Journal of Intensive Care Medicine

1-14
The Top Ten Websites in Critical Care ª The Author(s) 2018
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Medicine Education Today DOI: 10.1177/0885066618759287
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Traci A. Wolbrink, MD, MPH1,2, Lucy Rubin, BA1,3,

Jeffrey P. Burns, MD, MPH1,2, and Barry Markovitz, MD4,5

Abstract
Introduction: The number of websites for the critical care provider is rapidly growing, including websites that are part of
the Free Open Access Med(ical ed)ucation (FOAM) movement. With this rapidly expanding number of websites, critical
appraisal is needed to identify quality websites. The last major review of critical care websites was published in 2011, and
thus a new review of the websites relevant to the critical care clinician is necessary. Methods: A new assessment tool for
evaluating critical care medicine education websites, the Critical Care Medical Education Website Quality Evaluation Tool
(CCMEWQET), was modified from existing tools. A PubMed and Startpage search from 2007 to 2017 was conducted to
identify websites relevant to critical care medicine education. These websites were scored based on the CCMEWQET.
Results: Ninety-seven websites relevant for critical care medicine education were identified and scored, and the top ten
websites were described in detail. Common types of resources available on these websites included blog posts, podcasts,
videos, online journal clubs, and interactive components such as quizzes. Almost one quarter of websites (n ¼ 22) classified
themselves as FOAM websites. The top ten websites most often included an editorial process, high-quality and appro-
priately attributed graphics and multimedia, scored much higher for comprehensiveness and ease of access, and included
opportunities for interactive learning. Conclusion: Many excellent online resources for critical care medicine education
currently exist, and the number is likely to continue to increase. Opportunities for improvement in many websites include more
active engagement of learners, upgrading navigation abilities, incorporating an editorial process, and providing appropriate
attribution for graphics and media.

Keywords
online learning, e-learning, web-based learning, websites, critical care medicine, intensive care medicine, pediatric critical care
medicine

