It is fashionable in education at present for teacher to beat ourselves up for not using ‘enough’ evidence in our practice. When we get bored of that, its then fashionable to beat up educational researchers for not creating ‘usable-enough’ research. And when we get bored of that it’s really really fashionable to say that the government needs to start using research properly without saying at all where the government should get it from or why, once they had it, teachers might pay any attention it anyway.
The reason we (teachers) like to do this is because we think that medicine works this way. Apparently there is a Body of Knowledge from which all doctors draw The Truth and that is how they heal people. It teaching just had The Truth, then everything would be dandy.
But, sad to say, it isn’t like that in medicine. Not really.
First, there is often lengthy debate about what should happen when a certain set of symptoms present themselves, or when a particular institutional issue keeps rearing its head (e.g. bed-blocking or MRSA infections). And then, even if a solution is agreed on in the research, it simply isn’t true that doctors and nurses keep engaged with this latest research and instantly implement it into practice. Some might, but many don’t.
An interesting-if-lengthy paper on this very matter is called “The Nonspread of Inventions” and looks at just this matter. Often the inventions that stick are not merely a matter of evidence but of a series of circumstances coming together in the right way. Sometimes it is a strong ethos, it matches a government policy, it suits someone wanting a promotion, etc. but rarely does it come just down to the evidence.
Unfortunately that leaves us with a rather depressing conclusion that most research doesn’t make much difference, even if correct. Its implementation will ultimately be down to a series of factors that contribute as much to luck as they do to effort – though one must always stay alive to the possibility that we can get better at making those factors come about now that we know what they are. Furthermore, the upside is that it means that we teachers can stop beating ourselves up – if even the doctors can’t solve this then what chance do we have?! – and, to their great relief, I’m pretty certain we can leave the academy and the politicians alone on this particular point too.
2 thoughts on “Medics Don’t Always Use Research Well Either”
Many policy makers and gurus try and justify policy with phrases like ‘research says’ when there is actually little viable evidence to speak of? Even if evidence isn’t driving practice in medicine surely it is something we should aspire to anyway because an objective search for what works seems preferable to what we have now – an education system that singularly fails to challenge and even rewards the ignorant or morally bankrupt.
You’re spot on with this, there’s been a sudden spate of medicine-education comparison and it’s not entirely helpful. Medics may have been more rigorous in some ways, and NICE and the Cochrane Reviews have been very helpful, but a lot of this is around specific treatments, much less so about prevention, and even less around the way doctor’s interactions with patients can affect outcomes. Actually we’ve learned much more in education about the power of interacting in different ways, but then it seems to be much harder to change instinctive patterns of response than it is to start making different diagnostic decisions.
I wrote a blog piece on this same area here:
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