Evidence–informed teaching

An effective teacher, as highlighted in the previous chapter, requires a set of technical competencies, a basic understanding of educational principles and a passion for teaching, but that is not the end of the matter. There is something else to consider. There is a need for the teacher to openly accept that there may be different and possibly more effective methods of teaching than those they are currently employing. They should not assume that the methods by which they have been taught or those they are currently using are the best.

Doctors are encouraged, as far as possible, to make decisions about the diagnosis and management of their patients on the basis of the evidence of what works and what does not work. This is the key principle of the evidence-based medicine (EBM) movement in health care. Evidence-based education – or probably more appropriate, evidence-informed education – has a similar objective. Teachers should make conscientious explicit and judicious use of evidence as to what works and does not work in their teaching practice. This involves teachers integrating their individual expertise as a teacher with the best available external evidence. Teachers need to question whether a new approach advocated will prove better or worse than the traditional approach which it would be replacing. The concept of evidence-based decision-making was one of the three fundamental principles incorporated in the Carnegie ‘Teachers for a New Era’ initiative in the USA.

A ‘PHOG’ approach

Decisions in medical education in the past have been made on what might be called a ‘PHOG’ approach, with decisions based on the prejudices of the teacher, hunches of what works best, personal opinion and guesses as to the most suitable approach.

Sixteen years ago, Cees van der Vleuten at Maastricht highlighted a paradox in medical education. ‘I noticed that my new colleagues – clinical and biomedical researchers – had the same academic values as I did, which reassured me

Fig 4.1 The PHOG approach to teaching decisions.

and made me feel comfortable. However I quickly noticed something peculiar; the academic attitudes of the researchers seemed to change when educational issues were discussed. Critical appraisal and scientific scrutiny were suddenly replaced by personal experiences and beliefs and sometimes by traditional values and dogmas.’

Today the need for evidence-informed teaching has been widely accepted, even if it has not been fully implemented in practice. A recent curriculum document from Maastricht, for example, describes the new Maastricht curriculum as an ‘evidence-based curriculum’.

What is evidence?

What counts as evidence is a difficult question. Relevant evidence may come from professional experience and professional judgement as well as from formal experimental or quasi-experimental research studies. Evidence to inform your decisions as a teacher can come from a variety of sources: