As with the other chapters the introduction will be divided into a series of subsections. The first will provide a brief overview of my interest, background and involvement with open education movements and the resources and cultures they produce. The second section will outline the study’s central theoretical and pedagogical underpinnings, along with considering some of the problems associated with them. I will then elaborate on why Free Open Access Education (FOAMed) fits so well with Emergency Medicine (EM), before providing some organisational context. The dissertation contains a number of multi-modal resources (including podcast interviews) so it adheres to FOAMed and open access principles (you can find a PDF of the dissertation here)
My involvement with OERs started in a somewhat generic and nebulous manner. Working as a lecturer in English departments with large module cohorts generated my interest in how technology could help maintain threads of conversations – individually or with your peers – beyond the bounded space of the classroom. I operated in the humanities and I wanted to see how the private experience of reading and negotiating texts could be discussed in a forum outside of the physical teaching space to see if others had similar experiences. I used tools such as the discussion forums on Blackboard to maintain dialogues about texts, ideas and themes; participation was recognised in assessment rubrics and threads from the exchanges could be cited in research essays so a number of steps were taken to embed continuing dialogues into module syllabi.
Working in the English Department at the University of Tennessee, Knoxville (UTK) from 2006-08 also gave me the opportunity to reflect on the relationship between teaching, research and how scholarship is created and disseminated. Emerging trends in digital education moved these interests along and they were manifested in two ways. Firstly the proceedings of a conference I organised shortly after the publication of Cormac McCarthy’s Pulitzer Prize winning novel The Road were published online by the university in traditional text and video format; this was the first time in the scholarly community devoted to McCarthy studies that the knowledge and ideas generated by a conference reached an audience beyond the delegates in attendance. The success of this project led to further work with Newfound Press, the digital imprint of UTK’s library service, resulting in the open access publication in 2010 of my book on Cormac McCarthy. The peer review process was incredibly thorough, and the book was available to download in individual chapters or its entirety. It was the perfect way to finish my time at UTK as it had challenged my thinking on research, teaching and the production and sharing of knowledge.
A career in academia failed to materialise, but I’m fortunate enough to currently work in a highly rewarding educational environment. There has been a confluence of academic and professional interests at the RCEM between changing philosophies of producing and sharing knowledge and emerging technological functionalities that facilitate this (Fitzpatrick 2011). These issues largely play out in the development of the RCFN and they have crystalized in the research questions for this dissertation which are: should these resources somehow be legitimised, acknowledged or in the very least signposted in the curriculum? Given their popularity should a reflective learning log or diary be developed so learners can record interaction with these resources as they operate in learning cultures which demand proof of activity, and FOAMed traditionally does not offer credentialed learning? The relatively closed nature of these questions can be attributed to the fact that as FOAMed is such a heterogeneous and rapidly changing educational movement I needed to be as specific as possible to devise a workable operational solution for the RCEM to embed FOAMed into its educational procedures and strategy. But this had to be accomplished without undermining the fluid dialogic spaces that FOAMed is enabling to emerge between learners, their organisation and the curriculum which guides their training and ongoing education.
It may seem surprising but there is something of a cross-over between the theoretical landscape of the humanities and the world of evidence-based medicine -the spirit of which infuses the FOAMed movement – as both see knowledge as open to challenge, critique and often contingent upon local meanings. It helps to return to Foucault here as his theories of discourse, of how language either legitimates or critiques hegemonic ways of doing things, allows us to see how FOAMed is a discursive practice which challenges ‘the sovereignty of collective consciousness’ as embodied in official texts such as curricula, and it encourages questioning of ‘ready-made synthesis, those groupings that we normally accept before any examination’ (Foucault, 1997, p 22). FOAMed is a hybrid educational movement that simultaneously critiques and (where appropriate) upholds and endorses existing clinical practice, but it is inescapably discursive in nature.
One aspect of FOAMed’s appeal is that it helps to fulfil a fundamental human need for stories and context (Norman 1993). Theories around dialogic education and the narrativization of learning – something which FOAMed does extremely well – have been incredibly influential. Although he doesn’t deal with FOAMed or OERs the work of Rupert Wegerif (2013) has been a particularly important influence in this regard. Wegerif will be dealt with more thoroughly in the review of the literature but it is interesting to note his point that digital modes of education return us to Socratic models (2013) which privileged questioning and discourse; this parallels with the FOAMed movement as it contemporizes rather than supersedes long-held medical education practices predicated on questioning and ongoing dialogues. In another allusion to classical paradigms some members of the FOAMed community often refer to the section of the Hippocratic Oath that champions the passing on of knowledge and expertise ‘without fee or covenant,’ as captured in the image below, which parallels with the OER ethos:
Even at the most junior professional levels RCEM members have an extremely high level of academic attainment so their learning now centres more around the process of learning rather than the accumulation of information (Jarvis et al 2003). A lot of medical education and the FOAMed movement in particular is inherently constructionist as it encourages learners to be an active agent in the process of interrogating and developing knowledge, which is illustrated with increased attention on reflective learning and evidence-based medicine (Roland and Brazil 2015). Many forms of contemporary medical education also privilege discursive practice (Selwyn 2011, Rovai 2004). The evolving nature of clinical knowledge and the evidence-base associated with it ensures that experiential learning is a feature of FOAMed as ideas are ‘formed and re-formed through experience,’ and shared in a freely accessible form (Kolb, 1993, p 144). FOAMed also represents an example of Di Sessa’s (2000) concept of committed learning as users feel deeply connected to the activities in which they learn. Committed learning entails feelings of ownership, personal connection, and competence, which also characterise constructionist pedagogies (Di Sessa 2000).