Introduction
The amount of online educational resources for critical care
medicine (CCM) is rapidly expanding. This rapid growth has
been facilitated by the increasing ease with which individuals
can create, upload, and share resources online,1,2 which has
contributed to a rapid explosion in the number of websites
available on the Internet. Only 17 000 websites existed in
2000; currently there are over 1 billion.3 Another key driver
of this explosion in resources has been the FOAM movement,
conceived in 2012, which has inspired the development of at
least 275 blog sites in critical care and emergency medicine
alone.4 FOAM refers to Free Open Access Med(ical ed)uca-
tion, an extensive online community of resources for physi-
cians and trainees, often shared on social media, including
blogs, podcasts, videos, applications, and more.5 The last major
review of websites applicable to the critical care clinician was
published in 2011 by Kleinpell et al.6 Of the 135 websites
identified in this review, only 67 are still available online. This
1
Department of Anesthesiology, Critical Care and Pain Medicine, Boston
Children’s Hospital, Boston, MA, USA
2
Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
3
Tufts University School of Medicine, Boston, MA, USA
4
Department of Pediatrics, Children’s Hospital Los Angeles, University of
Southern California Keck School of Medicine, Los Angeles, CA, USA
5
Department of Anesthesiology Critical Care Medicine, Children’s Hospital
Los Angeles, University of Southern California Keck School of Medicine, Los
Angeles, CA, USA
Received December 22, 2017. Received revised January 20, 2018.
Accepted January 24, 2018.
Corresponding Author:
Traci A. Wolbrink, Department of Anesthesiology, Critical Care and Pain
Medicine, Boston Children’s Hospital, 300 Longwood Avenue, Bader 634,
Boston, MA 02115, USA.
Email: traci.wolbrink@childrens.harvard.edu
2 Journal of Intensive Care Medicine XX(X)
rapidly changing landscape suggests that a new review of avail-
able critical care educational resources is needed.
With this vast expansion in the number of available websites
for critical care medicine education, there is also an obvious
need to critically appraise these websites for accuracy and
quality.7 There are many evaluation tools for websites,8 includ-
ing several for medical education sites 9,10 and FOAM
blogs;11 however, no formal evaluation tool for assessing the
quality of critical care medicine education websites was iden-
tified. In this report, we describe the development of an evalua-
tion tool for critical care medicine education websites, provide
the results of a literature and web search designed to identify
critical care medicine education websites, and describe in detail
the top ten scoring websites for critical care medicine education
based on their performance in the evaluation tool.
Methods
The following steps were performed to identify and evaluate
the top ten websites in critical care medicine education:
1. Modification of a medical education website assess-
ment tool for use in the field of critical care medicine.
2. Literature review and web search to identify critical
care medicine education websites.
3. Evaluation and ranking of identified websites using the
modified tool.
Modification of a Medical Education Website
Assessment Tool
An objective tool was required to evaluate existing critical care
medicine websites. A literature search utilizing PubMed was
conducted using the following search terms: “medical educa-
tion website assessment,” “medical e-learning evaluation,”
“medical education quality,” and “critical care education web-
site evaluation.” The search yielded several website evaluation
tools but none specific for critical care medicine. Two website
evaluation tools were designed specifically for medical educa-
tion and seemed most closely aligned with the aim of this study.
The Medical Education Website Quality Evaluation Tool
(MEWQET) was developed and validated by Alyusuf et al for
the assessment of undergraduate medical education websites
in the field of pathology.10 This tool was subsequently mod-
ified and validated by Yang et al for the assessment of under-
graduate and graduate medical education websites in the field
of Otolaryngology as the Modified Education in Otolaryngol-
ogy Website (MEOW) assessment tool.9 Both tools assign a
score to websites based on authorship, credibility, aim/scope,
comprehensiveness, content quality/accuracy, currency of
information, site navigability, access, interactivity, and gra-
phic/media elements uaccuracy, and ease of access), a second
content expnmarked set by lucyrubin.
A modified assessment tool based on the MEWQET and
MEOW was constructed to be applicable to resident, fellow,
and/or faculty medical education websites in critical care
medicine, the Critical Care Medical Education Website Qual-
ity Evaluation Tool (CCMEWQET). Several experts in crit-
ical care medicine and medical education reviewed each of
the tools’ items, and items that were not applicable to critical
care medicine were either modified or discarded. We com-
pared the CCMEWQET criteria to those criteria utilized
when evaluating general medical or nonmedical web pages,
such as the Health on the Net Code of Conduct for medical and
health websites,12-14 and found them to be very similar in cri-
teria. Additionally, we compared these criteria to the established
metrics for evaluating blog quality to ensure that all metrics were
also incorporated in the tool, trying to ensure that the tool would
also be effective when evaluating FOAM websites.11
Literature Review and Web Search
To identify websites in critical care medicine education, a lit-
erature review and web search were conducted in collaboration
with the Boston Children’s Hospital library services (Figure 1).
We performed a PubMed search from 2007 to 2017 using the
following search terms: (“critical care” OR “intensive care”)
AND (“online resources,” “online education,” “online
learning,” “educational website(s),” “educational video(s),”
“video-based education,” “video-based learning,” “e-learning,”
“internet-based resources,” “internet-based education,”
“internet-based learning,” “web-based resources,” “web-
based education,” “web-based learning,” “web-based educa-
tional resources,” “podcast(s),” “vodcast(s),” “blog(s),”
“serious gaming,” “free open access medical education,” OR
“FOAMed”). Titles and abstracts of all resulting English lan-
guage articles were screened for relevance, which was defined
as relating to online critical care medicine education for phy-
sicians or physician trainees. Relevant articles were further
reviewed for website titles/URLS.
Additional websites were then identified using the Start-
page (www.startpage.com) search engine, which generates
Google results that are not influenced by geographic location
or user browser history. We performed a search using the
terms: (“education,” “learn,” “resource,” “FOAM”) AND
(“critical care,” “intensive care,” “ICU,” “CCM,” “pediatric
critical care,” “pediatric intensive care,” “PICU,” OR
“PCCM”). The resulting websites were screened by title and
description for relevance, again defined as relating to online
critical care medicine education for physicians and physician
trainees. Relevant websites were further reviewed for website
titles/URLs.
Websites that had educational materials relevant for physi-
cian providers in critical care medicine were free to access,
written in English, and functioning were included. Websites
that had less than 5 relevant posts,were solely medical calcu-
lators, YouTube channels, Googleþ communities or were
designed for emergency department–based critical care (not
applicable in an intensive care unit environment) were
excluded. Online journals were felt to be beyond the scope of
this article; however, websites of online journals were included
Wolbrink et al
Figure 1. The PubMed and Startpage search strategy used to identify websites for scoring with CCMEWQET. CCMEWQET indicates Critical
Care Medical Education Website Quality Evaluation Tool.
if they contained other types of educational materials (eg, pod-
casts) on their website. All websites were reviewed on a com-
puter and were not assessed for functionality in a tablet or
mobile environment.
Evaluation of Identified Websites/Tool Application
Two independent reviewers (T.W., L.R.) reviewed all websites
identified from the literature and online search, and scored
them based on the CCMEWQET. All scores were reviewed
for agreement, and any disagreement was discussed with both
reviewers until consensus was reached together. To provide
additional review of the 4 more subjective questions in the
CCMEWQET assessment tool (relevancy, comprehensive-
ness, accuracy, and ease of access), a second content expert
in critical care medicine (B.M.) was blinded to the scores
3
generated by the other 2 independent reviewers, and scored
each website in these 4 items. All scores were reviewed for
agreement and consensus was achieved. No reviewer reviewed
his or her own website.
Results
The CCMEWQET was developed (Table 1) and contains 30
items assessing 10 domains (authorship/credibility/disclosure,
aim/scope/audience, content quality, currency of information,
navigability/speed, access, interactivity, graphics/media, lay-
out/design, and hyperlinks) for a total possible score of 73.
Seventy-nine articles and 114 websites were identified
through the initial PubMed and Startpage search, and addi-
tional websites were identified from references and links from
these resources.15-25 After inclusion and exclusion criteria
4 Journal of Intensive Care Medicine XX(X)

Table 1. The Critical Care Medical Education Website Quality Evaluation Tool (CCMEWQET).

