Evidence-Based Education

Many people are not aware that as a physician, I make hundred of evidence-based decisions during my workday.  The practice of medicine is founded on treating patients in a manner consistent with what has been proven to work. The aim of evidence-based medicine is simple: “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (Sackett, 1996).” There are entire databases and electronic medical record support systems of information dedicated to helping physicians sort through an unbelievable amount of data as they make decisions in real-time. My patient has health-care associated pneumonia with a penicillin allergy? I am a few clicks away – using Up To Date online – from information about the latest evidence on treatment of this condition, with modifications and options for treating my particular patient. If I want to research more in-depth about a medical condition I see frequently, I can go to the Cochrane database and find a systematic review of the available evidence. I can also find and read any number of meta-analyses (studies which aggregate data and findings from multiple smaller studies) on the topic.

Medicine is able to accomplish this because we receive funding for research – to test theories in the lab, or enroll patients in clinical trials. The gold standard for internal medicine is the independently funded (not by the pharmaceutical company) double-blinded (no one who is treating the patient knows what they are receiving), placebo-controlled (some folks receive the drug, others receive an inert pill), randomized controlled trial (patient are assigned randomly to each treatment.) A large, well-designed trial such as this can change the practice of medicine within the course of a year after being published. For instance, when I was a medical student, we routinely placed women on estrogen after they had a heart attack, because the best available evidence at the time showed that we should do this to improve their heart health. After I finished residency, a large trial was published showing that not only were we not preventing heart attacks with estrogen therapy, but that we were potentially causing harm. Over the course of the next few years, the practice of medicine changed, and nowadays essentially no one would start estrogen on a woman after she’s had a heart attack.

However, this data was years in the making. It takes several years -sometimes ten or more – to design, get funding for, administer, synthesize, and disseminate information from a clinical trial. The wait is usually worth it, because we then have good, evidenced-based data on what to do as physicians in treating our patients. New technologies are generally adapted only after they have been proven to work, this protecting the patients from potential harm. If a patient has a time-sensitive condition – such as an aggressive cancer – they are able to be enrolled in clinical trials as new medicines become available.

With the above in mind, it has frustrated me ever since my children entered the school system that education is not more progressive and evidence-based. My child is highly gifted with dyscalculia? I initially spent my time looking for a database of studies, the systematic review with the computer-based decision support to guide her teacher on how to teach her most effectively. What I found were websites and expert opinion articles, but very little evidence-based data. What about the new iPad apps that seem to come out every week to help kids learn math? Should I use the Dragon Box app to teach her algebraic concepts – and algebra? And if I can use it to learn algebra in 42 minutes, why isn’t our school testing and using it right now?

As I searched, I did uncover information regarding evidence-based education. The Best Evidence Encyclopedia  and The Center for Evidence-Based Education have some great information on available evidence, but many of the listed materials on both websites have not been updated in a year or more.  The Ted talks are a great way to disseminate information about current educational practices, but the short talks make it difficult to assess the evidence; the TedEd website shows definite promise in sharing lessons. Dr. Ben Goldacre wrote the a more recent article in March of 2013 entitled “Building Evidence into Education”, and he points out the “need for a coherent ‘information architecture’ that supports evidence based practice.”

My realization over the last few years – driving part of the decision to homeschool our kids – is that education will never be as evidence-based as medicine for my children. I’m not willing, as a parent, to wait while my child sits as part of a study, possibly getting the intervention or not, while she gets older every year. In ten years she’ll be long gone from K-12 education, and while enrolling her in a study would be paying it forward to other students with her condition, it won’t help her now, while she grows and struggles and learns. Plus, there would be countless more iPad apps, technologies, and teaching innovations while the study was underway, so any study would potentially be out-of-date even before it was published.

I do hope that education is able to move in the direction of medicine, with an easily accessible infrastructure that can be utilized from any classroom or household by anyone educating a child. Not so many years ago, colleagues of mine were convincing others in medicine to embrace evidence-based care, and now we can’t imaging practicing any other way. I will watch from a distance as these developments move through education, but in the meantime, I’ve got children to teach.

Advertisements

5 responses to this post.

  1. Agree with you in hopes for more advancement in evidence based data, but not convinced the health care world is in any better shape. Both have their flaws. :-/

    Reply

    • I hit post before I wrote a THANK YOU for those great best evidence links! 🙂

      Reply

      • Posted by Kathy on July 29, 2013 at 6:58 am

        Glad you liked the links! Definitely agree that health care has major flaws in this area. However, in health care, the information is readily available, but not enough physicians and nurses are using the data to make decisions. Luckily, I work for a medical group that is committed to evidence-based practice, with the information available, so this helps. I would like to see education move in the direction of acquiring and organizing the data. Getting everyone to use the evidence to make decisions is another challenge… 🙂

      • Agreed….not a big fan of willy nilly decision making when it comes to our futures!

  2. Posted by C Riley on July 30, 2013 at 7:19 am

    The Common Core will put an end to teaching to the individual student. In homeschool, we can void it for awhile.

    Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: