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Evidence based practice

One way research can relate to practice is through a commitment to evidence-based practice. It sounds like a good idea, but first listen to a note of scepticism: doctors have been struggling for some years now with the concept of evidence-based practice and apparently are beginning to divide into the 'isn't that what we do anyway?' camp, and those who have the trouble Phil Hammond describes in making it make sense. Are there any lessons to be learned here for careers guidance?

'In my last stint as a GP, I tried communicating in 'evidence based' language to help patients make more informed choices, but every preventative treatment came down to this type of wording: if a hundred patients like you take this tablet every day for five years, one life will be saved, but I don’t know whether it will be yours. The more honest I tried to be, the more likely the consultation would end in 'Bollocks to that'.' [Dr Phil Hammond from the 'Trust me, I'm a doctor' programmes touching on the self-deluding potential contained in the idea of evidence based practice in Hammond (2003)]

So we need to be aware of the limits of evidence-based practice, but if as practitioners we are trying to build up abody of evidence about our practice, we could use a practical guide to undertaking evidence based research: A Little Book of Evaluation. This was written specifically to encourage practitioners to reflect on their practice within the context of developing a Connexions service, and to examine ways in which a clear evaluation strategy can be undertaken in order to help determine what works and what does not. The booklet provides a framework to enable project managers and practitioners to evaluate and assess their work. Within this context evaluation is seen as a way of investigating 'what works best', and this fits with the contention that proponents of evidence-based practice make that it has the potential to:

help ensure that new initiatives are likely to be successful, as they have been proven to work in a similar context;
maximise efficiency, especially in the light of scarce resources;
give value for money research that will directly link to practice;
support the transparency and accountability of decision-making;
empower practitioners and encourage self-directed learning for staff;
enhance multi-disciplinarity (Trinder, 2000).

Bowes, L., Hartas, D., Hughes, D. and Popham, I. (2001) A Little Book of Evaluation Derby: CEGS.
Hammond, P (2003); The whole truth? British Medical Journal, 2003 Jun 14; 326(7402):1340.
Trinder, L. (2000) A critical appraisal of evidence-based practice. In Trinder, L. & Reynolds, S. (Eds.) Evidence-Based Practice: A Critical Appraisal, pp. 212-241, Oxford: Blackwell.
One important issue is whether the knowledge claims of research into guidance can be justified beyond the particular context in which the research occurs. This is a particular challenge where the research is complex, affected by many variables and in many cases is interventionist in that it is trying to 'improve' practice. Additionally, many studies rely on narrative accounts to communicate and justify their findings. The narratives though are written from a particular perspective and may be open to very different interpretations.

Key questions include:

What is our basis of understanding guidance encounters as outlined in research studies?
How can we demonstrate a basis of our knowledge claims to others?
Can we build evidence-based knowledge to complex questions about the nature and outcomes of guidance?
Are our ideas of what constitutes an appropriate evidence base different from those of policymakers (and paymasters)?
It would a brave individual who tried to tackle these issues, confidently. However, this forum offers an opportunity for a collective consideration and response to the questions posed. This is a space for discussion of and reflection on research. It is an opporutnity to gain acknowledgment of the range of issues relating to research in practice whatever the standpoint from which you are coming. Your perspective will contribute to knowledge development and help to adapt and sharpen theories and explanations of guidance in context.