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Every dog has its day

Is evidenced-based education on the brink of achieving widespread acclaim?

A dog lying down next to a trophyEvidence-based medicine is now widely accepted as standard within medicine and the pharma industry. All healthcare professionals want to prescribe products that are evidence based and the pharma industry aspires to provide them with products that have a strong evidence base of their effectiveness.

Compared to evidence-based medicine however, evidence-based education is still in its infancy – we know a little about what types of education work most effectively, however there is still a long way to go. There is also a long way to go before we start to implement what we do know about evidence-based education. Like evidence-based medicine, we need to build the evidence base for various forms of medical education and then get this evidence into practice.

Effective interventions
Much research is going on at present within education generally and medical education specifically in terms of what educational interventions work most effectively. The past 20 years have seen the traditional classroom turned on its head with widespread recognition that certain forms of educational interventions work better than others.

For example we know that short sessions work better than long ones, that an audience that is interacting is learning more than one that is sitting passively, and that practical small group workshops are better for gaining new knowledge and skills than having 500 people in the audience doing nothing while the expert on the podium does all the work (and for those of you who have sat through too many interminable lectures then the above quote may have particular resonance).

Big groups in themselves are not so much the problem as big groups that are passive. Interactive voting technology can make an individual member of even the largest audience feel that they are participating, and testing and training their knowledge as the expert works through the talk. That much we know, however we also know that up to now pharma has had an arm's length relationship with most academic medical educationalists.

Most medical educational research is carried out on undergraduate and postgraduate trainees with relatively little research happening in continuing professional development (CPD) – the very area that is likely to have the most impact on clinical practice. But the past need not necessarily be the future – is it now time for pharma to look at what forms of education work best?

If the industry is to do this seriously, then it is not a small undertaking. To find out what works best will require research that will build on the knowledge we already have. And there are a lot of unanswered questions out there.

On trend
Blended learning is the buzz term of the moment, but how much exactly do we really know about it? According to Elliot Masie, an e-learning guru, blended learning is: "The use of two or more distinct methods of training. This may include combinations such as: blending classroom instruction with online instruction, blending online instruction with access to a coach or faculty member or blending simulations with structured courses." But what is the optimal blend of online and face to face? What should we use online for and what outcomes should we aim for in lectures?

A good blend involves using learning formats that are tailored to achieve the outcomes that you want. So it seems intuitive to gather knowledge via e-learning and practical skills in simulation, but what strong evidence is there to back this up, and how often do we ignore blended learning and try to teach practical skills via a manual? How often do we pay lip service to blended learning when we look at the resources that we have and stick them together to make a course and call that blended learning?

If more assessment is needed within medical education, then what forms of assessment do we need? Summative or formative assessment? Assessment by multiple choice questions or by open ended questions? The questions could go on and on and there is a real need for answers. Some may know the answers already, but this leads us to another problem within medical educational research: many pharmaceutical companies gather data on the popularity and effectiveness of various forms of educational interactions with healthcare professionals and yet most such data are held internally and not published – mainly because such information is felt to give competitive advantage to individual companies.

At present, pharma companies are not obliged to share this data in the same way that they would perhaps share patient safety data externally, but if we are to move the specialty of medical education forward then maybe now is the time to start sharing what we know. 

If trials of educational interventions are to be shared then there is no shortage of journals that could publish them. From Medical Education to Medical Teacher to Academic Medicine, such trials are bound to find a home. There is, of course, an imperative to keep CPD away from marketing, so that it can remain impartial and independent of those companies providing financial support. This new approach should not affect the underlying principle in any way.

Evidence-based learning is like evidence-based medicine in another form – the evidence itself is of purely academic interest unless you put the evidence into practice.

Interdisciplinary learning is a case in point. For a number of years now there has been a growing body of evidence of the effectiveness of interdisciplinary learning. Healthcare professionals work as a team and patients can benefit if they learn as a team.

And yet most educational meetings are still unidisciplined in nature – doctors go to meetings with other doctors at their particular royal college and the same is true for most other professional groups – despite evidence to suggest that this is not the optimal way of doing things.

For and against 
Some will no doubt disagree with the approach that aspires to evidence-based education and say that the message of education is what is important and that the medium matters not so much. Richard Smith, the former editor of the BMJ, suggested a club for those who did not believe in evidence-based medicine – called clinicians for the restoration of autonomous practice (CRAP). Perhaps a sister club could be set up for those who don't believe in evidence-based education – coaches for the restoration of autonomous pedagogy (CRAP 2). 

The forms of research into medical education that are needed will depend on exactly what questions need answering. Sometimes it will be hard research comparing different educational interventions and sometimes more qualitative, descriptive studies asking learners what they think of various interventions. The good news is that at a time when the morale of doctors is low and when pharma is facing its fair share of setbacks, medical education is still something that excites and stimulates a wide variety of stakeholders. Both teachers and learners are still enthusiastic about medical education and are usually willing to try new methods of teaching and learning and to put these to the test. 

The time is now ripe for the industry to analyse what forms of medical education are best. It needs to research  this area, publish the results and to apply the same rigour to this research and the analysis of it that it would to basic science or clinical research. Evidence-based medicine is now mainstream – now is the time for evidence-based education. Once we have more of a grip on what is effective in medical education, we can start to work out another thorny problem: what is the most cost-effective form of medical education?

The Author
Dr Kieran Walsh is editor of BMJ Learning – the medical education division of the BMJ Group

To comment on this article, email

19th March 2010


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