Three fundamental problems encountered by statisticians in the training of undergraduate medical (MBChB) students and qualified doctors are:
1. poor retention of key statistical concepts such as confidence interval, absolute risk, relative risk, odds ratio, p-value, statistical power and significance level;
2. incompetence in communicating notions such as relative and absolute risk and more generally, the findings of systematic reviews to patients; and,
3. inability to use the statistical findings presented in medical journals to make informed decisions on the optimal choice for the patient.
Statistical reasoning is fundamental to the development of sound critical thinking within Evidence-Based Medicine. It ought to be a major concern, therefore, to teachers of medical students that Tomorrow’s Doctors [1], the official report of the General Medical Council defining the required “knowledge, skills and behaviours” of UK medical graduates, does not currently provide statistical learning outcomes for medical students. This deficit is likely to have been influenced by the absence of any published literature that defines a statistical curriculum for undergraduate medical students. These observations formed the basis for a call for University of Edinburgh to serve as a pioneer in setting the standards for statistical learning within UK medical schools through the provision of research-informed learning outcomes. From a practical perspective, the development of these learning outcomes involved an investigation of the needs of undergraduate medical students throughout their courses and those of practising physicians when engaged in clinical research, problem-solving and decision making.
The potential impact of this collaborative approach in improving the quality of statistical learning within the MBChB curriculum is evident from existing literature. For example, findings dating back to the 1980s report that through the absence of a working knowledge of statistics, practising physicians struggle to interpret or evaluate the presentation of clinical findings in medical literature. [2] This result is particularly troublesome given the recognised demand on practising physicians “to demonstrate that they can reach correct diagnoses using both clinical and statistical data.” [3] Through exposure to a prescriptive set of statistical learning outcomes from an early stage, the doctors of tomorrow will be less likely to fall into the same pitfalls as their predecessors when researching clinical findings.
This outcomes of this miniproject include: provision of Computer-Aided Learning materials featuring a topical real-life problem solving scenario which qualified doctors may expect to be faced with at an early stage of their career; development of an implementation guide for tutors to use, outlining cases where the exercises and tutorials could be integrated throughout the medical curriculum.
[1] GMC (2009) ‘Tomorrow’s doctors: Outcomes and standards for undergraduate medical education’. London.
[2] Windish, D.M., Huot, S.J. and Green, M.L. (2007) ‘Medicine residents’ understanding of the biostatistics and results in the medical literature’, JAMA, 298(9), 1010 - 1022.
[3] Freeman, J.V., Collier, S., Staniforth, D. and Smith, K.J. (2008) ‘Innovations in curriculum design: A multidisciplinary approach to teaching statistics to undergraduate medical students’, BMC Medical Education, 8(28).