Three steps to using evidence in practice – diagnosis, treatment & progress


Ben Durbin explains how teaching can be enhanced by the use of evidence in practice and – inspired by the approach taken by medical professionals – he gives three steps for its effective use.

Earlier this year I signed up for Twitter. Besides learning to understand the #lingo and @social_conventions of this strange new world, the main challenge I found was writing my “bio”. How do I sum myself up in just 20 or so words? 

Following a quick browse of people’s descriptions, I discovered that a popular choice is to simply list the different “hats” we all wear. For example: Parent, football fan, film buff, physicist.

I am a mathematician by background, maintain an amateur fascination with history, and have a professional interest in how research can help make the world – and in particular our schools – better. 

At first glance, the first two have nothing at all to do with the third. However, they do help to explain why I got quite so excited recently when I discovered Google’s Ngram search engine. Ngram allows you to search how often a word or phrase has appeared in the English language over the past couple of centuries, and then plots the results in a graph.

When you type in the phrase “evidence-based practice”, the graph is fascinating (see below: source It graph illustrates a growing call for frontline practice across a range of professions to be informed by the best available evidence; a call that is increasingly being made to teachers and schools.

This raises an interesting set of questions – we all bring a much wider set of experiences and interests to our jobs than just our role-specific training. Then what role does individuality – of teachers and pupils – play in a world of evidence-based practice? Is there any room for professional judgement, individual flair or adaptation to the differing needs of every pupil or class? Or has the time come for all teachers to update their Twitter bios with the bland moniker, “Teacher: dispenser of evidence-based wisdom”?

The best medicine?

There’s been a lot of talk recently about greater use of evidence by teachers. In his recent report to the Department for Education, Building Evidence into Education, Dr Ben Goldacre hailed the “huge prize waiting to be claimed by teachers” by using evidence on what works best. 

The Education Endowment Foundation’s Pupil Premium Toolkit provides a large menu of interventions together with a growing base of randomised controlled trial evidence on their effectiveness.

Comparisons are being made to the medical professional, which has been transformed by the greater use of evidence to inform practice. But many – quite reasonably – balk at the idea of the profession becoming a “teaching by numbers” operation, following pre-prescribed formulae and issuing educational pills. 

The majority of teachers are highly motivated, skilled practitioners, and bring their own unique blend of skills, experience and personality to the role. 

But the same surely applies to GPs – perhaps the nearest medical equivalent to a classroom teacher. So how do evidence and individuality co-exist in the doctor’s practice?

There are three main steps in a patient-GP journey, each of which are most effective when successfully blending universal evidence applied by individual professionals: diagnosis, treatment and on-going monitoring and evaluation.


An evidence-based approach to medicine has yielded a range of new diagnostic scans and tests and a better understanding of medical conditions. Making an accurate diagnosis requires a GP to be able to access and interpret the latest evidence, but it will never be possible to test every patient for everything. They therefore also need to be able to ask the right questions of patients, to unearth vital clues, and to have the necessary bedside manner to do this well. A diagnosis then becomes a judgement on the part of the doctor, made by applying two types of evidence: external scientific evidence and evidence they themselves have gathered during the course of the patient consultation.


For any given condition, there will in turn be a wide range of possible treatments available, each supported by evidence as to its effectiveness. No doctor would dream of adopting an approach unsupported by such evidence, given the potential damage to the patient and their own professional standing. However, among these treatments the doctor will nevertheless be required to make judgements on which is most suitable given the patient’s previous conditions, lifestyle or the specifics of the symptoms. They will also draw on their skill and experience in administering the treatment and/or instructing the patient.


Finally, it is often not enough for a GP simply to prescribe a treatment. It may be necessary to monitor the patient’s progress, tweak the treatment and sometimes even to re-visit the original diagnosis. This process requires constant interplay between what the evidence says and the doctor’s own observations and judgement. Each step of the way, the GP is required to exercise judgement and to apply the best available evidence. The two are mutually reinforcing, not mutually exclusive. 

Classroom treatment

The comparison is clearly not perfect: teachers do not solely treat “educational ailments”, and perhaps comparison with a personal trainer would be more fitting. 

Nevertheless, many of the same principles apply. Teaching informed by the best available evidence should not be a constraint on innovation, individuality or professional judgement. Rather, it should provide new, more effective tools that empower well-motivated professionals. So how does this translate into the classroom? 

Diagnosis: Understanding your pupils

Teachers get to know the pupils they teach, and come to understand their strengths and weaknesses, interests and motivations. This understanding can be crucial in identifying when pupils need additional support and when they need to be stretched further. This can be even more effective when combined with the latest available evidence (revealing for example the barriers to learning faced by socially disadvantaged pupils) or evidence-based tools (such as formative assessments). See NFER’s work developing indicators for identifying 14-year-olds at risk of disengagement from learning. Visit:

Treatment: Classroom practice

The list of resources, strategies, and interventions available to teachers is endless. Only some of these have been developed using systematic evidence or have subsequently been scrutinised to see if they really work. And even from among this shorter list of options, teachers must still exercise their judgement in choosing which will be most suitable for their pupils and then deliver them effectively. NFER produces a range of useful research, such as its recent tips on running a successful summer school. Visit:

Progress: Monitoring progress

The findings from research are most valuable when they are applied critically, with the impact on pupils monitored and evaluated. This may lead to changes in how a particular resource is used, targeting of an intervention on particular pupils, or perhaps a complete change in approach. This self-critical, adaptive approach will again involve careful judgement on the part of the teacher, but can also be combined with collecting pupil data and further exploration of research findings. NFER offers support to teachers conducting their own research and has launched the NFER Research Mark to recognise their efforts. Visit:

Evidence everywhere

So is this just another fad among educationalists? Or the latest attempt by government to interfere with teachers doing their jobs? Perhaps. On the other hand, it may provide the silver bullet that defeats faddishness and top-down meddling once and for all. 

Research evidence is simply the weight of others’ classroom experiences analysed and captured in a way that minimises the risk of false or misleading interpretation. No politician would dream of interfering with the choice of drug a doctor prescribes for a particular condition. Instead, due respect is given to evidence interpreted and applied by skilled professionals. This is the prize waiting to be claimed by teachers.

Inspired thinking

There is every place for individuality in a world of teaching informed by evidence. Many of us remember that teacher who inspired us, or gave us a break, or had a particular way of explaining things that just made sense. 

Such traits will always remain the mark of good teachers, and should not be left at the school gates. But the best teachers will combine these traits with the ability to skilfully apply the best available evidence in their particular context. Perhaps a more appropriate Twitter bio should be: “Teacher: evidenced and excellent; individual and informed.”

  • Ben Durbin is head of impact at NFER.


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