Approaches to evidence-based teaching

It is timely that such a distinguished group as the Association for Medical Education in Europe should be holding a major international conference on `A Critical Appraisal of Medical Education’ , given the broad and growing interest throughout the world in evidence-based medicine (EBM), evidence-based health care (EBHC) and evidencebased policy and practice (EBPP). A recent meeting in London, England brought together educationalists, health care researchers and social scientists from the United States and Europe to discuss the development of an international collaboration on systematic reviews of the effects of social and educational interventions (Davies et al., 1999). One consequence of that meeting was the formation of the Campbell Collaboration, which will establish an electronic database of systematic reviews of the effects of social and education interventions, in a similar way to the high quality reviews of health care interventions that are provided by the Cochrane Collaboration. There are also initiatives in the United Kingdom, and in other countries, to establish centres of evidencebased policy and practice in education, and to improve the accessibility to teachers, students and educational policy makers of the best evidence of teaching and learning effectiveness. A critical approach to medical education is not new. Even a cursory search of databases such as MEDLINE and ERIC, or a casual perusal of journals such as Medical Education,Medical Teacher and Academic Medicine, indicates at least two decades of debate about the most effective ways of teaching medica l underg raduates, and of organising the professional development of doctors and other health care personnel. Some of this literature reports on controlled evaluations of different teaching methods and curricula arrangements. Other papers and articles in this literature report on less controlled trials, or on descriptive studies, or are more theoretical discussions of the principles, objectives and methods of medical education. Medical and other health care education inevitably involves teaching and learning by adults. Consequently, it is important that it uses teaching methods that are appropriate for adult learners, that understand the learning needs of adults, and that are based on the best empirical evidence of the most effective ways of teaching adults. This paper will review some of the main principles of adult learning, will present some of the ways in which these principles have been put into practice in medical and health care education, and will consider the available evidence on the effectiveness of different teaching methods and curricula arrangements in medical education. Principles of adult learning