Abstract
There is a need to move from opinion-based education to evidence-based education. Best Evidence Medical Education (BEME) is the implementation, by teachers in their practice, of methods and approaches to education based on the best evidence available. It involves a professional judgement by the teacher about their teaching taking into account a number of factors — the QUESTS dimensions. The Quality of the research evidence available — how reliable is the evidence?, the Utility of the evidence — can the methods be transferred and adopted without modification?, the Extent of the evidence, theStrength of the evidence, the Target or outcomes measured — how valid is the evidence? and the Setting or context — how relevant is the evidence?
The evidence available can be graded on each of the six dimensions. In the ideal situation the evidence is high on all six dimensions, but this is rarely found. Usually the evidence may be good in some respects, but poor in others. The teacher has to balance the different dimensions and come to a decision on a course of action based on his or her professional judgement.
The QUESTS dimensions highlight a number of tensions with regard to the evidence in medical education:quality v relevance; quality v validity; and utility v the setting or context. The different dimensions reflect the nature of research and innovation. Best Evidence Medical Education encourages a culture or ethos in which decision making takes place in this context.
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References
Antil, L.R., Jenkins, J.R. & Wayre, S.K. (1998). Co-operative learning research: Prevalence, conceptualisations & the relation between research & practice. American Educational Research Journal 35(3): 419–454.
Anderson, M.D. & Swanson, A.G. (1993). Educating medical students – the ACME-TRI report with supplements. Academic Medicine 18: 284–297.
Aspegren, K. (1999). Teaching and learning communication skills in medicine: a review with quality grading of articles. Medical Teacher 21(6): 563–570.
Association of American Medical Colleges (1994). Physicians for the twenty-first century: Report of the project panel on the General Professional Education of the Physicians and College Preparation for Medicine. Journal of Medical Education 59(2).
Association of American Medical Colleges (1998). Report 1: Learning Objectives for Medical Student Education. Guidelines for Medical Schools. Washington: Medical School Objectives project, AAMC.
Bligh, J. & Parsell (1999). Research in medical education: finding its place. Medical Education 33: 162–164.
Boruch, R.F. (1997). Randomised Experiments for Planning and Evaluation: A Practical Guide. Thousands Oaks, CA: Sage Publications.
Brown, S. (1996). The role of research in mature education systems. Proceedings of the NFER International Jubilee Conference, Oakley Court, Windsor.
Campbell, J.K. & Johnson, C. (1999). Trend spotting: fashions in medical education. British Medical Journal 318: 1272–1275.
Chalmers, I., Sackett, D. & Silagy, C. (1997). The cochrane collaboration. In A. Maynard & I. Chalmers (eds.), Non-Random Reflections on Health Services Research, pp. 231–249. London: The British Medical Journal (BMJ) Publishing Group.
Collins, J.P. & Harden, R.M. (1998). AMEE Medical Education Guide No 13: real patients, simulated patients and simulators in clinical examinations. Medical Teacher 20(6): 508–521.
Davies, P. (1999). What is evidence-based education? British Journal of Educational Studies 47(2): 108–121.
Donmoyer, R. (1985). The rescue from relativism: two failed attempts and an alternative strategy. Educational Researcher 14(10): 13–20.
Ellis, S.J. & Matthews, C. (1999). What has gone wrong in stroke research? Postgraduate Medical Journal 75: 449–450.
Foster, P. & Hammersley, M. (1998). A review of reviews: structure and function in reviews of educational research. British Educational Research Journal 24(5): 609–628.
GeneralMedical Council (1993). Tomorrow's Doctors: Recommendations on Undergraduate Medial Education. London: General Medical Council.
Gibbs, G. (1995). Research into student learning. In B. Smith & S. Brown (eds.), Research, Teaching and Learning in Higher Education, pp. 19–29. London: Kogan Page.
Gonella, J.S., Hojat, M., Erdmann, J.B. & Veloski, J.J. (1994). The ultimate argument in medical education: the health outcome. Changing – Medical Education and Medical Practice. WHO/EDH/NL 94(2): 8–9.
Grant, A. (1999). Learning curves and health technologies the Sorcerer's apprentice. Summer p1.
Greenhalgh, T. (1997). How to Read a Paper: The Basis of Evidence-Based Medicine, p. 119. London: BMJ Publishing Group.