Category Criteria Weight

1. Authorship, credibility and 1.1 Disclosure of content author(s)?

disclosure A. Author(s)’ name(s), credentials, and contact information A¼3
B. Author(s)’ name(s) and credentials B¼2
C. Author(s)’ name(s) C¼1
D. No disclosure of authorship D¼0
1.2 If content author(s)’ credentials are given, author is (if multiple authors, the majority are):
A. Critical care physician A¼2
B. Other health-care professional/scientist B¼1
C. Other or no credentials listed C¼0
1.3 Disclosure of content author(s)’ institution?
A. Educational, nonprofit or governmental institution A¼3
B. Other or no disclosure of institution B¼0
1.4 Is the website domain educational, nonprofit, or governmental (ie .org, .edu, or .gov)? Yes ¼ 3 No¼ 0
1.5 Is there an editorial review process stated on the website? Yes ¼ 3 No ¼ 0
1.6 Is there a general disclosure, including a privacy policy? Yes ¼ 1 No ¼ 0
1.7 Are references provided? Yes ¼ 2 No ¼ 0
1.8 Is an e-mail or contact form provided for feedback to the webmaster? Yes ¼ 2 No ¼ 0
1.9 Is advertising distinct from content?
A. No external commercial advertisements A¼4
B. Yes B¼1
C. No C¼0
Subtotal /23
2. Aim, scope and audience 2.1 Is critical care medicine the intended subject scope?
A. Yes, exclusively critical care medicine A¼2
B. Yes, critical care medicine as part of another resource, that is, Emergency Medicine B¼1
C. No C¼0
2.2 Is the educational material relevant to residents, fellows, and/or faculty in critical care?
A. Highly relevant A¼5
B. Relevant B¼3
C. Minimally relevant C¼1
D. Not relevant D¼0
Subtotal /7
3. Content quality 3.1 Comprehensiveness: Does it cover critical care medicine education comprehensively?
A. Yes A¼7
B. No, but fairly comprehensive coverage of more than one specific area of interest B¼6
C. No, but fairly comprehensive coverage of one specific area of interest C¼4
D. No, even specific area(s) of interest is/are not covered comprehensively D¼1
3.2 Accuracy: Is the information accurate?
A. Accurate A¼6
B. Somewhat accurate B¼3
C. Inaccurate C¼0
3.3 Does the website have summary statements/take-home points? Yes ¼ 2 No ¼ 0
Subtotal /15
4. Currency of information 4.1 Is the date of content creation/revision disclosed? Yes ¼ 1 No ¼ 0
4.2 When was the website/content last updated?
A. <1 year ago A¼2
B. 1 year ago but <5 years ago B¼1
C. 5 years ago or not disclosed C¼0
Subtotal /3
5. Navigability and speed 5.1 Can necessary information be found easily from the main homepage of the site? Yes ¼ 1 No ¼0
5.2 Does the site include a usable search engine or table of contents? Yes ¼ 2 No ¼0
5.3 Does every page include a way to return to the homepage for the site? Yes ¼ 1 No ¼0
5.4 Was the website or server accessible in a timely manner? Yes ¼ 2 No ¼0
Subtotal /6
6. Access 6.1 Is the site accessible from the main search engines? Yes ¼ 1 No ¼0
6.2 How does access to the information through this website compare to other available sources?
A. Easier to find/use A¼2
B. About the same effort to find/use B¼1
C. More difficult to find/use C¼0
(continued)
Wolbrink et al 5

Table 1. (continued)

Category Criteria Weight

6.3 Is special hardware or software required to access some or all of the resources?
A. No A¼1
B. Some or all of the site require special hardware or software B¼0
Subtotal /4
7. Interactivity 7.1 Are there any interfaces requiring relevant action on the part of the learner (eg, quizzes,
self-assessments, interactive figures)?
A. Definitely A¼6
B. Somewhat B¼3
C. No C¼0
Subtotal /6
8. Graphics and media 8.1 Are graphic/media elements included to provide additional information to clarify existing
content?
A. Present, pertinent, high-quality, and with appropriate attribution A¼2
B. Present, pertinent, and with appropriate attribution B¼1
C. Not present, not pertinent, and/or not appropriately attributed C¼0
8.2 Are graphic/media elements well integrated into the website? Yes ¼ 1 No ¼0
Subtotal /3
9. Layout and design 9.1 Is the display of information clear and professional? Yes ¼ 1 No ¼0
9.2 Is the website user friendly and intuitive, with a logical layout? Yes ¼ 2 No ¼0
Subtotal /3
10. Hyperlinks 10.1 Are there any links to provide relevant additional information? Yes ¼ 2 No ¼0
10.2 If links are provided, are they active (90% of total links)? Yes ¼ 1 No ¼0
Subtotal /3
Total Score /73

were applied to the screened websites, 97 websites were
included and reviewed using the CCMEWQET. A list of the
included websites can be found in Table 2, along with the
website name, URL, description, and ranking by tertile. The
average score across all websites was 46. Nine (9%) web-
sites were from national or international societies, 22 (23%)
websites declared themselves as FOAM, and 64 (66%) web-
sites were associated with an educational institution. In
terms of the types of resources available, 35% featured blog
posts, 27% featured podcasts, 33% featured videos, 15%
featured online journal clubs, and 37% had interactive com-
ponents such as quizzes (Figure 2). Questions to test the
learner’s knowledge represented the majority of the interac-
tive components, with polls, medical calculators, and simu-
lators rounding out that category.
Compared to the rest of the critical care medicine educa-
tional websites, those that described themselves as FOAM
websites differed from the other critical care medicine web-
sites in several important ways (Table 3). The majority of
FOAM website domains were not educational, nonprofit, or
governmental (.edu/.org/.gov). The FOAM websites were
updated more recently than the other critical care medicine
educational websites. Finally, the access to information in
the FOAM websites was scored as more difficult to find/
use, included layouts that were scored as less logical or
intuitive, and contained fewer opportunities for interactivity.
When comparing the FOAM websites to the top 10
websites, the FOAM websites were far less likely to have
an explicit editorial process and provide appropriate attribu-
tion for graphics and multimedia.
The top 10 sites in critical care medicine differed from the
rest of the critical care medicine educational websites in several
important ways (Table 3). First, the majority provided details
about an editorial process for website content, included high-
quality and appropriately attributed graphics and multimedia,
and included a privacy policy. Additionally, these websites
scored much higher for comprehensiveness, universally pro-
vided disclosure of authors’ institutions as an educational, non-
profit, or governmental institution, and all were updated within
the last year. Finally, all of the top 10 sites scored higher for
ease of access including perception that the website was user-
friendly and intuitive. Each of the top 10 critical care medicine
educational websites is described in detail below (in alphabe-
tical order):
The American Thoracic Society (ATS) Critical Care web-
site (https://www.thoracic.org/professionals/clinical-
resources/critical-care/) contains peer-reviewed educational
materials for intensivists, developed by the ATS Critical Care
Assembly. Resources have integrated self-assessment ques-
tions and include clinical cases, video lectures, slide presenta-
tions, text-based tutorials, podcasts, and an online journal
club with recorded webinars. There are also links to external
free resources for ultrasound, echocardiography, and
procedures.
6 Journal of Intensive Care Medicine XX(X)

Table 2. The Website Name, URL, Description, and Overall Ranking by Tertile for Each Critical Care Medicine Education Website Reviewed
With the CCMEWQET.

