Medical education research: evidence, evaluation and experience

Extract from introduction:

The need for a firm evidence base for clinical practice is undisputed. Evidence of effectiveness, and of ineffectiveness or harm, necessarily informs decisions about patient care. The hierarchy of evidence is dominated by systematic reviews, meta-analyses and randomised controlled trials. Ideally, perhaps, such a rigorous approach should be brought to bear on innovations in the delivery of healthcare – the skill mix of the extended primary-care team, the balance between face-to-face and remote electronic consultations, the funding formulae to address problems of illness, deprivation, and inequality, for example. However, geographical and demographic heterogeneity frequently mean that the best solutions to delivery of care problems must be found locally, and sometimes urgently, rather than awaiting the results of large controlled trials, which may not be capable of providing generalisable results and frequently take so long to conduct that the answers are out of date by the time they have reported. Careful evaluation of local initiatives and new mechanisms to share and spread best practice may be more appropriate – the “middle ground“ research described by Guthrie and colleagues.