Blogging about Blogs, part 1: Life in the Fast Lane

This is the first in a 6 part series on education blogs edited by Anthony Llewellyn (@hetimeddir) and Teresa Chan (@TChanMD)

Don’t miss Anthony’s first post: “What Makes a Great #MedEd Blog“.

-Jonathan (@sherbino)

This blog is an interview by Anthony Llewellyn with Chris Nickson (@precordialthump) and Mike Cadogan (@sandnsurf) of Life in The Fast Lane and  Social Media and Critical Care (SMACC) fame, among other projects listed below.

Life in the Fast Lane or LITFL is the largest #FOAM website in the world, focusing on both emergency medicine and intensive care. It contains comprehensive online resources such as the ECG Library and The Critical Care Compendium. It serves as a ‘one stop shop’ for #FOAM users by providing weekly reviews of highlighted new #FOAM resources (‘The LITFL Review’) as well as suggested readings from the published medical literature (‘Research and Reviews in the Fastlane’). LITFL has had many themed series over the years, ranging from purely educational (e.g. case based question and answers) to the satirical (e.g. the ‘Utopian College for Emergency Medicine’), as well as opinion and insights (e.g. ‘ER doc gone Walkabout’). Ultimately, LITFL aims to be comprehensive #FOAM resource for emergency medicine and intensive care.  It is widely viewed as the hub of the ‘FOAM movement’. LITFL can be hard to describe!

LITFL averages around 2,200,000 page views a month with 800,000 active users a month (56% new visitors).  It is primarily a just-in-time learning platform with most users spending an average of 3 minutes reviewing 2-3 pages per visit.  It is visited by readers from 241 countries with USA, UK, Australia, Canada, India, Ireland, Malaysia, South Africa accounting for 75% of visits per month.

SMACC is the website and podcast that provides free access to talks and other educational materials from the annual SMACC global conference. It includes all the talks from the conferences as audio podcasts. There are also video versions of the plenary talks.

INTENSIVE is a #FOAM resource that publishes the educational output from The Alfred ICU. This includes journal club summaries, talks from the education program and other events that Alfred ICU staff are involved in, practice questions for the Australasian ICU exams, simulation scenarios, etc. It is an opportunity for trainees to get involved in FOAM and educational publishing.

RAGE is an interactive podcast that intermittently publishes group discussions on key resuscitation topics in a unique format. The format involves recent  #FOAM highlights, key topic discussions, historical interludes and quirky asides. The team are high profile critical care physicians from a range of specialties (emergency medicine, ICU and retrieval medicine) who bring different perspectives to the medical literature and clinical problems faced by those looking after critically ill patients.

Other key links:

@SMACCteam; the global #FOAM RSS feed created by Mike Cadogan


Q: When did you start your blog?

A: Chris Nickson first started medical blogging in 2008 with a site called Aequanimitas. This soon combined with Mike’s original to evolve in the site that exists today. The SMACC podcast started in 2013, following the first SMACC conference.

Q: How many people are involved?

A: has many contributors – it is difficult to quantify! Contributors vary in their ongoing activity. The LITFL Review and R&R projects alone have over 50 contributors from around the world. Over the years there have been over 30 blog editors. Marjorie Lakoff now edits The LITFL Review and a separate team are responsible for ‘Research and Reviews in the Fastlane’ (Anand Swaminathan, Soren Rudolph, Nudrat Rashid, Jeremy Fried and Chris Nickson). The major page and post writers are Mike Cadogan and me, who between us have written about 5,000+ pages and posts since 2008.

RAGE has 5 active contributors. Former contributors include Michelle Johnston and the late John Hinds.

INTENSIVE has a growing list of contributors, comprising the junior and senior staff of The Alfred ICU.

The SMACC podcast has multiple contributors, who have been presenters at the SMACC conferences.

Q: How would you describe your audience?

A: has huge global audience of people interested in emergency medicine and critical care at all levels. The ECG Library in particular has cross-specialty relevance. Users of the website include paramedics, nurses, medical students, doctors-in-training and consultants.

Q: Can you describe your process for generating content?

A: Posts on LITFL are generated in different ways. Individual posts may be written and published directly by the post writer, especially if they are part of the editorial team. Otherwise, most posts are reviewed by one of the LITFL editorial team prior to publication.  The LITFL Review is assembled by Marjorie Lakoff from a Google Document that is collaboratively created by LITFL Review Contributors every week.  R&R in the Fastlane is created weekly by one of the R&R team from a spreadsheet containing article submissions from R&R contributors.

All posts on INTENSIVE are written as a Word or Google Document then peer reviewed by an Alfred ICU consultant before being posted. Any clinically related information is de-identified/ fictionalised.

RAGE episodes involve a Google Document to assign topics that team members research. We then Doodle a meeting time and run a Skype conference call. Each person records their own order as a separate channel using Audio Hijack Pro (or similar). The individual audio files are shared using Dropbox (or similar) and edited by myself [Chris Nickson] into a single audio file using Audacity. Levelator is sometimes used to help even out the sound. The podcast is stored on Libsyn and is accompanied by posts on a WordPress blog.

Q: What’s your technology stack (i.e. how do you host your site, how do you code it, do you have a CMS, do you use any integrations e.g. Facebook, Twitter, Google etc…?)

A: In the spirit of #FOAM, the LITFL team — led by Mike Cadogan — have built, hosted and developed 100+ websites for members of the FOAM community. LITFL hosts the domains on a number of servers it runs in Australia, UK, USA and Canada. These sites a paid for, hosted, developed and maintained by LITFL team prior to handing over to the principal site author.

Sites are all and integrate via a series of plugins to social media such as Facebook, Twitter, Instagram, Linkedin and Google +. Our favourite theme producer is Genesis by Studiopress and we code specific parts of the themes to enhance mobile readability and HTML5 compliance.

All sites are linked to Google, Alexa and Bing Webmaster tools; the Yoast SEO platform and Uptime monitoring sites such as pingdom. We utilise as many free platforms as possible to enhance readability, searchability and durability of the sites we maintain

Q: What’s one interesting thing you have learnt through the process of developing a MedEd blog / website?

A: [From Chris Nickson]

My involvement in #FOAM was initially a hobby and means of self-educating, but has become central to my career as a clinician and Clinician Educator. It facilitates networking and collaboration, has become integrated into the education program  I coordinate at The Alfred ICU, has lead to the creation of a major international critical care conference (i.e. SMACC), and provided the basis for publications in peer-reviewed journals and invitations to speak at international conferences. Perhaps surprisingly, I have also found that involvement in these projects is an important defence against career burnout, through the sense of purpose and social interactions that they generate.

A: [From Mike Cadogan]

Health professionals are generous with their time, experience and desire to educate. But, they don’t want to reinvent the wheel, they don’t want to learn to code and to have the responsibility of building, hosting and maintaining a website.

Once the barrier to social engagement and computer programming is lowered or removed…the medical educators of the world are able to educate, write, disseminate and curate free and influential educational resources without incumbency.

Q:  What do you need to think about in terms of the sort of physical and software technology (toolkit or stack) to create and sustain a great #MedEd Blog? 

A: Free updatable resource such as with a dedicated ‘backend’ crew to maintain security, SEO, functionality.

A post and a page are nothing in the blogosphere without appropriate triangulation of keywords, database placement and metadata.