Systematic reviews of evidence in medical education and clinical medicine: is the nature of evidence similar?

It is accepted worldwide that clinical and educational decisions should be informed by the best available evidence, not individual opinion only. This article discusses the epistemological basis of educational evidence, as compared with clinical evidence, looking at the different nature of the science behind each one. Two models--BEME Reviews in medical education and Cochrane Reviews in clinical medicine--based on our own experience of a soon to be published BEME Review (BEMER) and several systematic reviews our group has published in clinical medicine--were used to identify similarities and differences between the two approaches. The evidence to support clinical as well as educational decision making is different in its nature, as well as in its quality. However, their approach is similar in its fundamental steps (design a question, select evidence, critically appraise it, synthesize and apply), so the differences between BEME and Cochrane are perhaps more a matter of degree, than the existence of fundamental differences. Two fundamental principles--decision making should be supported by a hierarchy of evidence and evidence alone is never sufficient for sound practice--apply to BEME and Cochrane reviews. The capacity to transfer their results into practice is the most important factor in terms of success of both approaches.