Scores achieved on certification examinations and licensure examinations taken at the end of medical school show a sustained relationship, over 4 to 7 years, with indices of preventive care and acute and chronic disease management in primary care practice.

Health care professionals are expected to use a systematic approach based on evidence, professional reasoning and client preferences in order to improve client outcomes. In other words, they are expected to work within an evidence-based practice (EBP) context. This expectation has had an impact on occupational therapy academic programs' mandates to prepare entry-level clinicians who demonstrate competence in the knowledge, skills and behaviors for the practice of evidence-based occupational therapy. If the EBP approach is to be entrenched in the day to day practice of future clinicians, a pedagogically sound approach would be to incorporate EBP in every aspect of the curriculum. This, however, would require a comprehensive understanding of EBP: its basis, the principles that underpin it and its effectiveness in promoting core professional competencies. The existing literature does not elucidate these details nor does it shed light on how requisite competencies for EBP are acquired in professional education in general and in occupational therapy education in particular. Drawing from educational psychology and EBP in the health professions, this paper provides a critical review of the evidence that supports EBP and the effectiveness of EBP teaching and assessment interventions in professional heath sciences programs and offers suggestions for the design of EBP instruction, grounding recommendations in educational theory for the health professions.

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Unnecessary NSAID prescribing and suboptimal management of NSAID-related side effects were sufficiently common to raise questions about the appropriateness of NSAID use in the general population. If these results reflect current practice, prescribing patterns may contribute to avoidable gastrointestinal morbidity in elderly persons.

One-quarter of practicing physicians in the United States are graduates of international medical schools. The quality of care provided by doctors educated abroad has been the subject of ongoing concern. Our analysis of 244,153 hospitalizations in Pennsylvania found that patients of doctors who graduated from international medical schools and were not U.S. citizens at the time they entered medical school had significantly lower mortality rates than patients cared for by doctors who graduated from U.S. medical schools or who were U.S. citizens and received their degrees abroad. The patient population consisted of those with congestive heart failure or acute myocardial infarction. We found no significant mortality difference when comparing all international medical graduates with all U.S. medical school graduates.

These findings provide evidence for the validity of Step 2 CK scores. Given the magnitude of its relationship with patient outcomes, the results support the use of the examination as an effective screening strategy for licensure.

The development of the Best Evidence Medical Education (BEME) Collaboration is introduced in the context of other systematic review initiatives, specifically the Cochrane and Campbell collaborations. The commentary addresses two goals: to describe the current status of BEME and to situate BEME in the broader context of the medical education community's need to be accountable, to conduct research to understand educational processes and results, and the key role that medical educational research must play within the quality-improvement agenda. Lessons drawn from the evidence-based practice movement of the last ten years and the current experience with BEME suggest that, although BEME will inform some educational policies and practices, its initial success may be limited because of the paucity of studies that meet current standards for evidence and the great difficulty in conducting methodologically rigorous studies in the complex social interaction called education. Nonetheless, the need exists for medical education research to continue to address key issues in medical education using experimental designs, while at the same time anticipating the need for more situation-specific data to permit educators to monitor and benchmark their existing programs within a quality-improvement and accountability framework. The authors conclude that the very nature of being professional in today's social and fiscal context demands that medical educators provide evidence of effectiveness and efficiency of their programs while at the same time BEME and medical education research continue to grow and mature.

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