. CME pumped out of my speakers, carrying with it novel learning and gregarious discussions that had me fist pumping out the window as I tootled along. FOAM educators started travelling with me on crampons, skis, skins, bikes, and boards. My brain was wild and free and in a perfect position to listen and absorb. It was great and I was learning again. I could not believe that these common-sense medics were dishing out free medical beta like excited rock climbers after an on-site climb. I was smitten, and more importantly, as a remote practitioner, I was no longer alone. I felt supported, part of a community, and the fears I had of falling behind my peers started to fade. Therefore, it seemed only right that I should set out on a pilgrimage to Social Media And Critical Care Conference (SMACC) on Australia’s Gold Coast and meet some of my FOAM heroes.

The SMACC conference started with a boom. Barely 8am, coffee in hand, we were transported to magical neon land of tribal dancing, fire, and drums. Surely this had blown our entire conference fee? Glitter rained from the roof and dance music gave way to cheers: the FOAM educationalists were poised on stage to galvanise us with creativity, expressionism, and effervescent debates.

Although social media was the conference’s guise, medical multiculturalism and exemplary patient care was clearly its focus. Intensivists, Emergency Medicine Doctors, Ruralists, Pre-hospital providers, Wilderness and Expedition doctors, Paramedics, Nurses, and students from all corners of the globe laid down their tribal spears and medical stereotypes to bond over free medicine and freedom of speech. At this conference there was no sign of educational capitalism or lofty academics. Instead human factors and self-reflection shared the limelight with sexy topics such as ecmoCPR and ultrasound. Furthermore, lectures were hosted by what appeared to be normal folk being vulnerable, sharing life lessons, their motivations, and dipping into “before and beyond” the hospital on a regular basis.

This conference was unconventional to say the least with free alcohol, dance offs, and relaxed dress codes. I felt completely at ease. There were no conflicts of interests, but instead interest in the conflicts that we face in our daily practice. The learning was organic, and pushed us to be better by challenging and questioning everything that we thought we knew. There were workshops on expressing yourself, podcasting, creative writing, and graphic design. The classroom was well and truly inverted: as I sat and listened to Deniz Tek (the original ice man turned ER doc) talk to us about lessons learned – not only as fighter pilot but also as a member of a rock band – I realised that the path to success doesn’t have to be straight and should certainly be varied.


In 2007 I struggled to find my passion or heroes within my workplace. I listened to closed minds and wondered why everyone was, “just getting through it”. It was un-inspiring and at times depressing. I resigned from my job in the UK and headed to the wilderness of America, New Zealand, Nepal, and Australia. I was searching for heroes and inspiration relevant to my life. Then last year, by chance, I found that Mawson’s bravery, Shackleton’s leadership, Dean Potter’s composure and the family Robinson’s ingenuity were right here at my fingertips and living in these medical pioneers of FOAM. I will undoubtedly continue to venture into the wilderness for the rest of my life. The difference being that now I relish the re-engagement with work. I now know that I have champions there too: each and every one of them breaking trail through their own austere environments using cooperation, passion, and enthusiasm. Remaining open and modest at every hurdle and showering us with quality edu-tainment.

So what’s my point? Well I suppose, in the spirit of social media, I really just wanted to share my passion for this free spirited resource. It has been a colleague when I didn’t have one and a friend when I just wanted a rant. It has been extremely useful for me working in isolated environments and when I have been unsure. Its impact on me has been profound, sending sparks through my cerebral hemispheres for the first time in a long time. Reminding me that medicine is another place to which I should return and explore. Showing me that medicine can be a forum where freedom of speech is applauded and intellectual creativity blossoms.

So whether you’re tramping the hospital linoleum or the Mongolian Steppe, come and join the parallel adventure happening in the cyberspace. Share your experiences, your joys, your fears, your opinions, and your improvised medical talents. We all have something to learn from each other. Spread your enthusiasm for your interests and take with you a slice of someone else’s endeavours. But most importantly remember that when you’re at 5,364m in remote Nepal, thousands of experts can actually answer your call for help.

Useful Resources

  • Life in the Fast Lane / Australasian website with plenty of information on FOAM and how to get involved
  • SMACC Chigaco / Official website for the 2015 SMACC conference in Chicago. Their homepage also has a comprehensive list of affiliated blogs and websites, including Tash’s favourites mentioned above
  • Kangaroo Island Doc / Blog about rural medicine in Australia
  • Resus M.E. / Resuscitation medicine blog
  • Emergency Medicine Ireland / Podcasts and links for emergency medical education
  • iTeachEM / Podcasts and blogs dedicated to emergency medical teaching
  • #FOAM #FOAMed #FOAMcc / Your twitter hashtags to see what’s being discussed in the here and now
  • Resuscitationist’s Awesome Guide to Everything (RAGE) / audio podcast for all things critical care
  • PHARM / Prehospital and Retreival Medicine / Podcast from Dr Minh le Cong
  • EMCRIT / Blog and podcast for the resuscitator
  • Broome Docs / Rural generalist doctors’ education

And the list goes on… get browsing!