In contemporary medicine, the first exposure to new evidence comes first in abstracts and conference presentations, filters through peer-review into journal publication, and, finally, into textbooks. Then, the process of translating knowledge into practice change takes place, slowly percolating into the current physician base through guidelines and expert recommendation, followed by trainees indoctrinated into the latest evidence during graduate medical education. Efforts to speed this process have improved markedly in the decades since the advent of the internet, but remains an ongoing challenge.
However, the rise over the past few years of prominent FOAM resources is leading to a revolution in this process, resulting in sea change to traditional means of dissemination and scholarship. A fantastic recent example can be found in a recent post on Academic Life in Emergency Medicine. As part of a recurring Global Journal Club series, the moderator Brent Thoma compiled a list of prior FOAM discussion of a recent publication regarding therapeutic hypothermia.
Within a handful of days of publication, no fewer than 18 experts in emergency medicine and resuscitation had provided commentary, whether through blog posts or podcasts. A sampling:
- Therapeutic Hypothermia after cardiac arrest: Just not cool anymore? – Robert Simpson
- Targeted Temperature Management: Game changer or just another piece of the jigsaw? – Christopher Poynter
- The Adventure of the Empty House – Rory Spiegel
- EMCrit Wee: The Targeted Temperature trial changes everything – Scott Weingart
- Is this the end of therapeutic hypothermia? – Ang Shiang-Hu
- Giving hypothermia the cold shoulder – Ryan Radecki
- Should I cool the cardiac arrest patient? – Tim Leeuwnberg
- All in a lather over TTM – Mike Cadogan
- Not-so-therapeutic hypothermia? – Kasia Hampton
- Therapeutic Hypothermia does not improve arrest outcome – Cliff Reid
- What’s the target temperature for OOHA cooling? – Simon Carley
All this expert commentary is disseminated freely through the internet – and these experts are universally available through their blogs for further critique, discussion, and debate.
This is accelerated knowledge translation. No more waiting for professional societies and committees to process & regurgitate – nor must authors’ conclusions be taken at face value. Any healthcare worker willing to put the effort into keeping up to date has any number of excellent resources from which to draw. All of this expert commentary is, however, essentially, opinion. The peer-review and vetting process is crowdsourced and not evenly applied to all content – and may be non-existent. The reliability of each contributor is left to the individual read to discern, with few resources available to validate.
Regardless, it’s a leap forward in how practice change is influenced – and one we can all participate in, globally.