Thursday, 13 April 2017

The school research leads need 'mindlines' not 'guidelines

It has long been an article of faith amongst many educational researchers that education has little to learn from evidence-based medicine.  There are noble exceptions such as Professor Rob Coe and Professor Steve Higgins, but on the whole the educational research establishment perceive evidence –based medicine as being dominated by randomised control trials, the production of clinical guidelines which devalue clinical expertise and results in limited clinician’s discretion.  And as such, there is a view that there is little value in educationalists consulting the vast range of knowledge and experience about evidence-based medicine which has been developed over the last twenty years to see whether there are any lessons or insights for school-leaders, teachers, school governing bodies, trustees of multi-academy trust trustees and educational researchers.   

However, I believe there is much to learn from medicine about; the use of evidence; how knowledge is both mobilised and brokered; and, how tensions between different sources of knowledge is managed.   To support this argument I'll turn to the work (Gabbay and Le May, 2004) who undertook an ethnographic study to see how primary care clinicians went about making their individual and collective health-care decisions.    In doing so, we will see that health clinicians rarely accessed and used explicit evidence from research or other sources directly, but relied on “mindlines”—collectively reinforced, internalised, tacit guidelines. These were informed by brief reading but mainly by their own and their colleagues’ experience, their interactions with each other and with opinion leaders, patients, and pharmaceutical representatives, and other sources of largely tacit knowledge that built on their early training and their own and their colleagues' experience.    

These 'mindlines' are illustrated in Figure 1 - which has been taken from Gabbay and Le May.




The implications for teachers and school research leads

For me there are a number of implications of  (Gabbay and Le May, 2004) work for those educationalist looking to promote the use of research evidence in schools and other educational settings.   First, just like clinicians, teachers do not work with explicit codified knowledge but with ‘knowledge in practice'. Teachers and clinicians compare their own explicit and tacit knowledge with others as they developed their ‘mindlines’.  Teachers, if they are like clinicians, are unlikely to go back to research to check-out or validate of their evidence-based and will rely on others’ knowledge and experience

Second, as Gabbay and Le May note 'mindlines' are more sophisticated than ‘heuristics and rules of thumb’ as they are reliant on professional dialogue with colleagues.   However, as Gabbay and Le May note ‘mindlines’ are a form of short-cut and may appear to be more risky than other more structured approaches to evidence-based practice.   Gabbay and Le May argue that given clinicians – and in our case teachers - do not have the time or the skills to rigorously review and combine research evidence and other sources of evidence.  As such, knowledge and research literacy for teachers may be about how they can identify trusted sources of information and evidence either individually or in professional learning communities.

Third, if like clinicians, teachers are going on trusted sources of knowledge within schools and other settings, then school leaders and others have a responsibility to ensure that local opinion leaders within schools have access and time to critically evaluate research and other sources of evidence.   With that in mind, it may well be that school leaders have to ‘up-their-game’ in their knowledge of research evidence.  Furthermore, it may also suggest that a wide range of diverse colleagues – I’m trying to avoid terms like ‘old-lags’ and ‘staffroom lawyers’ - should be drawn into the ongoing development of ‘mindlines’.  Indeed, as (Gabbay and Le May, 2004) note given how ‘mindlines’ are constructed then everyone within a school community has a responsibility to engage in some form of professional learning and engagement with evidence, to support the on-going development of effective ‘knowledge in practice’.

Finally, if we accept that ‘social media’ has an increasing role in influencing educational debate both inside and outside of schools, then tweeters, such as myself need to ensure we ‘tweet responsibly’ – and make sure our argument, underlying claim and supporting evidence are explicit, so that they can be challenged and scrutinised.

Reference


GABBAY, J. & LE MAY, A. 2004. Evidence based guidelines or collectively constructed “mindlines?” Ethnographic study of knowledge management in primary care. BMJ, 329, 1013.


Author(s)
(Gabbay and Le May, 2004)
Title
·      Evidence based guidelines or collectively constructed “mindlines?” Ethnographic study of knowledge management in primary care?
Year
·      2004
Source
·      British Medical Journal, 329 1013
Setting
·      Two general practices, one in the south of England and the other in the north of England
Who was involved
·      Nine doctors, three nurses, one phlebotomist, and associated medical staff in one practice provided the initial data; the emerging model was checked for transferability with general practitioners in the second practice

Intervention
·      To explore in depth how primary care clinicians (general practitioners and practice nurses) derive their individual and collective healthcare decisions.

·      Design Ethnographic study using standard methods (non-participant observation, semi-structured interviews, and documentary review) over two years to collect data, which were analysed thematically

Outcomes
·      Clinicians rarely accessed and used explicit evidence from research or other sources directly, but relied on “mindlines”—collectively reinforced, internalised, tacit guidelines. These were informed by brief reading but mainly by their own and their colleagues’ experience, their interactions with each other and with opinion leaders, patients, and pharmaceutical representatives, and other sources of largely tacit knowledge. Mediated by organisational demands and constraints, mindlines were iteratively negotiated with a variety of key actors, often through a range of informal interactions in fluid “communities of practice,” resulting in socially constructed “knowledge in practice.” 
·      The construction of these ‘mindlines’ is illustrated in the following figure.

Significance


·      Primary care clinicians work in “communities of practice,” combining information from a wide range of sources into “mindlines” (internalised, collectively reinforced tacit guidelines), which they use to inform their practice
·      This has important implications for the dissemination and use of clinical research findings

Weight of evidence
·      Weight of evidence A – is the research of high quality and can it be trusted Yes – ethnographic study published in peer-reviewed journal.  However, only 15 practitioners and 2 sites involved in the study – so poses issues of generalizability.

·      Weight of evidence B – is the evidence fit for purpose in answering your problem of practice Yes – evidence drawn from multiple sources – not just surveys.

·      Weight of evidence C – is the evidence relevant to your context and setting – Medium – although research looks at evidence-based decision-making – as the context is a primary health-case setting, not directly relevant.

·      Weight of evidence D – is the extent to which the evidence provides and answer to your problem of practice – Medium – although the research suggests a number of useful ways forward, the nature of problem of the lack of evidence use in schools, will require a number of strategies.

Date and author
Dr Gary Jones  8 April, 2017

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