Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
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
Gandjour A. Educational Epidemiology. JAMA. 2004;292(24):2969-2971. doi:10.1001/jama.292.24.2969-b