If the initial 2012 euphoria of the free open access medical education (FOAM) movement is wearing off, it is not because its promise has not been fulfilled. Quite the opposite—it is a sign of success. For thousands of emergency medicine providers and learners, FOAM has become an essential and everyday component of the educational landscape. While some debates rage on as to the merits of FOAM versus classic learning tools such as textbooks and peer-reviewed journals (paid access medical education, or PAME), for the most part, one of my own early predictions is coming true: FOAM is becoming more PAME-like and PAME is becoming more FOAM-like.

For example, FOAM blogs and podcast online show notes are increasingly likely to have heavily footnoted bibliographies referencing top peer-reviewed research and respected texts. No longer solely the purview of the lone-wolf renegade educator, FOAM is increasingly published by authors associated with academic centers, and their work bears the imprimaturs of the prestigious institutions with which they are associated. FOAM as an educational activity has been studied and refined in order to optimize its integration into medical school, residency, and continuing medical education curricula. The results of these studies appear in the top peer-reviewed journals. Many of the same authors of influential research papers, textbook chapters, and clinical policies are creating or supporting FOAM. It is no longer Luddite-chic to be a FOAM detractor. It is clear that those who spurn FOAM, especially top medical educators, do so at the direct detriment of those whom they are responsible for teaching.

Meanwhile, PAME creators are waking up to the realities of the digital/FOAM world. Almost all major journals and academic conferences have Twitter accounts or promoted hashtags that tout links to new articles and lectures, some of which are made available for free. Some journals, including the Annals of Emergency Medicine, have gathered teams of plugged-in physicians to run these accounts. (I along with nine other FOAM-friendly emergency physicians now run the @AnnalsofEM account.) Even the so-called dinosaur EM core textbooks are attempting to keep up with the hurtling pace of FOAM. When ACEP released a new clinical policy stating that serum beta-hCG levels should not be used as discriminatory thresholds for attempting ED ultrasound in first-trimester pregnant patients with bleeding, the online eBook of Tintinalli’s Emergency Medicine was updated; the editors removed its previous algorithm that now runs afoul of ACEP guidelines. Of course, thousands of hard copies with now outdated information remain in circulation, a perennial problem of printed texts. And while FOAMites proudly flaunt their various adventures in “myth busting” (aka, dogmalysis) and their progressive practice styles, careful perusals of the most-used core EM textbooks reveal that there’s not as much new under the sun as we may have thought. Lido/epi in the fingers? Rosen’s Emergency Medicine supports it. Six-hour observation times for biphasic anaphylaxis? Neither Rosen’s or Tintinalli’s suggests it. Liberal use of ketamine for procedural sedation? It’s all in there.