Thursday, 25 September 2014

Can nurse education help you become a better evidence based educational practitioner?

A fundamental skill in becoming an evidence-based educational practitioner is the ability to formulate questions in a manner which allows them to be answerable.  Too often questions are phrased about in a way which is relatively unhelpful in trying to generate evidence based answers.  In this post I intend to adapt the work of Stillwell, Melnyk, & Williamson (2010)  in the field of nurse education in order to help teachers, educators and leaders go about the task of devising well formulated questions which contribute to better decision-making.

Stillwell states that one way of thinking about formulating questions is to distinguish between background and foreground questions.  A background question involves asking a broad question, which can be answered by accessing basic information - for example – what are the potential benefits of e-learning? Whereas a foreground question is more specific and relevant to a particular pedagogic or managerial issue, for example, for level 3 students does 24/7 access to iPads compared to the classroom use of Chromebooks improve the  timely completion of coursework?

Asking better foreground questions using the PICOT format

In evidence-based medicine well formulated  questions are often structured using the PICOT approach. PICOT is an acronym for the components of a clinical question and are as follows:

P — Patient(Pupil/student) or Problem. How would you describe the group of patients or problem?
I — Intervention. What are you planning to do with your patients?
C — Comparison. What is the alternative to the intervention (e.g.different intervention)?
O — Outcomes. What are the effects of the intervention?
T  - Time.  What time does it take for intervention to achieve the outcomes.

(Note in much of the literature PICOT is abbreviated to PICO, however I believe the longer version is more useful to educators). Now let's try and see if we can use this technique using to ask better questions to inform our educational practice.

Worked examples*
  • For general further education students aged 16 who failed to achieve at least at a grade C in GCSE English  (P) and subsequently retake GCSE English  (I) at the end of the academic (T) year, how well do they achieve (O) compared to students who have been prepared and entered  for iGCSE English (C). 
  • For students requiring students requiring additional learning support (P)  how does the provision of 1 to 1 support (I) compared with group support (C) affect retention rates (O) in the first term (T).
  • For level 3 BTEC Extended Diploma students who do not have a grade C or better in GCSE Mathematics on entry (P) and subsequently retake GCSE Mathematics (I), how do their two year (T) success  rates (O) on their level 3 BTEC Extended Diploma programme compare to students who chose not to re-sit GCSE Mathematics (C).
(* I'm sure readers can come up with their own examples which are more precise, as these are some of my first attempts at producing PICOTS - in that sense, this blog is personal CPD made public)

What are the practical implications for using PICOTs?
  1. For teachers it provides a structured framework to think through the challenges which they are facing in their own classrooms.
  2. It provides a structure for teachers to provide senior leaders within their school/college with constructive challenge when discussing substantive evidence based issues
  3. The introduction of PICOT type questions provide an opportunity for capacity and capability building across the school/college as a whole, and provides a mechanism to facilitate the creation of a school/college culture which values evidence-based practice and enquiry.
Stillwell, S. B., Melnyk, B. M., & Williamson, K. M. 2010. Asking the Clinical Question : A key step in evidence based practice. American Journal of Nursing, 210(3).


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