Viewpoint: Evidence-Guided Education: Patients??? Outcome Data Should Influence Our Teaching Priorities

Abstract

How should medical educators choose learning objectives and teaching content in clinical education? Given the informa- tion chain reaction, coverage of all signif- icant topics in sufficient depth is not pos- sible. Choosing subjects of high priority is essential if education is to have maxi- mum impact on quality of care. These priorities should not derive from tradition and opinion, but should be informed by patient outcomes, the ultimate standard for assessing educational effectiveness. Building upon prior initiatives linking ed- ucation to practice, the author uses the term "evidence-guided education" to express the process of influencing curric- ular choices with evidence from health outcomes. Sources of outcome evidence include incident reports, morbidity and mortality conferences, surveillance of quality of care in particular venues, case series, sur- veys of adverse events and "near- misses," and malpractice claims. Starting with anecdotal occurrences, additional case-finding may establish patterns of poor outcomes, some of which may be preventable. Credible research data on outcomes can inform prioritization for objectives and content at successive insti- tutional levels, which should improve practices and outcomes, completing the loop of feedback, implementation, and improved health. The closer the educa- tional intervention is to practice, the more accountable it becomes. Thus, EGE is more amenable to evaluation at resi- dents' and practitioners' levels and more difficult at the undergraduate level. How- ever, outcome evidence should still in- form undergraduate teaching, since this constitutes the platform for future learn- ing. Severe constraints on learning time mandate prioritization of content and suggest the need for the judicious appli- cation of outcome evidence in place of mere opinion. Acad Med. 2005; 80:147-151. How do medical educators decide what topics to teach? We think we know what should be taught, but these judgments usually derive from tradition and opin- ion. Students often complain that their instructors fail to teach "what we really need to know." The information chain reaction leaves no doubt that choices of content need to be made, but what should be the basis for setting the goals and content for clinically relevant teach- ing? The evidence from patient out- comes, rather than tradition and opinion, should be the ultimate standard for as- sessing educational effectiveness; such evidence can serve as a lens for focusing on areas of educational weakness. In this article, I describe an approach for select- ing teaching priorities that has been de- veloped from prior initiatives and my own experiences with research and implementation. Background