I recently came across the Twitter hashtag #FOAMed. Though images of bubble baths came to mind, I did a quick search and found out it actually represents “Free Open Access Medical Education“. Reading through what resources I could find, FOAMed actually started making a lot of sense.
First, some facts:
- Medical education is long and expensive endeavor, with students graduating with debt equivalent to a small mortgage.
- The style of medical education often depends on the institution offering it, and one size never fits all.
- We need more doctors (and health care professionals in general) to make the pending shortage less acute. Moreover, GME funding hangs in the balance as our national budget reckons with reality.
Why FOAMed?
If the proliferation of Internet-based courses from elite universities is any indication, online education is increasingly gaining traction and validity. All the information traditionally available in the lecture hall can be accessed through asynchronous learning networks that often cater to varied learning preferences.
These learning networks are inherently crowd sourced, which makes their relevancy with new medical knowledge near real-time. Last I checked, medical textbooks don’t auto-update for free, if at all (unless you use WikiDoc).
The only barrier in a FOAM learning environment would be internet access, but that barrier is eroding quickly. According to the Pew Internet and American Life Project, a full 66% of American adults have domestic internet access.
What’s FOAMed not good for?
Clinical experience. You can’t manage to get the entirety of human experience and emotion through a computer screen alone. Being a doctor entails constant human contact and connection, so bedside training is necessary in tandem with a basic medical education.
To my knowledge, FOAM is currently more of a concept than a platform, taking place among varied social networks. As an avid believer in good design philosophy, I believe a well-thought and consolidated platform for national, if not global, FOAM would really accelerate its progress and acceptance.
So, here’s what I envision for medical education in the radical future.
Instead of applying to a medical school, medical school applicants apply to a common asynchronous medical learning network (CAMLN), supported, and vetted, by all the major medical institutions. The concept of limited seats a medical school goes out the window because the only seat you need is the one you’re sitting in now. CAMLN is free-of-charge, provides structured, unstructured, or optimized learning modalities, virtual student and faculty support groups, communication channels, and digital “real-time” textbooks. Students progress at their own pace, thus lowering attrition rates, though incentives can be in place to complete in four years or less. USMLE/COMLEX testing is still utilized to ensure that CAMLN students know their stuff regardless of their chosen education style.
Clinical experience programs will run at hospitals and medical institutions nationwide. A CAMLN student pays a fee, say $1,000 per term, to access a few of these local programs that complement CAMLN’s curricula. Independent anatomy labs can be run similarly, though free digital options are available. Clinical and academic research opportunities are still open to those students who wish to pursue them. They can apply out of a CAMLN portal, where principal investigators can easily sort through desirable applicants. The same applies to dual-degree seekers. Applying to residency stands as it does today.
Because CAMLN is supported by most, if not all, major medical institutions, the individual institutional cost of providing an education plummets dramatically. The notion of “faculty”, in its traditional sense, changes as information is crowd sourced and teachers need just verify, rather than consistently provide. There are no maintenance budgets required to keep an educational campus open. The only real educational cost is paying for CAMLN’s initial knowledge base, its upkeep, and server space.
At four years of two terms each, that’s a grand total of $8,000 spent on a complete medical and clinical education, compared to the $200,000 we spend today. Everyone learns effectively according to their own preferences. We crank out more doctors because there are no institutional seats to limit us. The $1,000 each student contributes per term, as well as the money saved from not running an educational campus, can supplement shrinking hospital GME funding from the government. Hospitals can actually afford to open up more residency slots, thus ensuring against educational bottlenecks and producing more doctors to plug the gap.
The great thing is that CAMLN need not be limited to physicians or geography. Almost every type of health professional school in any kind of region can provide a similar network or become a sub-network under CAMLN’s umbrella system. That opens up the possibility of a more fluid international network of medical professionals, where everyone is trained with the same high-quality and high-relevancy medical knowledge.
The potential and possibility are of global-scale.
The only major obstacle I can see in to this future is the idea of a “brand-name” degree. The prestige associated with particular universities would make people averse to the idea of a homogenous educational platform. I figure there would be a number of ways to tackle that perception, but, in the end, would necessitate a universal push from all stakeholders.
What are your thoughts? Could CAMLN work?
