An argument for conducting methodologically strong, randomized, controlled trials in educational research.

Best-evidence medical education is an approach that promotes a culture emphasizing the use of sound empirical evidence by teachers, curriculum designers, and leaders in the medical and health professions (1). Bestevidence medical education is, therefore, conceptually opposed to decisions in medical education that are made on the basis of “pseudoscience, anecdotes, and flawed comparison groups” (1). A mission of Academic Psychiatry is to help advance evidence in psychiatric education. Rigorouslydesigned evidence is, however, a rare thing. Study designs should aim to minimize the possibility of bias when determining the efficacy of educational interventions; and demands for both efficiency and effectiveness in teaching are especially vital given increasing clinical service demands of clinical faculty, threatened decreases in funding for graduate medical education (2), and the possibility of a reduction in length of medical school training (3). In this issue, Shiralkar et al. (4) identified 13 randomized, controlled trials (RCTs) or controlled, non-randomized trials on the efficacy of stress-management programs for medical students. This manuscript, of merit in itself, gives us the opportunity to remark on the importance of conducting methodologically-sound, randomized, controlled trials for educational research. Shiralkar and colleagues, through their review and analysis of RCTs on the topic, present a compelling argument that there is a high prevalence of distress among medical students, with potentially serious consequences—distress that requires medical schools to respond (4). The authors therefore identified and critically appraised the 13 randomized, controlled and controlled, non-randomized trials on this topic. Of all of the controlled trials appraised, one was judged to be of high quality or validity, whereas the others were judged to fall within a narrow middle range of validity scores. The authors concluded, in part, that the small number of controlled trials and the limitations of those trials indicated a need for developing rigorously conducted studies on this important area of medical students’ mental health. The goal of this editorial is to emphasize the critical importance of educational randomized, controlled trials in developing evidence that informs education in the medical and health professions.Wewill discuss the theoretical underpinnings of the educational RCT, the evidence hierarchy, the relationship between validity and importance of results, and strategies for overcoming barriers in conducting robust RCTs. We hope to encourage the development of highquality educational RCTs, as well as to promote their use in the medical and health professions.