Crowdsourced Instantaneous Review: The Peer Review of FOAM?

In Knowledge Translation by Brent Thoma21 Comments

I was talking to my PD about FOAM the other day and mentioned how crazy it was that we have the ability to produce and disseminate content so widely, easily and cheaply. How great it was that this, in some respects, allowed us to unhinge CME from the clutches of drug and device companies and potentially speed up knowledge translation.

He agreed that it was awesome before adding a “but” of wisdom.

“But it’s not peer-reviewed”

That got me thinking. Much of FOAM critically appraises the literature. Other parts offer small tips and tricks. There’s some mentorship and career advice. Still more provides education and expert commentary. But what would happen if someone said something wrong? If they misread or misinterpreted or missed reading some literature and their inaccurate perspective was adopted by unsuspecting med students and residents (staff are omnipotent, aren’t they?)?

Certainly, this could happen in peer-reviewed literature as well, but there’s at least some semblance of protection from it. Here I can say whatever I want and I don’t have to prove how right I am to anyone before I do.

Batman is real.


I think I got my answer to these questions earlier this week. Shortly after I published my recent post on Normal Saline and Ringer’s Lactate I received an e-mail from Dr. Rory Spiegal, an EM resident from Newark, NJ. He respectfully offered his dissenting opinion. Now, I don’t think I posted anything egregiously incorrect in that post, but everyone is entitled their opinion and, after reviewing the same literature and listening to the same podcasts that I had, he came to a different opinion. That’s going to happen.

However, I am somewhat dismayed that the feedback came to me in the form of a private e-mail. From his perspective, he was being polite. He noted that he didn’t want to “overstep” by posting his opinion in the comments. I can understand his perspective and would probably have done the same had I been in his shoes. Additionally, what resident would want to publicly disagree with the FOAM heroes that I referenced like Scott Weingart and Cliff Reid? I sure wouldn’t.

And that’s unfortunate, because I think reluctance to make a comment neutralizes the substitute that FOAM has for pre-publication peer review: 24/7 near-instantaneous post-publication commentary by anyone in the world with an internet connection. This is a tool that would effectively neutralize the spread of inaccurate information.

I realize that the idea is not novel: Wiki sites offer a way to correct their errors and create content through crowd-sourcing – while incorrect information can get there, it generally does not stay for long. However, I had not thought or read about the lack of pre-publication peer-review in the context of FOAM before now (although I expect comments linking to others that have already discussed this).

In conclusion, I think it is extremely important that these comments need to be fostered. If the people reading my blog do not know that their dissenting opinions will be thoughtfully considered and any errors that I make will be publicly corrected, they might not post them. And I think that we’d all be poorer for that lack of interaction.

As I clearly think it is important for dissenting opinions to be heard, I asked Dr. Spiegal if he might be willing to post the thoughts that he shared in his e-mails. He responded positively, but I didn’t think it would do his well researched and thought-out opinions justice to simply add them into the comments section of a post. And so they will get a post of their own – look for it within the next couple of days.

Now… if I’m wrong about all of this, don’t hold back! Right or wrong, I want to get it straight – so tell me about it!

As always, thanks for reading! If you enjoyed this post I’d be extraordinarily grateful if you followed me on WordPress or twitter, forwarded it on, tweeted it or linked to it.

Brent Thoma @boringem

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Brent Thoma
Dr. Brent Thoma is a medical educator, blogging geek, and trauma/emergency physician who works at the University of Saskatchewan College of Medicine. He founded BoringEM and is the CEO of CanadiEM.
Brent Thoma
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Brent Thoma