EDITOR—We are not surprised by the conclusions drawn by Wyatt et al that educational visits added little to the uptake of evidence into practice.1 We question whether randomised controlled trials can be applied to studies evaluating education, which may use qualitative as well as quantitative methods.

A controlled trial may not be the appropriate tool to reflect changes of interventions in childbirth over time. It is not possible to isolate clinicians to one educational intervention (in this case an educational visit). Practice may also change as a result of experience as well as more formal learning such as reading journals and continuing medical education. Even if a change in practice had been shown by this study, a more qualitative approach would be required to determine if the change was due to the intervention being investigated.

The practice of evidence based medicine is the integration of individual expertise with the best available external clinical evidence from systematic research.2 Research, whether primary or review, needs to be appraised critically. Only four interventions from the …