To the Editor
With access to the information via digital and hardware platforms and formats, residents
(postgraduate trainees) have access to millions of published medical articles which
can be found on a variety of electronic databases. Resident physicians and clinicians
generally depend on the medical literature to keep their clinical knowledge up to
date and apply evidence-based methods (EBM) to answer specific clinical questions.
Although knowledge of epidemiology and statistics (E&S) is essential for comprehending
medical evidence, research has shown consistently low and variable knowledge among
resident physicians. Simultaneously, the complexity of statistical methods reported
in top-tier medical journals continues to be a challenge, as it makes the journals
difficult to understand.
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A study showed that the majority of the responding residents agreed that research
is essential and improves health care and that it helps in building a future academic
career. Lack of research training, lack of time, work-related stress, and lack of
supervisors are perceived barriers to doing research.
3
Teaching methods of E&S are wide-ranging; examples include blended format, case studies,
didactic lectures, computer simulations, etc.
4
There are few published papers about residents' ability to understand statistical
methods or how to interpret research outcomes appropriately. We have noticed that
during our journal club meetings, medical residents either skip the statistical methods
or describe results without fully understanding the important aspects of the statistical
analysis. We surveyed with the aim of describing residents understanding of E&S concepts
used in the interpretation of research results and describe the need for additional
E&S training to help medical residents evaluate and translate research into clinical
practice. The survey was made up of 19 multiple-choice E&S knowledge questions, 3
demographic questions, and 1 Likert scale question which addressed residents' desire
to receive more E&S teaching. The question regarding the desire to learn more E&S
was rated on a 5-point Likert scale, in which 1 represented strongly disagree, and
5 represented strongly agree. The survey was completed by 79% (n=82) residents, among whom
62% were interns (first-year resident), 78% were female, 95% were international medical
graduates (physicians who received their medical school education outside the United
States or Canada). The vast majority of participants agreed that more training opportunities
regarding E&S and its application to medical sciences are needed. On individual knowledge
questions, across all levels of training, the most correctly answered question was
related to the recognition of the value of masking in studies to prevent bias. This
was answered correctly by the vast majority of the participants. Few medical residents
correctly responded to the question regarding Cox's proportional hazard assessment,
and the use and interpretation of an ANOVA test. Across all levels of training, there
was variable performance (i.e., percent correct responses) in basic E&S concepts.
In basic concepts areas, where we expected high performance, we saw the opposite (examples
include the identification of continuous variables, interpretation of standard deviation
(SD), applied analysis using the Chi-Square test and ANOVA); surprisingly, in the
complex areas, such as randomization, the percentage giving a correct score was high
across all levels of training, and this was similar to the findings of a previous
study.
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The reason for the discordance is not known but may be attributed to differences in
residents' medical school training, knowledge base regarding E&S, participation in
advanced training, mathematical knowledge, and interest in statistics
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that most participants answered correctly. Studies continue to show clinicians and
residents have difficulty in understanding and interpreting p-values.
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Analysis showed that residents with previous advanced degrees generally fared better
on E&S knowledge tests, supporting the advantages of having advanced training linking
with ease in the interpretation of applied E&S concepts included in medical journals.
8
A previous study that described residents' E&S attitudes found that both the attitudes
and confidence of residents were positively associated with the number of journals
read monthly and formal coursework in biostatistics.
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Therefore it would be helpful to encourage residents to improve their attendance
and active participation in the monthly journal clubs. Most of the residents expressed
an interest in more E&S teaching, which would be a gateway to the better interpretation
of journal articles and application of EBM methods. Also, our study was limited by
the small sample size allowing prior preparation or forewarning the residents may
have improved some of the test scores. Scores were not influenced by gender or level
of training. The universal need for additional training was identified and will be
addressed using blended methods of online training, teaching, participation in a journal
club, and the sharing of current statistical methods as they are published in the
literature. Residents and students continue to articulate the relevance of E&S to
real clinical issues. Previously published work had suggested that the causes of
poor interest in E&S was due to the short duration of E&S teaching in the medical
curriculum, the lack of practice exercises, and the need for practical data collection.
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Even though we did not study the barriers, we intend to extrapolate what is known
in the literature to mitigate and plan a custom-made curriculum that works best for
current and future residents. Our survey showed some residents had trouble with correctly
answering simple and complex E&S concepts; we can align this with our continued observations
of similar difficulty during our monthly journal club and scholarly activities. We
continue to observe that some of our residents still have difficulties interpreting
research methodology and statistical details, even though it is expected that a medical
school training would have prepared them to analyze basic biomedical data using simple
statistical methods or collaborating with a biostatistician in cases that need more
complex methods. In conclusion, additional studies to describe specific E&S training
needs that will help residents rapidly evaluate and translate research into clinical
practice are needed.
Conflict of Interest
The authors declare that they have no conflict of interest.