Guglielmi, R.S. & Tatrow, K. (1998). Occupational stress, burnout and health in teachers: A methodological and theoretical analysis. Review of Educational Research 68(1): 61–99.
Hammersley, M. (1997). Educational research and teaching: a response to David Hargreaves's TTA lecture. British Educational Research Journal 23: 141–161.
Harden, R.M. (1986). ASME Medical Education Research Booklet No. 2: Approaches to research in medical education. Medical Education 20: 522–531.
Harden, R.M. (1998). Medical teacher. Medical Teacher 20: 501–502.
Hargreaves, D.H. (1996). Teaching as a Research-Based Profession: Possibilities and Prospects. London: Teacher Training Agency Annual Lecture.
Hart, I.R. (1999). Best evidence medical education (editorial). Medical Teacher 21(5): 453–454.
Herbert, C.P. (1998). Creative approaches to patient education. Patient Education and Counselling 35: 81–82.
Kirkpatrick, D.I. (1967). Evaluation of training. In R. Craig & I. Mittel (eds.), Training and Development Handbook. New York: McGraw Hill.
Labaree, D.F. (1998). Educational researchers: Living with a lesser form of knowledge. Educational Researcher 27(8): 4–12.
Macqueen, D., Chignell, D.A., Dutton, G.J. & Garland, P.B. (1976). Biochemistry for medical students: A flexible student-oriented approach. Medical Education 10: 418–437.
Ness, A.R., Frankell, S.J., Gunnell, D.J. & Smith, G.D. (1999). Are we really dying for a tan? British Medical Journal 319: 114–116.
Oakley, A. (1999). An infrastructure for assessing social and educational interventions: the same or different? Background paper for meeting at the School of Public Policy, University College London, 15/16 July 1999.
Oswald, N. (1999). Research in medical education. Medical Education 33: 470.
Perkins, E.T., Simnett, I. & Wright, L. (eds.) (1999). Creative tensions in evidence-based practice. In Evidence-Based Health Promotion, pp. 7–11. New York: John Wiley & Sons.
Petersen, S. (1999). Time for evidence based medical education: tomorrow's doctors need informed educators not amateur tutors. British Medical Journal 318: 1223–1224.
Powis, I. (1998). An evidence-based admissions process at Newcastle (New South Wales) Medical School. Education for Health 11(3): 409–412.
Rank Xerox (1998). Bulletpoint, November: 1.
Reed, J. & Proctor, S. (eds.) (1995). Practitioner Research in Health Care: The Inside Story. London: Chapman & Hall.
Rethans, J.J.E. & van Boven, C.P.A. (1987). Simulated patients in general practice: A different look at the consultation. British Medical Journal 294: 809–812.
Sackett, D.L., Rosenberg, W.M.C., Gray, J.A.M., Haynes, R.B. & Richardson, W.S. (1996). Evidence-based medicine: What it is and what it isn't. British Medical Journal 312: 71–72.
Scottish Intercollegiate Guidelines Network (SIGN). Edinburgh 1998. www.show.scot.nhs.uk/ sign/home.htm
Sebba, J. (1999). Priority setting in preparing systematic reviews. Background paper for meeting at the School of Public Policy, University College London, 15/16 July 1999.
Squires, G. (1999). Teaching as a Professional Discipline. London: Falmer Press.
Tamblyn, R. (1999). Outcomes in medical education: What is the standard and outcome of care delivered by our graduates? Advances in Health Sciences Education 4: 9–25.
US Department of Health and Human Services, Agency for Health Care Policy and Research (1993). Acute Pain Management operative or medical procedures and trauma. Clinical Practice Guidelines No. 1. AHCPR Publication No. 92-0023: 107. Rockville (MD): The Agency.
Van der Vleuten, C. (1995). Evidence-based education. Advances in Physiology Education 14(1): S3.
Walton, H.J. (1993). Proceedings of the world summit on medical education. Medical Education 28 (supplement 1): 140–149.
Warnock, M. (1994). Imagination and Time. Oxford: Blackwells.
Welfare, M.R., Price, C.I.M., Han, S.W. & Barton, J.R. (1999). Experience of volunteer patients during undergraduate examination. Medical Education 33: 165–169.
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Harden, R., Grant, J., Buckley, G. et al. Best Evidence Medical Education. Adv Health Sci Educ Theory Pract 5, 71–90 (2000). https://doi.org/10.1023/A:1009896431203
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DOI: https://doi.org/10.1023/A:1009896431203