Guest Editorial―Evidence-Based Education: From Paradigm Shift to Social Movement—and Back Again?

In 2003 my colleagues and I published the first account of a school of social work’s efforts to incorporate evidence-based practice (EBP) as the organizing factor in its MSW curriculum (Howard, McMillen, & Pollio, 2003). Since publication of that article, I have watched the broad acceptance of EBP by the social work education community and read interesting and insightful discussions and challenges in evidence-based education (EBE; Gambrill, 2003; Okpych & Yu, 2014; Proctor, 2007; Rubin & Parrish, 2007; Shlonsky & Stern, 2007). In 2014 two events occurred that caused me to once again reflect broadly on EBE as it has evolved since my first foray into this discussion. First, I became chair of a department of social work undergoing reaccreditation of our BSW program, and second, I joined the Editorial Advisory Board of the Journal of Social Work Education. These events caused me to extensively review the literature on EBP and EBE and revisit my original thoughts on EBE, leading to this editorial.

Although it is not the primary focus here, it is important to begin by making clear what I mean when I discuss EBP and EBE. It would be easy to spend this entire editorial discussing the variety of definitions available; however, for the sake of simplicity, when I refer to EBP, I will stick to what I view as the most common formulation, namely the systematic incorporation of evidence into practice. As described by Rubin and Parrish (2007) and others, this constitutes a process (formulating an answerable question, critically analyzing available evidence, etc.) and a product (implementing a specific intervention strategy). Logically proceeding from that definition, EBE is the process of teaching students to understand, evaluate, and incorporate evidence into their practice. Thus, EBP and EBE overlap, in that both are concerned with the inculcation of evidence into practice; yet they are different in that EBP focuses on the what do you do aspect of practice, and EBE focuses on how does one teach how to do practice? Having clarified the distinction between EBP and EBE used here, I turn my attention to EBE, discussing EBP only as it pertains to the educational process.

In reflecting on my first foray into EBE (Howard et al., 2003), I am particularly struck by our assertion that this approach, similar to evidence-based medicine, represented a paradigm shift in education. Kuhn (1962), in defining a paradigm shift, focused on a sudden and completely new way to look at science (or in this case, education), accompanied by new methods for conducting inquiry based on this shift. Certainly, the swift and ubiquitous uptake of the label EBE in master’s programs meets this definition. There is now broad written acceptance of evidence as central to education, and EBP as a key component of evidence (Bertram, Charnin, Kerns, & Long, 2014). However, the concept that the use of this new language represents a genuine transformation of the educational process is a problem. The importance of building practice and education on available knowledge has been part of the National Association of Social Workers’ (NASW) Code of Ethics since its inception in 1960. While the 2008 version of the Code of Ethics (NASW, 2008) more specifically focuses on research and evaluation, this is much more a change in emphasis than a new paradigm.

What has changed is our ability to access, create, and evaluate information through the development of new technology. The ability to easily access every version of the NASW Code of Ethics to produce this discussion is something that would have been time consuming and difficult only a very few years ago. Technology has changed our ability to disseminate and to teach evidence. But that is not EBE itself. Yet, even if it is not a paradigm shift, it is undeniable that something important has happened in the past decade that has potentiated our desire to make incorporation of evidence a central feature of our educational practices.

Rather than define the explosive growth of EBE as a paradigm shift, EBE as it has evolved in the past decade or more might better be understood as a social movement. A key element in successful social movements is establishing individual and collective identities (Snow & McAdam, 2000). At the individual level, many educators are happy to label themselves as evidence-based instructors; at the collective level, most of those in social work education publicly identify with EBE and incorporate some form of EBP in their program descriptions. Community practitioners and agencies have also caught EBP fever (albeit not without some reservations; Gray, Joy, Plath, & Webb, 2014). Speaking personally, I am much happier to label my practice as emerging from evidence rather than from authority (Pollio, 2006).

Defining EBE as a social movement rather than a paradigm shift resonates with my personal experience of the years since our original publication. The evidence-based label currently carries such a cachet that individuals and agencies describe themselves as being engaged in EBP whether they have the skill set or knowledge of what this entails. Practitioners use EBP, but research suggests that many (or even most) practitioners continue to use unsupported or ineffective practices (Pignotti & Thyer, 2012). Similarly, social work programs define EBE in a variety of ways, sometimes simply changing the language rather than rethinking the educational practices. In part, this may be because while there has been substantial discussion on how to conduct EBP (see MacGowan, 2008, among many others), there has been far less discussion on the andragogy that leads our students to become effective evidence-based practitioners (Howard, Allen-Meares, & Ruffolo, 2007; Pollio & MacGowan, 2010, 2011; Traube, Pohle, & Barley, 2012) and virtually no research on the effectiveness of our educational process in general (Yaffe, 2013) and far less for EBE specifically.

