Intended for healthcare professionals

Learning In Practice

Transferability of principles of evidence based medicine to improve educational quality: systematic review and case study of an online course in primary health care

BMJ 2003; 326 doi: (Published 18 January 2003) Cite this as: BMJ 2003;326:142
  1. Trisha Greenhalgh (, professor of primary health carea,
  2. Peter Toon, senior clinical lecturera,
  3. Jill Russell, non-clinical lecturera,
  4. Geoff Wong, clinical lecturera,
  5. Liz Plumb, educational researcherb,
  6. Fraser Macfarlane, lecturer in health care managementc
  1. a Department of Primary Care and Population Sciences, University College London Medical School, London N19 5LW
  2. b Marketing Research and Evaluation Unit, University College London, London WC1
  3. c School of Management, University of Surrey, Guildford Surrey GU2 7XH
  1. Correspondence to: T Greenhalgh

    The success of evidence based medicine has led to pressure to make medical education more evidence based. Greenhalgh and colleagues tested the transferability of these principles when developing a postgraduate course

    Evidence based medicine advocates a structured and systematic approach to clinical decision making using a five point sequence (box 1). The same principles, linked to audit and performance review, have been used extensively in policy making 1 2 and quality improvement initiatives 3 4 in health care. They have also been advocated as an approach to improving the quality of education in general,5 and medical education in particular, 6 7 though others have strongly rejected such approaches.8 We explored the extent to which the five stage evidence based medicine sequence can be applied to developing and implementing quality standards in online education.

    Summary points

    It is widely believed that the education of health professionals should be more evidence based

    Good randomised controlled trials in education (especially postgraduate education) are hard to find

    A systematic review of evidence on online education found only one relevant randomised controlled trial

    Independent qualitative analysis of students' and staff experience on our online course was invaluable when testing the validity and transferability of published research evidence and quality standards

    Evidence in education should include not only formal, research derived knowledge but also tacit knowledge (informal knowledge, practical wisdom, and shared representations of practice)

    Box 1 : Sequence of evidence based medicine

    Frame a focused question

    Search thoroughly for research derived evidence

    Appraise the evidence for its validity and relevance

    Seek and incorporate the user's values and preferences

    Evaluate effectiveness through planned review against agreed success criteria


    As the developers of an online degree course for health professionals, we aimed to:

    • Evaluate the use of an evidence based medicine framework in an educational development setting

    • Develop robust quality standards for the delivery of …

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