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Open Access Highly Accessed Debate

A hierarchy of effective teaching and learning to acquire competence in evidenced-based medicine

Khalid S Khan12* and Arri Coomarasamy1

Author Affiliations

1 Division of Reproductive and Child Health, University of Birmingham, and Birmingham Women's Hospital, UK

2 Professor of Obstetrics-Gynaecology and Clinical Epidemiology, University of Birmingham, Birmingham Women's Hospital, B15 2TG, UK

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BMC Medical Education 2006, 6:59  doi:10.1186/1472-6920-6-59

Published: 15 December 2006



A variety of methods exists for teaching and learning evidence-based medicine (EBM). However, there is much debate about the effectiveness of various EBM teaching and learning activities, resulting in a lack of consensus as to what methods constitute the best educational practice. There is a need for a clear hierarchy of educational activities to effectively impart and acquire competence in EBM skills. This paper develops such a hierarchy based on current empirical and theoretical evidence.


EBM requires that health care decisions be based on the best available valid and relevant evidence. To achieve this, teachers delivering EBM curricula need to inculcate amongst learners the skills to gain, assess, apply, integrate and communicate new knowledge in clinical decision-making. Empirical and theoretical evidence suggests that there is a hierarchy of teaching and learning activities in terms of their educational effectiveness: Level 1, interactive and clinically integrated activities; Level 2(a), interactive but classroom based activities; Level 2(b), didactic but clinically integrated activities; and Level 3, didactic, classroom or standalone teaching.


All health care professionals need to understand and implement the principles of EBM to improve care of their patients. Interactive and clinically integrated teaching and learning activities provide the basis for the best educational practice in this field.