Internal medicine residents had low scores in a test of biostatistics knowledge, and about three-fourths of the residents surveyed indicated they have low confidence in understanding the statistics they encounter in medical literature, according to an article in the September 5 issue of JAMA, a theme issue on medical education.
"Physicians must keep current with clinical information to practice evidence-based medicine," the authors write. "... to answer many of their clinical questions, physicians need to access reports of original research. This requires the reader to critically appraise the design, conduct, and analysis of each study and subsequently interpret the results." Little is known about residents' ability to understand statistical methods or how to appropriately interpret research outcomes.
Donna M. Windish, M.D., M.P.H., of the Yale University School of Medicine, New Haven, Conn., and colleagues conducted a multiprogram assessment of residents' biostatistics knowledge and interpretation of research results. The study consisted of a cross-sectional survey of 277 internal medicine residents in 11 residency programs. The survey included a biostatistics/study design multiple-choice knowledge test.
The overall average percentage correct on statistical knowledge and interpretation of results was 41.4 percent vs. 71.5 percent for fellows and general medicine faculty with research training. Higher scores in residents were associated with additional advanced degrees (50 percent vs. 40.1 percent); prior biostatistics training (45.2 percent vs. 37.9 percent); enrollment in a university-based training program (43 percent vs. 36.3 percent); and male sex (44 percent vs. 38.8 percent).
On individual knowledge questions, 81.6 percent correctly interpreted a relative risk. Residents were less likely to know how to interpret an adjusted odds ratio from a multivariate regression analysis (37.4 percent) or the results of a Kaplan-Meier analysis (10.5 percent). Seventy-five percent indicated they did not understand all of the statistics they encountered in journal articles, but 95 percent felt it was important to understand these concepts to be an intelligent reader of the literature.
"The poor knowledge in biostatistics and interpretation of study results among residents in our study likely reflects insufficient training. Nearly one-third of trainees indicated that they never received biostatistics teaching at any point in their career," they write. "Our results suggest the need for more effective training in biostatistics in residency education."
"If physicians cannot detect appropriate statistical analyses and accurately understand their results, the risk of incorrect interpretation may lead to erroneous applications of clinical research. Educators should re-evaluate how this information is taught and reinforced in order to adequately prepare trainees for lifelong learning, and further research should examine the effectiveness of specific educational interventions." (JAMA. 2007;298(9):1010-1022. Available pre-embargo to the media at www.jamamedia.org)
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