Challenging the Knowledge Translation Gap

By Emily Leighton, MA'13

“To teach them this art – if they desire to learn it – without fee and covenant.”

Written nearly 2,500 years ago, the Hippocratic Oath – perhaps the most famous text in medicine and a long-standing ethical guide for physicians – touches on a very modern idea.

Teaching has long been considered a duty of the medical profession, but the digital age has amplified the issues around who gets to access medical knowledge and when. As more people are turning to online learning sources, paywalls implemented by scientific journals, news organizations and other publishers have restricted access to evidence-based scientific literature and educational materials.

Faced with these barriers, researchers and educators are creating new opportunities to fulfill the call for free and accessible education outlined so poetically by the father of Western medicine.

An international movement known as FOAM (Free Open-Access Meducation) is one example of a culture shift that is disrupting medical education and making the exchange of knowledge and ideas more democratic.

Established in 2012 at the Conference for Emergency Medicine in Dublin, Ireland – over a pint of Guinness, the story goes – FOAM leverages social media to share users-generated content, resources and tools focused on medical education. The term covers free educational material available online, including blogs, podcasts, YouTube webinars and tweets.

The ethos behind the acronym emphasizes that high-quality medical education materials and discussion should be free and accessible to anyone caring for patients.

“This movement changed my world,” said Dr. Ken Milne, an emergency physician and Adjunct Faculty member in Family Medicine.

Dr. Milne produces and hosts The Skeptics Guide to Emergency Medicine (SGEM), a weekly podcast series and corresponding blog that reviews recent medical literature. Launched in 2012, Dr. Milne’s goal with the podcast is to tighten the knowledge translation gap, shrinking the time it takes for research to impact clinical practice.

“It takes more than 10 years for highquality, clinically relevant information to reach the bedside,” he explained. “Intellectual capital should be shared, it should help patients get the best care possible.”

With topics ranging from atrial fibrillation to high-flow nasal oxygen, Dr. Milne adds his quirky, fun-loving personality to the project. He engages his followers with trivia, polls, mystery prizes and GIFs, even inviting people to guess each episode’s intro song in advance.

“I’m reaching 40,000 subscribers from all across the globe and they provide feedback to me in real-time,” he said.

Because anyone with an Internet connection and mobile device can potentially contribute to FOAM, the movement is sometimes criticized for a lack of quality control. Alumna Dr. Teresa Chan, MD’08, co-authored a study published in the Canadian Journal of Emergency Medicine outlining strategies to help users find reliable FOAM resources and critically evaluate them, as well as actively participate in the movement.

Drs. Chan and Milne rely on scientific literature to carry out their educational work, but at this end of the spectrum the waters are also muddied.

Labelled the “war to free science” in a recent Vox magazine article, some in the research community are calling for changes to the for-profit publishing model and the high cost of academic publishing.

Dr. Michael Silverman, division Chair/Chief of Infectious Diseases, pays upward of $3,000 – out of pocket or via grant funding – to provide open access on some of his most clinically relevant research papers.

“The whole idea is to get people reading about my research, to try to get it seen by the health care community and acted upon,” he explained.

Dr. Silverman believes the government should fund journal access for all health care professionals,  particularly those working outside the academic hub. “This is a part of health care; an essential service,” he said.

Open access may also be valuable in the efforts to stem the rise of misinformation infecting the Internet, particularly if groups like the FOAM movement can take complicated literature and make it more straightforward, relatable and engaging.

“To cut the knowledge translation window, we’re combining high-quality information with entertainment,” said Dr. Milne. “Sometimes you won’t even know you were learning.”