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To the Editor: The Special Communication by Dr Carney and colleagues¹ identified several barriers to education research including unique ethical considerations, the difficulties of conducting randomized controlled trials in educational settings, and a dearth of funding. We believe there are additional important barriers to improving the quality of education research.

The purpose of randomization is to eliminate bias between control and intervention groups. Yet in medical education variation in educational interventions often overshadows these biases, and certain sources of variation are not addressed by randomization.² Factors such as differences in the quality and style of teaching, multimodal instructional activities, and learning outside the curriculum (which is often unequally distributed among intervention groups) challenge the interpretation of results from many otherwise well-designed educational studies.

Outcomes in education research are frequently difficult to assess. While the authors assert that validated outcome measures are available, a literature review of item-based instruments designed to . . . [Full Text of this Article]

Thomas J. Beckman, MD
beckman.thomas@mayo.edu

David A. Cook, MD
Department of Internal Medicine
Mayo Clinic College of Medicine
Rochester, Minn

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