LAUSR

Advancing the evidence base that informs educational research and practice must include studies with both randomized and nonrandomized designs. Although experimental designs produce results with a high level of internal validity, randomization and strict controls are not always feasible when evaluating the impact of an educational intervention, and experimental study designs are not suited for answering all evaluationquestions, especiallywhen the aim is to produce practical knowledge for immediate use. Many reports of evaluations of educational interventions— especially those employingnonrandomizeddesigns,whichhave methods and reporting conventions that are less standardized— are submitted to JCEHP with significant shortcomings and, as a result, go unpublished or require extensive revisions. In some cases, this reflects shortcomings in the study design; in others, the problem lies more with how the study was initially written up. This is unfortunate for several reasons, not the least of which is the investment in time and effort authors invest in preparing manuscripts for submission. There is currently little guidance specifically for reporting evaluations of continuing education interventions. There are guidelines on reporting innovations in medical school curricula, quality improvement projects in health care organizations, nonrandomized evaluations of public health interventions, and evaluation studies of health promotion and disease prevention programs. There are also general guidelines for reporting randomized controlled trials and complex interventions for improving health. However, none of these provides a comprehensive guide for continuing education for health professionals (CEHP) evaluations. Providing a comprehensive set of guidelines for reporting evaluations of CEHP interventions is beyond the scope of this editorial; however, we would like to highlight some of the common errors authors make and suggest ways to increase the likelihood that a manuscript will be accepted for publication, make an evaluation report more useful to its readers, and allow the reader to make a more informed assessment of the rigor of the study and the credibility of its findings. It is also our hope that through a process of backward planning, these suggestions will contribute to improved evaluation design and implementation as well. First, some background. Educational interventions are typically complex. Complexity may be due to the number of interacting components within an intervention, the difficulty of the behaviors required of those delivering or receiving the intervention, the number and variability of the intended outcomes, and the degree of tailoring of the intervention permitted. To the extent that the intervention has as its outcome improving clinical practice or practice redesign, it becomes a complex intervention in a complex system, resulting in multiple and sometimes unpredictable interactions between the components of the intervention and the environment inwhich it is implemented. There are several implications of this increase in complexity for CEHP evaluations: