FOAM authorship: Who's teaching our learners?

Background: Free open-access medical education (FOAM) is extremely popular among learners and educators despite lacking the traditional peer review process. Despite the potential for inaccurate, low-quality, or biased content, little has been published describing FOAM authors. Methods: We performed a cross-sectional analysis of 12 months of content from the top 25 blogs in the 2020 Social Media Index from August 2020-2021. We recorded the number of posts per site and descriptive characteristics of authors, including gender affiliation, conflicts of interest (COI) statements, and type of practice (academic, community, or hybrid). Results: We identified 2141 posts by 1001 authors. More than half were produced by six websites: EM Docs (266), Life in the Fast Lane (232), EMCrit (188), ALiEM (185), Don't Forget the Bubbles (181), and Rebel EM (174). Most content (1680 posts, 78.5%) lacked a COI statement. Authors were mostly academic (89%), mostly held MD degrees (67.4%), and were mostly men (59.7%). Geographically, most FOAM authors reside in the United States (59.5%), Canada (22.42%), or the United Kingdom (9.4%). Conclusions: Of all the posts in the top 25 sites in 2020, more than half came from six sites, and authors were largely North American men in academics with MD degrees. Learners, content creators, and educators should consider the ways in which a more diverse authorship pool might bring value to the FOAM educational experience.