Website URL Description

Top 10 websites, in alphabetical order

American Thoracic Society Critical https://www.thoracic.org/professionals/clinical- Clinical cases, online journal club, podcasts,
Care resources/critical-care/ text-based information, and links to external
resources. Website of the American
Thoracic Society
Critical Care Project http://ccproject.com/ Videos, text-based information, and clinical
cases with questions. Associated with the
University of Maryland, Tulane University,
the University of Pennsylvania, and the
National Institutes of Health
Intensive Blog http://intensiveblog.com/ FOAM website with clinical cases, online
journal club, and text-based information
with videos, graphics, and self-assessment
questions. Associated with The Alfred
Hospital in Australia
LearnPICU http://www.learnpicu.com/home Text-based information with associated
literature summaries and self-assessment
questions. Associated with Stanford
University
Medscape Critical Care https://emedicine.medscape.com/critical_care Text-based summaries of topics with graphics
and videos, interactive CME activities, and
updates on news and research in the field
Merck Manual Critical Care Medicine http://www.merckmanuals.com/professional/ Text-based information with figures, videos,
critical-care-medicine and quizzes
OPENPediatrics https://www.openpediatrics.org/ Videos, self-paced courses, interactive
simulators, congenital heart lesion library,
medical calculators, and medical animation
and illustration gallery. Associated with
Boston Children’s Hospital
PedsCCM.org http://pedsccm.org/ Online journal club, updates on news and
research, and links to external resources
SurgicalCriticalCare.net http://www.surgicalcriticalcare.net/ Collection of text-based PDFs, videos, and
medical calculators for surgical critical care.
Associated with Orlando Regional Medical
Center
WikEM https://wikem.org/wiki/Category:Critical_Care Text-based information and reference tables
for emergency medicine, with a specific
category for critical care
Remainder of upper tertile, in alphabetical order
CHEST http://www.chestnet.org/ Free educational resources include links for
trainees, videos, a blog, and an interactive
section from the journal, including podcasts
and clinical cases. Website of the American
College of Chest Physicians
Deranged Physiology http://www.derangedphysiology.com/main/ Collection of notes, short answer questions,
and slide presentations to provide study
support for the College of Intensive Care
Medicine (CICM) of Australia and New
Zealand Part 2 examination
EMCases https://emergencymedicinecases.com/ FOAM blog and podcast, with associated text-
and video-based summaries, and a section
with critical care cases
EMCrit https://emcrit.org/ FOAM blog and podcast for emergency
medicine and critical care with associated
PulmCrit blog for pulmonary and critical
care medicine
(continued)
Wolbrink et al
Table 2. (continued)
Website
European Society of Intensive Care
Medicine
Heart-lung.org
ICM Case Summaries
ICU Delirium
ICU Primary Prep
Intensive Care Medicine Working
Knowledge
Interpretation of the ICU chest
radiograph from the University of
Virginia
PICUDoctor Cardiac Guide
PulmCCM
Rational Evidence Based Evaluation of
Literature in Emergency Medicine
(REBEL EM)
Scottish Intensive Care Society
Society for Neuroscience in
Anesthesiology and Critical Care
(SNACC)
Society of Critical Care Medicine
Surviving Sepsis Campaign
The Alliance
The Bottom Line
The New England Journal of Medicine
(NEJM) Critical Care Medicine
URL
https://www.esicm.org/
http://www.heart-lung.org/home.html
https://icmcasesummaries.com/
http://www.icudelirium.org/
https://icuprimaryprep.com/
http://icmwk.com/
https://www.med-ed.virginia.edu/courses/rad/
chest/index.html
http://www.picudoctor.org/PICU/
https://pulmccm.org/
http://rebelem.com/category/clinical/critical-care/
http://www.scottishintensivecare.org.uk/
http://www.snacc.org/
http://www.sccm.org/Pages/default.aspx
http://www.survivingsepsis.org/Pages/default.aspx
https://organdonationalliance.org/
http://www.thebottomline.org.uk/
http://www.nejm.org/page/critical-care-medicine
7
Description
Free educational resources include past
webinars, an online journal club, and a blog.
Website of the European Society of
Intensive Care Medicine
Videos, podcasts, links to the author’s writings,
and learning modules relating to
cardiopulmonary interaction in the ICU
Collection of cases with evidence-based
summaries written by intensive care
medicine trainees from the United Kingdom
Resources for delirium prevention and safety,
including downloadable tools, slide
presentations, and videos. Associated with
Vanderbilt University Medical Center
Collection of notes and short answer
questions to provide study support for the
College of Intensive Care Medicine (CICM)
of Australia and New Zealand primary
examination
FOAM website with a collection of posts and
links to resources and key papers
Tutorial for chest film interpretation in an ICU
setting with multiple-choice questions
throughout. Associated with the University
of Virginia
Document containing text-based information
and figures for pediatric cardiac critical care
Online journal club, blog, and quizzes
Critical appraisals of research as podcasts and
text-based information, and a collection of
review charts, with a category specifically
for critical care
Learning modules with text and assessment
questions covering core ICU topics, as well
as links to resources for trainees and slide
presentations. Website of the Scottish
Intensive Care Society
Quizzes, interactive case presentations, and
audio and video interviews with experts.
Website of the Society for Neuroscience in
Anesthesiology and Critical Care
Free educational materials include iCritical
Care podcasts and LearnICU with
collections of resources categorized by
topic. Website of the Society of Critical
Care Medicine
Videos, slide presentations, and links to
podcasts relating to sepsis
Collection of resources on organ donation
topics, including articles, slide presentations,
one-page educational documents, and a blog
FOAM website with critical appraisals of
literature and a blog
Case-based scenarios for discussion with
associated review articles. Additional free
educational materials for pulmonary and
critical care medicine include interactive
cases and clinical images
(continued)
8 Journal of Intensive Care Medicine XX(X)
Table 2. (continued)
Website
Wiki Journal Club
World Federation of Pediatric Intensive http://www.wfpiccs.org/
and Critical Care Societies
Middle tertile, in alphabetical order
Acid-Base Physiology from
AnesthesiaMCQ
BestBETs
Broome Docs
Crit Cloud
Critical Care and Emergency Medicine https://www.usa.philips.com/healthcare/
Ultrasound Education from Philips
Critical Care Consortium Milwaukee
Critical Care Northampton
Critical Care Nutrition
Critical Care Practitioner
Critical care professional education
from Edwards Lifesciences
Critical Care Reviews
Critical USG
Echocardiography in the ICU from
