‘It’s chilling that when we think we are doing good, we may actually be doing harm’ – Dr Ben Goldacre
Giving Evidence has underway a major project to improve the effectiveness of education in less developed countries, by seeing what and how it can learn from evidence-based medicine (EBM). The first findings are here.
Performance has improved dramatically in medicine with the rise of evidenced-based practice: for example, deaths from infectious diseases in the US fell by over 95% during the 20th century. By contrast, educational learning levels are often abysmal: for example, in India, a third of 8-9 year olds can’t recognise simple words.
The move to evidence-based practice in medicine took decades. What can education emulate which will enable similar performance improvements? This project aims to find out. And inviting you to get involved.
Is medicine analogous to education?
Yes, up to a point. For example, in almost every country, education and healthcare are both delivered universally by government (with private alternatives for those who can afford them) and hence are major parts of government policy and spending. They share difficulties with incentives: funded by tax, neither the institutions (hospitals and schools) nor practitioners (doctors, nurses and teachers) are paid directly by the people they serve. Both have information asymmetry between providers and consumers (pupils don’t know what they need to learn, and patients don’t know what they need to take or do). Both have thousands of practitioners who go through a system for training and qualification, normally run or overseen by the state.
But they’re not identical, and hence lessons from health can’t automatically be transferred. For example, the goal of medicine (healthy people) is easier to define and less contentious than that of education (People who can pass exams? People able to get jobs? People who are fulfilled?) Education is normally a batch-process and proactive, whereas most healthcare is individual and reactive. Teachers don’t self-select for ability in science, whereas doctors do, and education is more context-dependent than many medical interventions are.
The project’s focus
1.The ‘evidence-systems’ in medicine and in education. Production: who produces evidence, why, how, how are they incentivised and funded; Dissemination: who disseminates it and why; and Use: how is evidence used, why and when, and why not, and what devices (e.g., checklists) can help in practice.
We are looking at what enables the helpful parts to work, such as: training and skill-levels, institutions (e.g., academic journals, watchdogs, regulators), funding mechanisms, politics, relationships (e.g., between practitioners and academics), tools (e.g., metrics and analytical frameworks), traditions, ‘customer’ expectations and norms. And what hinders good practice, which education in less developed countries should not emulate, such as distortion of the evidence-base by private operators.
2. Identifying ways that the evidence system in education can improve: not necessarily by emulating the system in medicine, but by learning from it.
3. Consult with funders and practitioners and other to mobilise action to improve the use of evidence in education in less developed countries.
If you are involved in education in less developed countries – as a provider, funder, academic, regulator, trainer or commentator – we’d love to talk to you. The project involves many senior medical practitioners and academics. contact us on: admin [at] giving-evidence [dot] com