Critical Appraisal of Evidence in Medical Education: A Systematic Review of Methodological Approaches, Evidence Types, and Appraisal Frameworks

Abstract Objective and Aim The growing emphasis on accountability, quality assurance, and outcomes-based education has intensified the demand for robust and critically appraised evidence in medical education. While the principles of evidence-based medicine have substantially shaped clinical decision-making, their direct transfer to educational contexts has proven conceptually and methodologically challenging. Objective: This systematic review aims to synthesize the literature on evidence types, critical appraisal frameworks, and methodological quality standards in medical education research, and to present an integrative appraisal matrix suitable for educational decision-making. Methods A systematic review was conducted in accordance with PRISMA 2020 guidelines (7). Searches were performed in MEDLINE (PubMed), ERIC, Scopus, and Web of Science for studies published between 2000 and 2024. Included studies addressed evidence hierarchies, critical appraisal, research quality instruments, or methodological frameworks in medical or health professions education. Data were synthesized narratively due to methodological heterogeneity. Results Eighty-four studies met inclusion criteria. Evidence in medical education was categorized into quantitative, qualitative, mixed-methods, and design-based research. Traditional biomedical hierarchies were insufficient to capture educational relevance and contextual complexity. Appraisal tools such as BEME, MERSQI, CASP, and realist review frameworks were commonly cited, yet inconsistently applied. Conclusions Critical appraisal in medical education requires a pluralistic, theory-informed, and context-sensitive approach. The proposed appraisal matrix integrates methodological rigor, educational relevance, outcomes meaningfulness, and transferability to support informed educational practice. Keywords: Medical education research; Systematic review; Critical appraisal; Evidence hierarchy; Research methodology