FOAM and the Rhizome: An interconnected, non-hierarchical approach to MedEd

(From the EiC: This is the third post in a series.  Part 1 looked at how we structure knowledgePart 2 looked at a how complexity and systems influence learning. This post uses the Free Open Access Medical Education movement as a case study for rhizomatic learning.)

By Daniel Cabrera and Damian Roland

In the previous two posts of this mini-series we have discussed the general idea of rhizomics applied to knowledge and how this informs a learning model for Social Media-based education.  In a nutshell rhizomics uses the analogy of the rhizome, the branching root structure used by plants, to demonstrate an interconnected and non-hierarchical community.  The re-construction of the principles of rhizomatic networks by Dave Cormier (@davecormier) has provided an explanation for complexity phenomena. In this third post we explore how rhizomics can function as a descriptive theory for the Free Open Access Medical Education (FOAM) movement and help understand its current state and future.

FOAM is a powerful and disruptive force in the current panorama of health professions education, particularly in emergency medicine, prehospital and critical care. More and more learners are turning to FOAM-created content, while many Clinician Educators are starting to create content with a FOAM (#FOAMed) badge.

Despite its great success, questions remain: what is FOAM exactly? Who are the users? How it is regulated? How open is the FOAM standard? What is the future of FOAM? It is just a fad or the advent of a new era?

The FOAM community is actively discussing these issues. (See for example: Baron, Brannigan)

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What is FOAM?

FOAM is a knowledge management concept based on complex, distributed, and communitarian principles. Access to the content, created by the collective, is open to all users (members or not). There are multiple delivery formats, including videos, narratives, infographics, and podcasts.

The characteristics of FOAM parallel the definitions of rhizomatic knowledge: distributed, non-linear or non-hierarchical, interconnected, no central authority figure, semiotic and self-sustained. FOAM core learning values empower the community to create, negotiate and value content, as well as foster collaboration, socialization and community. All of these attributes are a reflection of a rhizomatic process.

Who are the users?

A critical but often ignored component of the FOAM movement (and a rhizomic fundamental) are the individuals who make up the FOAM community. A significant portion of users/members of FOAM (demographics are hard to determine here, so estimations must suffice) belong to a post millennial generation, called Generation-C. Generation C is characterized by being hyperconnected to social media and their community and content centric/curious. Most importantly Generation C approaches knowledge as a metaphoric nomad (See Cormier and Moravec & Cobo).

The nomadic learner is a self-driven truth searcher, avid to know, looking to personalize the transformation of information into knowledge, where the jounrey (the acquisition experience) is as important as the destination (knowledge). 21C knowmads are young professionals, entrepreneurs who are very comfortable with digital tools and social media. Knowmads are creative, innovative and imaginative; actively pursuing change. FOAMites are well defined by this portrait. (However, this definition is far too prescriptive, given the variety of age ranges and cultures engaged in social media, to adequately capture the complexity of FOAM users.  It does provide a snap shot of a influential majority of users/members.)

FOAM exists because digital networks, like the “roots” of the rhizomic model, link people together through a variety of “routes.” You don’t need to be on Twitter to access a FOAM resource, a Google+ community or Reddit or other digital platform will connect you.

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How is FOAM regulated?

The regulation of knowledge within FOAM also occurs in a rhizomic paradigm. The content is created by members of the swarm for the sake of their own learning experience, and is rapidly shared with the community. It is within this network that content acquires importance and meaning as members of the swarm share it, review it, praise or destroy it. Content is validated as “truth” as a function of its relationship to the goals and values of the group.  In an ideal model, all content should be valued independent of the source and only on the merit (i.e., quality) of the resource. The interdependent equilibrium of FOAM creates a fragile ecosystem. Any internal disruption of balance (e.g., introduction of a culture of eminence or non-organic exclusion of members) or external force applied to the community (e.g., breakdown of social media platforms, loss of access to primary medical content) destabilizes the rhizome. Recent challenges to the FOAM process have raised concerns that certain material is valued not because of the content, but because of the source.

It is interesting that current debates about the utility of FOAM focus on the content that is produced and NOT the network. FOAM is a movement, a rhizomic network. The content is not FOAM; the content is independent, hosted in the (rhizomic) scaffold FOAM provides.

How open is FOAM?

The call for content quality control is an important driving force in health professions education. FOAM culture operates in a different philosophical realm. While it acknowledges the paramount importance of best practices, content is reviewed/approved with a guerrilla approach, where the process is not measurable and omits an external regulator between the learner and the content. Rhizomatics suggests that value is assigned as a function of the utility the content provides for the community. This creates a (foundational) problem. It is difficult for the traditional education community to validate and acknowledge content that originates from a fuzzy swarm of knowledge. While the principles of free and open access are a new reality in a digital world, debates about the determination of quality (e.g. expert peer review versus crowdsourcing) are on going.

The rhizomatic structure of FOAM positions the community on the “flat hierarchy” side of the debate. Let’s see how the discussion evolves!

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Further reading