Stanford University
EM Daily
Emergency and intensive care
ultrasound from AcidBase.org
ICU Web
Intensive Care Network
URL
https://www.wikijournalclub.org/wiki/
WikiJournalClub:Usable_articles#Critical_Care
http://www.anaesthesiamcq.com/AcidBaseBook/ Text-based information for acid-base
ABindex.php
http://bestbets.org/database/browse-by-
topic.php?CategoryID¼248
http://broomedocs.com/category/critical-care-icu/ FOAM blog and podcast for rural doctors,
https://www.crit.cloud/
education-resources/education-training/
ultrasound-education-critical-care-emergency-
medicine
http://www.cccmke.org/
https://criticalcarenorthampton.com/
https://www.criticalcarenutrition.com/
http://www.jonathandownham.com/
http://www.edwards.com/gb/education/ecce
http://www.criticalcarereviews.com/
http://www.criticalusg.pl/en/home
https://web.stanford.edu/group/ccm_echocardio/ Text and imaging-based content on point-of-
cgi-bin/mediawiki/index.php/
Echocardiography_in_ICU:About
http://emdaily.cooperhealth.org/topics/critical- Blog and podcast for emergency medicine,
care
http://www.acidbase.org/echo/index.php
http://www.aic.cuhk.edu.hk/web8/index.htm
https://intensivecarenetwork.com/
Description
Online journal club with text-based summaries
of clinical trials, with a specific category for
critical care
Video library and collection of slide
presentations and PDFs. Website of the
World Federation of Pediatric Intensive and
Critical Care Societies
physiology
Literature reviews for topics in emergency
medicine, with a specific category for critical
care
with a specific category for critical care
FOAM website with an online journal club,
slide presentations, and a blog
Text-based information with graphics and
imaging for ultrasound in critical care and
emergency medicine
FOAM website with videos, a blog, and slide
presentations
FOAM blog with podcasts, literature
summaries, slide presentations, videos,
medical calculators, an ICU drug formulary,
and links to external resources
Research group for improving nutrition in the
critically ill, with slide presentations, PDFs,
tools, and information about current
research
Blog, podcast, and text-based information
eLearning modules for Edwards critical care
products, a guidebook for cardiopulmonary
care, interactive learning games, and past
webinars. Requires registration
Videos of presentations from the annual
meeting, podcasts, and links to noteworthy
articles and external resources
Text and imaging-based tutorials covering
ultrasound topics relating to anesthesiology
and critical care. Associated with the Polish
Society of Anesthesiology and Intensive
Care
care echocardiography for intensivists and
emergency physicians. Associated with
Stanford University
with a specific category for critical care.
Associated with Cooper University Hospital
Text-based information and slide
presentations covering various ultrasound
topics in emergency and intensive care
Text-based information, slide presentations,
and an image library. Associated with the
Chinese University of Hong Kong
FOAM website with a podcast, blog, and
clinical and imaging cases
(continued)
Wolbrink et al
Table 2. (continued)
Website
International Respiratory and Severe
Illness Center (INTERSECT)
Life in the Fast Lane Critical Care
Compendium
Online ICU guidebook from the
University of Illinois at Chicago
OpenAnesthesia
PBL Curriculum for Critical Care
Trainees
Pediatric EM Morsels
PICU lectures from the University of
Texas Health Science Center
PICU resources from the University of https://www.med.unc.edu/cmep/education/
North Carolina School of Medicine
PICUPedia
Resources for health professionals from http://www.lhsc.on.ca/Health_Professionals/
the critical care trauma centre at the
London Health Sciences Centre
Resus Review
Video Library from the University of
Wisconsin School of Medicine and
Public Health
Vinnie’s ICU
Western Sono
Lower tertile, in alphabetical order
#ICURounds
AcidBase.org
Clinical education from Medtronic
Crashing Patient
URL
http://depts.washington.edu/intrsect/
https://lifeinthefastlane.com/ccc/
http://chicago.medicine.uic.edu/wp-content/
uploads/sites/6/2017/09/icuguidebook.pdf
https://www.openanesthesia.org/subspecialty/
critical-care-and-perioperative-medicine/
https://sunnybrook.ca/education/content/
?page¼critical-care-pbl-elearning
http://pedemmorsels.com/category/critical-care/
http://www.pediatrics.uthscsa.edu/CriticalCare/
lectures.asp
current-residents/rotation-information/
pediatric-intensive-care-unit
http://picupedia.net/
CCTC/
https://resusreview.com/
http://videos.med.wisc.edu/categories/31
https://icuvinnies.wordpress.com/
https://westernsono.ca/
https://icurounds65.wordpress.com/
http://www.acidbase.org/
http://www.covidien.com/pace/clinical-education
http://crashingpatient.com/
9
Description
Videos and links to external resources on
respiratory diseases and severe illness.
Associated with the University of
Washington
FOAM blog with a collection of posts
specifically for critical care
Document covering core topics in the ICU,
with text-based summaries, algorithms, and
links to external resources. Associated with
the University of Illinois at Chicago
Podcasts and links to key articles organized
into a curriculum for critical care and
perioperative medicine
Series of modules presenting patient cases
with self-assessment questions. Associated
with Sunnybrook Health Sciences Centre
and the University of Toronto
FOAM blog with text-based summaries of
pediatric emergency medicine topics, with a
specific category for critical care
Slide presentations covering topics in pediatric
critical care medicine. Associated with the
University of Texas Health Science Center
Downloadable handbook, slide presentations,
and links to key articles and procedural
videos. Associated with the University of
North Carolina
Collections of links to educational materials,
journal articles, and text-based information
on topics in pediatric critical care medicine
Text-based information, quizzes, e-learning
modules, drug monographs, and links to
external resources. Associated with the
London Health Sciences Centre
FOAM website with text-based information,
original graphics, and podcasts for topics in
cardiology, critical care, and emergency
medicine
Videos of presentations given at educational
events, with a category for emergency
medicine and critical care. Associated with
the University of Wisconsin
FOAM blog with text, videos, imaging, and an
online journal club
FOAM website with a blog, videos, and
tutorials for point-of-care ultrasound in
emergency medicine and critical care.
Associated with the University of Western
Ontario
Blog with text, questions, and cases
Module for analyzing a patient’s acid-base data
and links to acid-base and intensive care
resources
Tutorials with text, graphics, and quizzes on
topics in intensive care and pediatric
intensive care. Requires registration
Blog with text-based information on topics in
emergency medicine and critical care
(continued)
10 Journal of Intensive Care Medicine XX(X)