A corollary to FOAMed’s constructionist identity is its inherently social nature, which has a number of theoretical and logistical dimensions. FOAMed fulfils a fundamental need for storytelling and social interaction as ‘there is far more to human cognition than what goes on in the brain: we are social, interacting creatures’ (Norman, 1993, p 117). Social learning is embedded within medical education as it aligns with its constructivist nature and privileges learner participation and reflection on experience (Barab et al 2005, Bruning et al 2004). Although he does not specifically deal with FOAMed Wenger’s (1998) notion of communities of practice anticipates important tenets of the movements as for Wenger ‘knowing invites active participation in social communication’ (1998, p 10). FOAMed can be seen as a community of practice, which helps to explain FOAMed’s presence on social media (especially Twitter) as community members critique and share knowledge in ways that correspond with the conceptual and logistical characteristics of EM. For Wenger the act of knowing is a matter of participating and the dialogic nature of FOAMed aims to support learners in developing their knowledge (1998).
This is not to suggest that FOAMed is entirely free of problems when it comes to its relationship with pedagogy. One major issue is how FOAMed – especially evidence of activity – aligns with the curriculum and institutional requirements for the documentation of learning (Biggs 2003). The issue of alignment underpins my research questions as learning resources are currently being used in educational cultures that fail to recognise them.
FOAMed’s fit and popularity with EM practitioners can be attributed to empirical and logistical reasons. On a logistical level FOAMed and social learning is crucial to EM as it is a specialty that is ‘always open’ and is characterized by shift work, demanding rota challenges and vast geographical spread. Learning resources that help to supersede scheduling and environmental constraints are therefore a significant help (Alexander and Boud 2001, Cadogan 2014). EM physicians heavily involved in the FOAMed community have formulated metaphors to help explain it – such as ‘corridor conversation’ and the ‘digital water cooler- which are imbued with a dialogic ethos (Nickson and Cadogan 2014, Lin 2012). EM physicians are presented with a range of diverse clinical issues on a daily basis so it’s a specialty that demands resourcefulness and a heterogeneity of learning resources, and FOAMed answers this need (Vartabedian 2014). Emergency Departments (ED) never shut, so practitioners need resources which update frequently and which keeps them up to date, and FOAMed does this. Furthermore their physical environments also do not necessarily afford opportunities for consistent learning, teaching or reflection, so this is another function the FOAMed movement supports. Some sceptics may question the ‘goodness of fit’ between 21st century technologies and 20th century theories of how people learn (Selwyn, 2011, p 80) but FOAMed’s emergence within the EM community is an example where this is not a pronounced concern.
The RCEM is atypical amongst medical royal colleges as it has its own elearning portfolio. The majority of colleges host their online education on elearning for healthcare run by Health Education England. Although the RCEM has some live sessions here the majority of its content is currently published across two sites; RCEMLearning and the RCFN; the former was launched (out of a previous iteration) in March 2015, and the RCFN was launched in September 2014. RCEMLearning resembles a conventional VLE as it’s comprised of an etextbook and modules containing a series of assessable components ranging in length and complexity from brief clinical cases to involved 60-90 minute long learning sessions. Anything with assessable components on RCEMLearning generates a certificate in users’ portfolios, which also includes an optional reflective log. Users can track activity but reports do not automatically update external platforms such as the RCEM CPD diary. All content is open access aside from anything with assessable components, access to which is password-protected for RCEM members. Open content on RCEMLearning is differentiated from open content on the RCFN mainly by type (that is it tends to resemble conventional elearning content as opposed to blogs and podcasts found on the RCFN). The RCFN publishes nothing but podcasts and blogs, content contains no assessable components, and there’s no ability to capture or reflect on activity undertaken on it. However RCFN content is highly dialogic in nature as the podcasts are exchanges between two or more contributors and there is the option for listeners to leave comments for the authors and members of the FOAMed community. This conversational style is informed by a strong evidence base, as illustrated by a recent journal club-style podcast and coverage of the RCEM’s annual scientific conference.
Both sites generate a variety of learning analytics, but one graph is particularly illustrative for our purposes. The image below shows major content areas for both sites (etextbook/RCEMReference, learning management system and FOAMed) and relevant completion analytics for each major content type; page views, completion rates and downloads from the launch of the respective sites until the end of August 2016. Podcast downloads are significantly outstripping analytics for any other content type and it reinforces that devising a solution so learners can reflect on them – thereby aligning with FOAMed’s metacognitive ethos – is imperative but problematic. FOAMed is traditionally resistant to credentialisation, but consumers of FOAMed resources operate in contexts that demand credentialed learning and tangible proof of activity, so we have a duty as an organisation to provide a solution here:
Image 2: Usage analytics for each major content type or area. PV = page view, C = completions, D = downloads.
Aside from the question of credentialing or recognition another motivation for this research was to determine if FOAMed resources should somehow more fully be incorporated into the RCEM curriculum. The most recent iteration of the RCEM curriculum alludes to FOAMed resources but it doesn’t signpost to any, even those produced by the RCEM. This is an increasingly pressing concern given the popularity of the resources amongst the RCEM’s stakeholders. RCEMLearning and the RCFN provide a thorough curriculum map where content is mapped against individual competences but that is not replicated in the official curriculum, something which could change to further embed FOAMed into the learning cultures of the organisation:
Image3: Example of curriculum mapping on RCEMLearning
My interest in OERs pre-dates my current role but recent events have serendipitously linked longstanding educational and professional interests. These interests are informed by a commitment to dialogic principles which encourage an ongoing critique and contestation of knowledge. The FOAMed movement is a natural fit with the EM community but mechanisms need to be implemented to ensure learners receive appropriate recognition for engaging with them.