The rebel, the professor, and the entrepreneur: Qualitative study to explore creator stories of FOAM.

Introduction: The free open access medical education (#FOAMed, or FOAM) movement creates educational content intended to inform medical education and clinical practice and is distributed in an unrestricted fashion (e.g., open access website). The who, what, and in particular the how of FOAM has raised important questions about the sustainability of the movement.

Methods: We recruited a diverse research team that included educational researchers, FOAM contributors, a business academician, and medical trainees to design and conduct a qualitative study exploring the work of FOAM creators. We analyzed the transcripts of interviews with 11 participants from top FOAM websites in emergency medicine and critical care. The team met frequently to iteratively identify and discuss emergent themes (major and minor) until saturation of concepts was achieved.

Results: Creators of FOAM could be categorized using three archetypes: the rebel, the professor, and the entrepreneur. The rebel was categorized as distinctly rejecting "traditional academic structures" yet was compelled to deliver educational content via alternative routes. The professor retained a traditional academic role, instead creating FOAM to supplement academic activities (teaching courses, disseminating scholarship, promotion). Entrepreneurs focused on creating a sustainable entity in an effort to supplement their income and reduce clinical obligations.

Conclusion: While all FOAM creators appear unified in their passion to create, promote, and distribute educational material with unfettered access to educators, their motivations for creating content could be differentiated. Given the grassroots nature of FOAM, creators share concerns related to financing, time commitments, and threats to sustainability of these businesses. The longevity of FOAM and what business models are best suited to support them are uncertain. Further exploration of the implications could investigate the best ways to engage with and support the different FOAM creator archetypes and develop models of sustainability.