Table 2. (continued)

Website URL Description

Critical Care Perspectives in Emergency http://www.ccpem.com/ Podcast with discussions about critical care
Medicine and emergency medicine
Critical Insight https://criticalinsight.wordpress.com/ Blog and online journal club
Essential Critical Care http://www.essentialcriticalcare.com/ Blog with links to external podcasts
Expensive Care https://expensivecare.com/ Blog for end-of-life issues relating to critical
care
Free Emergency Medicine Talks http://www.freeemergencytalks.net/tag/critical- FOAM podcast for emergency medicine, with
care/ a specific tag for critical care
ICU Rounds http://burndoc.libsyn.com/ Podcast on critical care topics encountered in
the Burn ICU
Intensive Care Online Network http://www.intensivecareonline.com/ Past webinars on topics in critical care, device
(ICON) tutorials, and literature reviews. Requires
registration
Intensive Care Society Podcast http://icspodcast.libsyn.com/ Podcasts of educational events and interviews
International Sepsis Forum http://internationalsepsisforum.com Videos from the 2014 annual meeting
MICU lectures from the University of http://www.fammed.wisc.edu/category/media/ Video series covering medical ICU topics.
Wisconsin Department of Family micu/ Associated with the University of Wisconsin
Medicine
Mini lecture series from the University http://www.ccmpitt.com/minilecs/index.html Video lecture series. Associated with the
of Pittsburgh Critical Care Medicine University of Pittsburg
Notes from Dr RW http://doctorrw.blogspot.co.uk/search/label/ Blog for hospitalist medicine, with a specific
critical%20care category for critical care
Oxford Deanery Intensive Care https://oxicmblog.wordpress.com/about/ Blog and a link to the main site, which includes
Medicine an online journal club
Peds/PICU tools http://www.mverive.com/MedApps/ Tools for use in the PICU, including
PedsPicuTools/ calculators, guidelines, charts, and graphics
PICUInfo http://www.picuinfo.net/ Collection of links to resources, including
guidelines, websites, journal articles, medical
calculators, and videos
Prehospital and Retrieval Medicine https://prehospitalmed.com/category/intensive- Blog and podcast for prehospital and retrieval
(PHARM) care/ medicine, with a specific category for
intensive care
Propofology https://www.propofology.com/ FOAM website with graphic tutorials and a
podcast for anesthesia, critical care, and pain
medicine
Resus.Me http://resus.me/category/intensive-care/ Blog for resuscitation medicine education,
with a specific category for ICU
Resuscitationist’s Awesome Guide to http://ragepodcast.com/ FOAM podcast with videos and interviews
Everything (RAGE) covering topics in critical care
ScanCrit http://www.scancrit.com/ FOAM blog for anesthesia, intensive care, and
emergency medicine
Sheffield Teaching Hospitals Journal https://sthjournalclub.wordpress.com/ Blog with summaries and critiques of
Club anesthesia and critical care journal articles,
as well as slide presentations. Associated
with Sheffield Teaching Hospitals in the
United Kingdom
Social Media and Critical Care https://www.smacc.net.au/ FOAM website with videos, podcasts, and
(SMACC) summaries of the talks given at their
conferences
St. Emlyn’s http://stemlynsblog.org/category/emergency- FOAM blog and online journal club for
medicine/resus-crit-care/ emergency medicine, with a specific
category for resus and critical care
Sunderland ICCU Medical Education http://www.iccueducation.org.uk/ Blog with posts about topics in critical care and
links to external resources
The Resus Room http://theresusroom.co.uk/ Podcast and links to relevant papers for
resuscitation medicine, with a tag for critical
care
(continued)
Wolbrink et al
Table 2. (continued)
Website URL
Thinking Critical Care https://thinkingcriticalcare.com/
Vent World http://www.ventworld.com/index.asp
Wellington Intensive Care Unit http://www.wellingtonicu.com/
Wessex Intensive Care Society http://www.wessexics.com/
Abbreviations: FOAM, Free Open Access Med(ical ed)ucation; ICM, intensive care medicine; ICU, intensive care unit.
Figure 2. Percentages of the types of resources available on the CCM
education websites.
The Critical Care Project (CCP; http://ccproject.com/) is an
educational initiative associated with 4 institutions that share
their internal critical care education materials online. The
Maryland CCP features video lectures with text summaries and
clinical cases with questions. The Tulane CCP also features
video lectures with summaries, as well as monthly collections
of top critical care articles. The Penn CCP focuses on resusci-
tation, with clinical cases, text, and questions. The National
Institutes of Health CCP features video lectures.
Intensive Blog (http://intensiveblog.com/) is a FOAM-
affiliated website associated with The Alfred Hospital Inten-
sive Care Unit in Australia. The site contains peer-reviewed
educational materials for intensive care medicine physicians
and trainees, including clinical scenarios with imaging stud-
ies and self-assessment questions, critical appraisals of lit-
erature, and dedicated sections for echocardiography,
ultrasound, and extracorporeal membrane oxygenation.
They additionally post simulation scenarios and link to
many relevant resources.
LearnPICU () is a website associated with Stanford Uni-
versity Pediatric Critical Care. It features succinct
11
Description
FOAM blog
Case studies, links to articles, tools, and
medical calculators related to mechanical
ventilation
Study aids, examination notes, and links to
external resources. Associated with
Wellington Regional Hospital in New
Zealand
Blog with text-based summaries of talks.
Website of the Wessex Intensive Care
Society
summaries of essential topics in pediatric critical care
medicine. The text-based summaries contain graphics,
references, literature summaries, and self-study questions
with answers. The site also contains links to key articles
and quick references for medication dosing and equipment.
Medscape Critical Care (https://emedicine.medscape.com/
critical_care) contains a robust collection of critical care med-
icine education resources, written and reviewed by experts. The
eMedicine page features text-based information on pertinent
topics, with embedded videos, graphics, and tables. There are
also interactive continuing medical education activities with
videos and assessment questions, as well as articles relating
to news and literature in the field.
Merck Manual’s Critical Care Medicine page (http://
www.merckmanuals.com/professional/critical-care-medicine)
is part of the online version of the well-known reference book.
Text-based information is available by topic and also includes
relevant graphics, videos, and hyperlinked words that lead to
more information. The site maintains a transparent editorial
review and revision process.
OPENPediatrics (www.openpediatrics.org) is an open-
access learning platform associated with Boston Children’s
Hospital. The website features a library of over 500 peer-
reviewed educational videos on various critical care and
pediatrics topics, authored by experts and edited with text and
high-quality animations. Mechanical ventilation, hemodialysis,
and peritoneal dialysis simulators allow learners to interact
with those technologies and master important skills in a safe
environment. Guided learning pathways allow learners to learn
at their own pace, with pre-and post-including clinical scenar-
ios with imaging studiesand self-assessment questions, critical
appraisals test multiple-choice questions. The site also includes
medical calculators and summary documents/protocols for
reference.
PedsCCM.org (www.pedsccm.org) is a website associated
with the Laura P. and Leland K. Whittier Virtual Pediatric
Intensive Care Unit. It serves as a comprehensive hub for
pediatric critical care medicine professionals, with links to
vetted clinical resources and organizations, as well as updates
on news and research in the field. The website hosts an online
12 Journal of Intensive Care Medicine XX(X)

