Hierarchies of evidence and hierarchies of education: reflections on a multiprofessional education initiative

The concept of a hierarchy of evidence is an established part of the discourse of evidence-based health care. In the drive to incorporate research findings into all aspects of health and social care practice, value judgements about the quality of the evidence available are commonplace, with research findings obtained via particular research approaches often being given more scientific credence than those obtained by using alternative methods. This hierarchy of evidence mirrors the existence of a well-documented professional hierarchy within the healthcare workplace, with medicine as the dominant occupational group. Academic arguments for a broader appreciation of research evidence have been made in the literature for a number of years and have achieved considerable success. Equally, medical dominance in the workplace has been addressed on various levels, one approach being the rise in multiprofessional education initiatives. This article draws on the experience of facilitating multiprofessional groups undertaking a research appraisal skills programme within National Health Service-based ‘classroom’ settings. The continuing existence of both medical dominance in the healthcare arena and a belief in a hierarchy of evidence was apparent from the courses. In addition, what might be called a hierarchy of educational backgrounds, presented some complex dynamics within the teaching situation and raised a number of hitherto seemingly unaddressed questions for the group facilitator.