Overcoming barriers to high quality evidence in health care education: Re(e)-forming the randomised educational trial

Abstract

1. Presentation Title Overcoming barriers to high quality evidence in health care education: Re(e)-forming the randomised educational trial 2. Level of presenting experience Experienced presenter 3. Introduction/background Health care education has been described as an 'evidence free zone' and educators often face criticism from clinicians that the levels of evidence on which we base our educational practice would never 'pass muster' for health care interventions. The gold standard for evidence of effectiveness in health care practice is the randomised clinical trial but randomised trials in educational practice are very rare indeed. We suggest that this relates to the identification of supposed barriers to the use of randomisation, resulting from failure, on the part of educators and students, to identify circumstances in which 'educational equipoise' exists. Often, this is the result of 'premature adjudication' about the likely outcome of the trial. Similar 'barriers' are often suggested in clinical settings when time-honoured treatments are proposed as the subject of randomised trials - the classical example being the sham-surgery placebo-controlled study of arthroscopy for osteoarthritis of the knee by Moseley and colleagues. In this instance a procedure in which the majority of a clinical specialty 'believed', and in support of which there was copious (but low-quality) 'evidence', was ultimately shown to be useless only when the barriers to a randomised trial were overcome by diligent investigators. A range of ethical arguments also bear on the conduct of randomised trials but critics tend to focus only on the ethical barriers to conducting trials rather than the ethical imperative to ensure that resources and learners' effort are not wasted on educational interventions that are ineffective. These barriers have recently been overcome a Griffith University School of Medicine, with the commencement of two-year a randomised trial of an intensive learning methodology for senior students in the MBBS. The experience of the investigators in initiating this trial will inform the discussion. 4. Purpose/objectives To explore delegates experience of the ethical and practical barriers to instigating randomised educational trials in healthcare settings. To develop a network of practitioners interested in conducting randomised educational trials in healthcare settings. 5. Issues/questions for exploration or ideas for discussion What are the ethical arguments for and against the conduct of randomised trials in healthcare education? What are the practical barriers to be overcome to initiate randomised educational trials? Is it all worth the trouble?