As part of our recent reaccreditation efforts for our BSW program, I became extremely familiar with the core competencies required by the Council on Social Work Education. In conducting this process, I was struck by the thoroughness of the process and by the lack of information about the evidence supporting the educational basis for these competencies. Nor am I the first to notice this. In her editorial in this journal in 2013, Yaffe challenged social work education to begin “systematically mapping and appraising the evidence base for social work educational competencies” (p. 527). In essence, Yaffe is calling for an evidence-based approach to our system of accreditation.

This links directly to another indication that currently EBE is a social movement rather than a paradigm shift. Rather than focusing on evaluating the new paradigm, social work education has taken on faith the conclusion that EBE represents an improvement in education and that individuals indoctrinated in EBP will be better practitioners. A paradigm shift would include a new method of examining educational outcomes, whereas a social movement takes the improvement in outcomes based on faith.

In the context of this editorial, this leads to a slightly more focused question than the excellent ones asked by Yaffe (2013): How do we know our students are learning EBP, and how do we know the EBE process is leading to more competent practitioners? More simply put, is EBE producing better social workers? In 2003 my colleagues and I worried about the acceptability of EBP to students, but now we can see that this concern did not play out. In 2015 my concern is the opposite: How do we know that this broadly accepted approach is leading to better practice?

Another interesting result of my examination of EBP in the context of our BSW accreditation is my realization that the EBE social movement is almost entirely localized in MSW education. BSW education (and to a slightly lesser extent PhD/DSW education) is rarely the exclusive focus of the discussion. The EBE literature either explicitly states it is about MSW education, uses structures and concepts that clearly are designed to fit MSW curriculum, or mentions BSW only as part of the term BSW/MSW. This matches an experience I had teaching group work at the BSW level for the first time. Naively, I made the assumption that I could simply translate my own ideas of teaching evidence-based group work at an MSW level (Pollio, 2003; Pollio & MacGowan, 2010) to the BSW classroom. Those who have taught group work at both levels are probably chuckling quietly to themselves right now. Of course it failed miserably. As an honest (if sometimes somewhat dense) teacher, I went looking for models of EBE for my BSW class. Much to my surprise, I found little applicable.

In developing my argument that EBE in social work is more a social movement than a paradigm shift, it is important to note that this represents an analysis of what has happened rather than an effort to advocate for the field to give up the concept of EBE as a paradigm shift. It is my belief that EBE should, and can, be a paradigm shift, if we go back to Kuhn’s (1962) definition. Three transitions (or shifts) need to occur for us to truly earn the label my colleagues and I claimed in 2003.

First, we need to specify what constitutes EBE pedagogy. Work has been done to identify what constitutes and how one conceptualizes the processes and products of EBP. Some serious effort is required to specify how one teaches these skills at the classroom level and across entire programs. Work has been done in these areas for specific classes (Bricout, Pollio, Edmond & Moore-McBride, 2008; Pollio & MacGowan, 2010) and for entire programs at the MSW level (Howard et al., 2007), but a larger effort needs to focus on the andragogy of EBE and how it is distinct from previous approaches. I believe this also implies a serious focus on the use of technology in our educational efforts, as improvements in technology have significantly increased our ability to acquire evidence.

Second, a clear effort needs to be made toward affirming the validity of EBE through a serious evaluation of the effectiveness of this approach. EBE is driven by evidence, and we should not be afraid to turn our critical lens on evaluating ourselves. As we asserted in 2003, “only rigorous empirical testing can determine whether students trained to practice in consonance with the best empirical evidence actually do so and provide consumers with services that are superior to those provided by social workers adopting other practice approaches” (Howard et al., 2003, p. 256). This challenge remains as relevant today as it did then.

Finally, EBE requires clear articulation at the BSW and PhD/DSW levels. Having spent most of my career teaching at the MSW and PhD levels, as director of a BSW program, I can personally attest to the differences between the two degrees. Although there is overlap in competencies, the outcomes of the two degrees are distinct and call for different approaches to EBE. The assumption that a single EBE approach fits BSW and MSW programs must be set aside, and we must examine what constitutes EBE at all levels of education. Further, we must examine our doctoral-level education, not just in efforts to improve social work research but also to train our future faculty in EBE practices.

In looking back on our 2003 assertion that EBE represented a paradigm shift for social work, I think that at that time this assertion represented more of an aspiration than a reality. The years since we began integrating EBE and EBP as key facets in social work have demonstrated that it has been a great success as a social movement but has failed to meet our hope that it truly represents a paradigm shift for the entire field. I believe that EBE has the potential to be a positive transformation of our educational processes and that a critical assessment of how EBE has affected practice will demonstrate that it does improve the services we provide and will point to directions for further improvement of practice. But much work needs to be done. It is time to move from a successful social movement to a true paradigm shift, one that truly improves our field as a whole and is responsive to the opportunities of technology and the emergence of a new EBP.