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

Professor Greenhalgh and her colleagues clearly
illustrate the difficulties encountered when attempting
to apply the techniques of evidence-based medicine to
complex problems in medical education. However, the
study presented also clearly illustrates that there are
some broad principles that can be generalised in order
to help identify and synthesise evidence. At the risk of
over simplifying the "system" for the "systematic" review
may require amendment but the shift from selective
narrative to systematic review still brings benefit. If
nothing else the easy claims of success resulting from
a variety of educational innovations are made to look
less certain and thus educational decision makers may
be reminded of the need to pay more attention to the
detailed implementation of change in a specific context.

But why limit this lesson to educational developments?
We have argued elsewhere (1) (although far less
eloquently) that the same complexities arise in relation
to many health care questions, particularly those
relating to questions of complex service delivery. For us
the challenge was managing the transition from child to
adult services (2 ) but the problems - imprecise
terminology for searching the literature, lack of good
quality research and multiple qualitative questions -
were remarkably similar.

Greenhalgh's suggested sequence for evidence-based
educational development could equally be applied to
many health care developments. We would however
suggest a change in emphasis for the latter stages of
the sequence. Rigorous in-depth primary research may
not always be viable but client focussed evaluation,
assessing issues identified in the review of the
evidence, is simple good practice (quality assurance).
In this way development can be informed by the best
available evidence but not necessarily stymied by the
need to devote considerable resources to further
research, one of the oft overlooked potential benefits of
evidence-based practice.

1. Forbes A, Griffiths P. Methodological strategies for
the identification and synthesis of 'evidence' to support
decision-making in relation to complex healthcare
systems and practices. Nursing Inquiry
2002;9(3):141-155.

2. Forbes A, While A, Ullman R, Lewis S, Mathes L,
Griffiths P. A multi method review to identify
components of practice which may promote continuity
in the transition from child to adult care for young
people with chronic illness or disability. London:
National Co-ordinating Centre for NHS Service Delivery
and Organisation Research, 2001.

Competing interests:  
None declared