A Qualitative Study on the Benefits and Costs to Creators and Producers of Medical Open Educational Resources: Freely Given, but at What Cost?

Background The Free Open-Access Medical Education (FOAM) movement has produced a wealth of open educational resources (OERs) for asynchronous learning, bedside teaching, and journal clubs. Although these resources remain free to end-users, the burden of production and cost of maintenance has largely fallen on their producers. Much of this work is sustained through the unpaid and unfunded efforts of creators, contributors, and producers. Methodology This qualitative study was conducted within a constructivist and interpretivist paradigm, using semi-structured interviews. Website administrators from the top 25 Emergency Medicine FOAM platforms, identified via the Social Media Index, were invited to participate. One-on-one semi-structured interviews focused on motivations, challenges, and sustainability were recorded and transcribed verbatim. A diverse research team collaboratively coded transcripts through thematic analysis, refining a framework of themes and subthemes. Data collection concluded upon reaching thematic saturation. Results A total of 11 website administrators were interviewed, with interviews lasting between 14 and 48 minutes and generating 125 pages of transcripts. Thematic saturation was achieved with these participants. Participants (aged 35 to 63 years) described many benefits of their OER involvement, including enhancing their own learning, personal fulfillment, and career advancement. However, they also reported significant barriers to sustainability, such as financial costs, opportunity costs (e.g., reduced time for personal activities), and mounting pressure to consistently produce content. Conclusions The nomenclature FOAM does not equate to entirely free. The costs are shifted away from end-users, and while there are clear benefits to the model, the long-term sustainability of the movement is uncertain, particularly in the absence of sophisticated funding models. It is crucial to examine how we support this movement as a broader medical education community to determine how we might continue to foster a widely useful and democratizing approach to learning.