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December 22/29, 2004

Educational Epidemiology

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(24):2969-2971. doi:10.1001/jama.292.24.2969-b

To the Editor: Dr Carney and colleagues1 criticize education in medical schools for not being evidence-based and call for more funding to promote rigorous educational research. While I agree with their criticism, funding educational research may not yield the same benefit to the community as clinical research. Results from even rigorous educational studies often have limited generalizability beyond the study setting. Compare the applicability of 2 randomized controlled trials: an educational trial at a single medical school that shows that online surgery lectures for third-year medical students produce greater knowledge than standard lectures; and a clinical trial at a single medical center that shows that a certain drug improves memory of patients with Alzheimer disease stage 5 on the Global Deterioration Scale, compared with placebo. Transferral of the clinical trial results seems more valid because patients at Global Deterioration Scale stage 5 have the same disease severity everywhere, compared with the variable prior knowledge and computer literacy of third-year medical students at different medical schools. The drug and placebo have the same composition everywhere, compared with the variable lecture content at different medical schools due to different communication skills, enthusiasm, and effort of teachers. With broader applicability due to well-defined interventions and participant characteristics, clinical trials are likely to yield a larger benefit per dollar invested.

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