Table 3. Average Scores for Each Domain for the Websites and Subgroups.

Top 10 FOAM
All Top 10 Top Middle Lower Websites FOAM Websites
Websites Websites Tertile Tertile Tertile Excluded Websites Excluded
Criteria (n ¼ 97) (n ¼ 10) (n ¼ 33) (n ¼ 31) (n ¼ 33) (n ¼ 87) (n ¼ 22) (n ¼ 75)

Content author disclosure 1.90 2.2 2.00 1.90 1.79 1.86 2.00 1.86
Author specialty 1.26 1.8 1.45 1.23 1.09 1.20 1.66 1.24
Content author institution disclosure 1.98 3 2.18 1.85 1.36 1.86 1.91 2.00
Is website domain educational, nonprofit, or 1.21 1.5 2.00 1.26 0.36 1.17 0.55 1.36
governmental
Editorial review process 0.53 2.4 1.36 0.10 0.09 0.31 0.41 0.56
General disclosure and privacy policy 0.38 0.7 0.64 0.39 0.12 0.34 0.27 0.41
References provided 1.52 2 1.82 1.48 1.25 1.47 1.17 1.49
E-mail or contact form 1.59 1.8 1.88 1.68 1.21 1.56 1.91 1.49
Advertising 3.05 3.7 3.52 1.51 2.52 2.98 3.18 3.01
Critical care medicine as intended subject scope 1.37 1.3 1.42 1.29 1.39 1.38 1.36 1.40
Material relevant to residents, fellows and/or 4.24 5 4.76 4.16 3.79 4.15 4.09 4.31
faculty in critical care
Comprehensiveness 3.32 5.9 4.94 3.52 1.52 3.02 2.95 3.45
Accuracy 5.63 6 6.00 5.61 5.27 5.59 5.05 5.80
Summary statements 0.85 0.8 0.79 0.84 0.91 0.85 1.00 0.80
Date of content creation/revision disclosed 0.84 0.9 0.85 0.77 0.88 0.83 0.91 0.81
When was the website/content last updated 1.40 2 1.73 1.10 1.36 1.33 1.73 1.31
Information found easily from homepage 0.79 1 1.00 0.87 0.52 0.77 0.82 0.80
Usable search engine or table of contents 1.75 2 2.00 1.68 1.58 1.72 2.00 1.71
Way to return to the homepage 0.79 0.9 0.82 0.74 0.82 0.78 0.73 0.80
Accessible in a timely manner 1.90 2 2.00 1.87 1.82 1.89 1.91 1.89
Accessible from main search engines 0.98 1 1.00 0.97 0.97 0.98 1.00 0.97
Access to information 0.80 1.6 1.21 0.84 0.36 0.71 0.50 0.91
Special hardware or software required 0.95 1 1.00 0.94 0.91 0.94 1.00 0.93
Interactive elements 1.61 3.6 2.73 1.16 0.91 1.38 1.09 1.72
Graphic/media elements present and 0.40 1.2 0.79 0.42 0.00 0.31 0.45 0.39
appropriately attributed
Graphic/media elements well integrated 0.71 0.9 0.85 0.81 0.48 0.69 0.91 0.67
Display of information clear and professional 0.84 1 0.97 0.87 0.67 0.82 0.73 0.87
User-friendly, intuitive, and logical 1.26 2 1.88 1.35 0.55 1.17 1.00 1.33
Links present 1.67 2 1.82 1.81 1.39 1.63 1.82 1.63
Links active 0.72 1 0.91 0.68 0.58 0.69 0.91 0.68
Total 46.20 62.2 56.30 45.87 36.39 44.36 45.23 46.55
Abbreviation: FOAM, Free Open Access Med(ical ed)ucation.

