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Levels of Evidence (LOE) in Education

Education should be delivered using the best practices that have been identified by research findings. In order to identify what can be considered best practice, the findings are optimally evaluated or graded. One mechanism for grading evidence is the use of level of evidence (LOE) models. LOE models were initially designed for the purpose of evaluating research regarding medications and focused primarily on results from quantitative research studies. Randomized controlled trials (RCT) were suggested as providing the best method for determining effectiveness and safety of medications. Numerous LOE models have been developed for evaluating medical research, with the majority being hierarchical, placing the highest level of evidence on RCT (Atkins, 2007; Issac & Franceschi, 2008; Mantzoukas 2007). As medical research expanded beyond just the evaluation of medications, experts found that RCT might not always be realistic or appropriate for all medical therapies, and began to include qualitative research in the LOE models (Daly, et al., 2006; Mantzoukas, 2007; Salmond, 2007).

Experts in education are recognizing that learners can benefit from learning strategies that are based on best practice evidence. While the No Child Left Behind Act (NCLB) has received criticism, it did serve as the impetus for academia to begin assessing how best practices in education would be determined (Trybus, 2007). In response, education leaders turned to the medical model and recommended that RCT become the gold standard for determining best practices in education (Levin, 2004; Whitehurst, 2002). However, educators have struggled with finding realistic ways to conduct RCT in education resulting in a limited number of these types of studies (Mantzoukas, 2007; Stuart, Tondora, & Hoge, 2004). Yet, academia has numerous well-developed quantitative and qualitative studies. Academicians have recognized, like their medical counterparts, the stringent mentality of one gold standard results in a lack of guidance regarding other types of research evidence. This article includes an example and description of one LOE model designed for evaluating a variety of types of research evidence in education.

LOE Model for Education

The framework for the LOE model includes quantitative, qualitative and mixed methods research approaches (Pilcher & Bedford, 2011). There is no implication that one method is preferable, instead the emphasis is on identifying the best evidence available to answer the specific practice question.

In the center of the model is the ultimate goal of providing Evidence Based Education (EBE). Three nodes surround the central focus. Each node contains one of the different research approaches (quantitative, qualitative, and mixed methods). Within each node are the levels of evidence for that particular approach. The highest level of evidence for each approach is positioned at the top of each list. The remaining levels are listed in descending hierarchical order. Encircling the model is a ring titled Professional Expertise. The outer ring signifies the decision-making process of the professional as they examine and choose evidence based on their specific practice question, situation, and needs of the learner.

Evlauating Evidence

All research is not created equal. As a result, professionals are encouraged to critically appraise evidence before applying it to practice. Appraisal includes reviewing the level of evidence, quality and validity of the study, and analysis of the results. The LOE model can be used in conjunction with Critical Appraisal Tools (CATS) when analyzing research evidence. The LOE model provides the reviewer with a tool to assess the level of the evidence, regardless of whether it is quantitative, qualitative, or a mixed approach. The reviewer can then select a CAT to assist in further analysis of the study. A list of CAT tools are available through the International Center for Allied Health Evidence- University of South Australia at http://www.unisa.edu.au/Research/Sansom-Institute-for-Health-Research/Research-at-the-Sansom/Research-Concentrations/Allied-Health-Evidence/Resources/CAT/

Summary

Before the evidence-based practice movement, it was not uncommon for care to be provided based on tradition, opinion, intuition, outdated research, and sometimes on unethical experimentation (Levin, 2004; Salmond, 2007). Academia has also been criticized as being guided primarily by tradition and intuition, rather than by evidence (Stuart, Tondora, & Hoge, 2004). Learning opportunities are optimally designed based on the best available evidence. This evidence may be gained from quantitative, qualitative, and/or mixed methodologies. Hierarchy or LOE models, along with CATS, can provide educators with tools to assist in evaluating education evidence.