Evidence Informed Education

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Evidence Informed Education

• Dr Marilyn Hammick
• September 08 2006

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Biog

• Consultant to Best Evidence Medical Education
  (BEME)
• Research Evaluation Consultant, HEA Health
  Sciences Practice
• Research into effectiveness of interprofessional
  education
• Chair, Centre for the Advancement of
  Interprofessional Education
• International consultancy
• Sharing evidence about effectiveness
• Effective for patients, clients, families, and
  communities
• Improving services, the organisation of practice,
  staff work settings

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Evidence based practice

• Preparing, maintaining and promoting the
  accessibility of systematic reviews of the
  effects of health care interventions

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Evidence based practice

• Without question, doctors have been much better
  than teachers than advancing their professional
  effectiveness by combining research with practice
  in the interests of knowledge production
• Hargreaves 2000

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Does educational research matter?

• ask difficult questions
• demand evidence, rather than anecdote for answers
• generate, through our research, new knowledge
• Mortimore 2000
• British Educational Research Association

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Editorials Time for evidence based medical
education Tomorrow's doctors need informed
educators not amateur tutors Stewart Petersen,
Professor of medical education.  Faculty of
Medicine and Biological Sciences, University of
Leicester , 1999
John Bligh and M Brownell AndersonEditorial
Medical teachers and evidenceMedical Education
(2000) 34, 162-163
Philip DaviesApproaches to evidence-based
teachingMedical Teacher (2000) 22, 1, pp
14-21 Fredric M Wolf Lessons to be learned from
Evidence-based Medicine practice and promise of
Evidence-based Medicine and Evidence-based
EducationMedical Teacher (2000) 22, 3 pp
251-259 C P M van der Vleuten et al The need
for evidence in educationMedical Teacher (2000)
22, 3, pp 246-250
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and more

• Fredric M Wolf, Judy Shea, Mark AlbaneseTowards
  Setting a Research Agenda for Systematic Reviews
  of Evidence of the Effects of Medical
  EducationTeaching and Learning in Medicine
  (2001) 13(1) 53-60
• Hilliard Jason Editorial The Importance - and
  Limits - of Best Evidence Medical
  EducationEducation for Health Change in
  Learning Practice (2000) 13, 1, pp 9-14

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the students response

• I doubt informed consent could be granted in the
  setting of medical education, which may raise
  ethical concerns.
• medical education may experiment with a number of
  concurrent variables, making it difficult to
  dissect the contributions each has played in
  determining outcome.
• that trials will bypass the bench top and in
  vitro phases and blindly move straight onto the
  guinea pigs.
• J S Dawson 3rd Year Medical Student, Leicester
  University

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the clinicians response

• Not clearly acknowledged, however, are the limits
  of EBM. An intrinsic gap exists between clinical
  research and clinical practice.
• Despite its promise, EBM currently fails to
  provide an adequate account of optimal medical
  practice.
• A broader understanding of medical knowledge and
  reason is necessary.
• Michael M. Daly, Director, Palliative Care
  Service, Columbia, USA

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• No more than 20 of medical practices have been
  adequately evaluated
• Eddy 1994
• Use of individual expertise and best available
  evidence
• Sackett et al 1996

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• What are we to do when the irresistible force of
  the need to offer clinical advice meets with the
  immovable object of flawed evidence?
• All we can do is our best give the advice, but
  alert the advisees to the flaws in the evidence
  on which it is based.

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• What are we to do when the irresistible force of
  the need to offer advice meets with the
  immovable object of flawed evidence?
• All we can do is our best give the advice, but
  alert the advisees to the flaws in the evidence
  on which it is based.

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Global village

• It has been long known
• It is believed
• It is generally believed
• Typical results are shown
• It is hoped that this study will stimulate
  further study in this area

• I didnt look up the original reference
• I think
• Two other people also think so
• This is the prettiest graph
• I quit

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Global village

• It has been long known
• It is believed
• It is generally believed
• Typical results are shown
• It is hoped that this study will stimulate
  further study in this area

• I didnt look up the original reference
• I think
• Two other people also think so
• This is the prettiest graph
• I quit

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Levels of evidence

• York hierarchy
• Experimental studies (RCT with concealed
  randomisation)
• Quasi-experimental
• Controlled observational studies (cohort/case
  control)
• Observational studies
• Expert opinion

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more specifically

• Evidence based education
• Public care services health and well being
• Professional practitioners/the workforce

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Evidence informed education

• International Campbell Collaboration
• National EPPI-Centre
• Professional BEME

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• Best Evidence Medical Education
• www.bemecollaboration.org
• Mission
• to encourage and facilitate the implementation,
  by teachers and educational bodies in the health
  sciences field, of methods and approaches to
  education based on the best evidence available

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• Dissemination of information
• Appropriate systematic reviews of education
  policy and practice
• Culture of best evidence medical education

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BEME Systematic Review

• systematic up-to-date summary of evidence
• issues in classroom and clinical education
• practical decisions

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Taking a BEME approach to educational decisions
in the health sciences means -

• Comprehensively critically appraising the
  literature that already exists
• Categorizing the power of the evidence available

• Identify the gaps and flaws in the existing
  literature
• Suggest and carry out appropriately planned
  studies to optimize the evidence necessary to
  make the proposed educational intervention truly
  evidence based

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Discussion R(D)SVS Review Topic

• Assessment
• veterinary education
• clinical and professional
• day one competencies
• final year