Evidence-Based Journal Club, containing nearly 1000 peer-
reviewed reviews of pertinent clinical trials.
SurgicalCriticalCare.net (http://www.surgicalcriticalcare.
net/index.php) is a website associated with the Surgical Critical
Care and Acute Care Surgery Fellowship programs at Orlando
Regional Medical Center. The most thorough aspect of the
website is their evidence-based medicine guidelines, which are
a collection of downloadable PDFs containing recommenda-
tions, an overview and literature review on pertinent topics.
The documents are all referenced, with clear disclosure of
authorship, editorial review, and revision date. The website
also contains medical calculators and videos.
WikEM (https://wikem.org/wiki/Category:Critical_Care),
also known as The Global Emergency Medicine Wiki, is an
emergency medicine education resource with a specific cate-
gory for critical care. The website contains pages organized by
topic, with text and hyperlinks for more information, as well as
weight-based reference tables for vital signs, medication dos-
ing, and equipment size for critical care. The information is
well-referenced with clear authorship and a review process.
Discussion
In this report, we reviewed 97 websites aimed at providing
education for the critical care clinician, and describe in detail
the top 10 websites currently available in critical care medicine
education. The top 10 websites represent websites that overall
adhere to the best practices in medical education website devel-
opment as outlined by critical appraisal tools, including the
Health on the Net Code of Conduct.12 The top 10 websites
more often included an editorial process, high-quality and
appropriately attributed graphics and multimedia, and scored
much higher for comprehensiveness and ease of access. Almost
all of the top 10 websites include interactivity, whereas only
Wolbrink et al
one-third of the total websites include robust interactive experi-
ences for the learner to learn and apply their knowledge. Only 1
FOAM website was included in the list of the top 10 websites.
This review differs from the most recent review from Klein-
pell et al in 2 important ways. First, the majority of the websites
that existed in 2011 and were still available to be reviewed
were general medicine websites with some resources on critical
care or were non-Additionally, many FOAM sites maintaina-
critical care subspecialty websites with material that could also
be applicable to the critical care clinician, such as interpreting
radiology images or techniques for suturing. However, as many
more websites designed specifically to provide educational
resources for critical care medicine education exist now than
did in 2011, the majority of websites reviewed in this review
were targeted specifically for critical care clinicians. Second,
the FOAM movement did not exist in 2011, and nearly one
quarter of the websites in this review were classified as FOAM
websites.
The FOAM movement has changed the landscape of med-
ical education, allowing anyone to access, share, and contribute
to resources online. It affords all learners the equal opportunity
to benefit from educational materials and supports the need for
asynchronous learning in an age of increasing time demands on
physicians and trainees. Additionally, many FOAM sites main-
tain a post-publication peer review process, either formally or
informally, by allowing resources to be accessed by learners
and reviewed simultaneously.5 Our review highlights some
important ways that FOAM websites differ compared to other
critical care medicine websites, especially the top 10 websites,
and offers some opportunity for potentially increasing the cred-
ibility of these websites including developing formal editorial
processes, providing appropriate attribution for graphics and
media, and improving navigability.
Several limitations exist in our review. First, we did not
conduct a formal validation study of the CCMEWQET. Given
that this tool was based on 2 similar medical education tools
that had been formally validated, and included all of the major
topics contained in most website evaluation tools, we felt that
this modified tool should be able to discriminate the quality of
CCM websites. However, despite ensuring that we included the
established criteria for evaluating blogs, we still observed that
most FOAM sites scored lower than traditional websites on the
CCMEWQET. Thus, perhaps our tool was not as well-suited
for evaluating FOAM websites, and we may need to consider
utilizing a more specialized FOAM evaluation tool for FOAM
websites. The second limitation is there are likely websites that
contain content applicable for the critical care clinician that
have been missed in our website search. This is in part due to
the fact that many educational websites still exist behind hos-
pital firewalls and are thus inaccessible. However, by searching
all of the articles and websites identified in our PubMed and
Startpage search for additional websites through links, we
believe we identified the key websites in critical care medicine
education, especially as we repeatedly identified many web-
sites that were linked from multiple websites. Finally, it would
have been impossible to look at every resource on every
13
website, and thus, we may have missed some features. We
attempted to review at least 1 resource in each of the sections
on each website to try to limit this problem as much as possible.
Conclusion
There are many excellent resources for critical care medicine
education that exist at present and are only likely to continue to
grow in number. This review should serve as a reference for
residents, fellows, and attendings/consultants in critical care
medicine seeking high-quality critical care websites to supple-
ment their education. To maximize the awareness of these
resources among clinicians, we advocate a broad sharing of the
table of critical care websites and encourage critical care web-
sites to link to this article. Increasing the capability for inter-
activity, promoting easier navigation, incorporating an editorial
process, and providing appropriate attribution for graphics and
media are opportunities for improvement for many websites.
Authors’ Note
OPENPediatrics is a not-for-profit entity in collaboration with the
World Federation of Pediatric Intensive and Critical Care Societies.
PedsCCM.org is a non-profit website for Pediatric Critical Care Med-
icine, supported in part by The Virtual PICU (vpicu.org) and Anesthe-
siology Critical Care Medicine at Children’s Hospital Los Angeles.
Acknowledgments
The authors thank Meaghan Muir, MLIS, manager of library services
at Boston Children’s Hospital for her help with developing the liter-
ature and web search strategy, and Ms. Mollie Grunat and Ms. Eleanor
Keller for their help with proofreading the manuscript.
Declaration of Conflicting Interests
The author(s) declared the following potential conflicts of interest
with respect to the research, authorship, and/or publication of this
article: All of the authors are affiliated with websites that were eval-
uated in the paper. T.W., L.R., and J.B. are affiliated with OPEN-
Pediatrics, and B.M. is affiliated with PedsCCM.org. No author
reviewed his/her own paper.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article
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