Transferability of principles of evidence based medicine to improve educational quality: systematic review and case study of an online course in primary health care

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Abstract
The success of evidence based medicine has led to pressure to make medical education more evidence based. Greenhalgh and colleagues tested the transferability of these principles when developing a postgraduate course Evidence based medicine advocates a structured and systematic approach to clinical decision making using a five point sequence (box 1). The same principles, linked to audit and performance review, have been used extensively in policy making 1 2 and quality improvement initiatives 3 4 in health care. They have also been advocated as an approach to improving the quality of education in general,5 and medical education in particular, 6 7 though others have strongly rejected such approaches.8 We explored the extent to which the five stage evidence based medicine sequence can be applied to developing and implementing quality standards in online education. #### Summary points It is widely believed that the education of health professionals should be more evidence based Good randomised controlled trials in education (especially postgraduate education) are hard to find A systematic review of evidence on online education found only one relevant randomised controlled trial Independent qualitative analysis of students' and staff experience on our online course was invaluable when testing the validity and transferability of published research evidence and quality standards Evidence in education should include not only formal, research derived knowledge but also tacit knowledge (informal knowledge, practical wisdom, and shared representations of practice) ### Box 1 : Sequence of evidence based medicine Frame a focused question Search thoroughly for research derived evidence Appraise the evidence for its validity and relevance Seek and incorporate the user's values and preferences Evaluate effectiveness through planned review against agreed success criteria As the developers of an online degree course for health professionals, we aimed to: