This is a response to the excellent discussion on LITFL around Chris Nickson’s post questioning whether it is “Time for a FOAM Charter?” Technicalities prevented me from submitting directly to the conversation (too wordy?), so have done below. Please do not respond to this post. If you would like to jump in on the convo, go to the original post here.
1) This is a great initiative. Thanks, Chris, for putting it out there. But to answer some of the questions raised we need to decide what the charter is trying to accomplish. A charter/code of honor can serve to strengthen the scientific quality of published content. It can also increase users’ faith in FOAM by maintaining a certain minimum professionalism and ethical standard. Furthermore, as stated, it would be great for community building and branding. My feeling is that the role of a charter, etc would not be scientific critique per se. That should be left to the community. After all, the beauty of FOAM is that it provides writers and consumers with unfettered access to an enormous range of educational materials. It is up to the end user to read these materials with a critical eye and assess how reliable a certain source is. This task, however, is impossible without some basic assumptions. And this is where the charter comes in. It should be a set of values that all participants (writers and consumers alike) adhere to. In this way, any user who sees the FOAM logo would know that the author is providing their materials in good faith, free of COI, and that the content is as accurate as possible. I like the wording as outlined above, with 3 changes (see below).
2) Enforcement – On the one hand, I completely agree with Minh in that a committee would be the best way to ensure standards and to provide a degree of content review. That said, I think we should avoid the idea of pre-publication review. This is what we are trying to get away from. FOAM contributors should be able to publish their materials free from unseen biases. Also, as one commenter wrote, these groups tend to be selected, not elected, and users and contributors may lose faith by questioning selection by whom, for how long, and what specifically is the group’s role, etc. Creates a non-inclusive atmosphere. On balance, would avoid a group/committee. But now we’re left with enforcing standards; who gets to remove the logo from sites that violate the charter, and how? I think it’s best left to one or two people from the largest EM/CC websites (LITFL, ALiEM, etc) who would serve as moderators for the larger FOAM community and who would take action after public discussion, perhaps on a dedicated website that would also link to all the sites that carry the FOAM logo. Would emphasize that the role of the charter/code is not content review or any kind of content control or editorial control, only an assurance of ethical and professional standards, as this concern could turn off some users.
3) Privacy – Patient privacy is obviously of critical importance to this entire venture and must be emphasized. It is easy to see how, in the US at least, hospitals may be quick to ban/block certain resources if they believed they exposed the institution to any kind of legal risk. So, would add to the privacy item wording that would indicate that privacy standards differ from country to country and that users must review their own local regulations before using any patient images.
4) COI – As noted by others, FOAM should strive to be free of conflict of interest. Sites with any kind of pharmaceutical or medical device connection should not be able to display the FOAM logo. Alternatively, if people felt strongly about it, perhaps there would be a (very) different logo for sites that otherwise met all other criteria – as long as it is clear to users that the materials are, by definition, biased. Would also expect writers to disclose any connections (even non-financial) to materials they are discussing. For instance, if discussing a study in which they were involved (again, even if not financially) this information should be clearly disclosed.
5) References – All writing should be referenced, when available, to allow for further reading and critical appraisal by users.
6) I like Scott’s suggestion of a logo that links to the charter. Clean and simple. Ideally this would be hosted on an independent site dedicated to the charter which would also link to all sites that carry the logo, host conversations of users’ concerns over non-adherence, and also host a universal disclaimer to be used by FOAM contributors. This way every new writer would not have to reinvent the wheel and would be able to link to it. To critics of disclaimers I would suggest that it can’t hurt to have these in place. The plain truth is that FOAM has yet to be tested in court. Hopefully it never will, but given our current practice environment it is very possible that somebody will try to claim that the FOAM charter or the writers are liable for something. Now, I don’t know that disclaimers even work, but they at least provide a backing if they are worded to indicate that materials are for educational purposes only, need to be verified, are not aimed to treat any specific patient, and that some subjects are controversial and will not represent the local standard of care, etc etc etc…
7) Agree with Creative Commons theme/attribution