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      Statistical Trends in the Journal of the American Medical Association and Implications for Training across the Continuum of Medical Education

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          Abstract

          Background

          Statistical training across the continuum of medical education may not have advanced at the pace of statistical reporting in the medical literature, yet a comprehensive understanding of statistical concepts most commonly presented in current research is critical to the effective practice of Evidence Based Medicine. The objective of this content analysis was to describe statistical techniques used in a leading medical journal, JAMA, across a 20-year period, with a focus on implications for medical education.

          Methods and Findings

          Two issues of JAMA published each month in 1990, 2000, and 2010 were randomly selected; from these, 361 articles were reviewed. Primary focus, study design, and statistical components were abstracted and examined by year of publication. The number of published RCTs and cohort studies differed significantly across years of interest, with an increasing trend of publication. The most commonly reported statistics over the 20-year period of interest included measures of morbidity and mortality, descriptive statistics, and epidemiologic outcomes. However, between 1990 and 2010, there was an increase in reporting of more advanced methods, such as multivariable regression, multilevel modeling, survival analysis, and sensitivity analysis. While this study is limited by a focus on one specific journal, a strength is that the journal examined is widely read by a range of clinical specialties and is considered a leading journal in the medical field, setting standards for published research.

          Conclusions

          The increases in frequency and complexity of statistical reporting in the literature over the past two decades may suggest that moving beyond basic statistical concepts to a more comprehensive understanding of statistical methods is an important component of clinicians' ability to effectively read and use the medical research. These findings provide information to consider as medical schools and graduate medical education training programs review and revise their statistical training components.

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          Most cited references12

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          Medicine residents' understanding of the biostatistics and results in the medical literature.

          Physicians depend on the medical literature to keep current with clinical information. Little is known about residents' ability to understand statistical methods or how to appropriately interpret research outcomes. To evaluate residents' understanding of biostatistics and interpretation of research results. Multiprogram cross-sectional survey of internal medicine residents. Percentage of questions correct on a biostatistics/study design multiple-choice knowledge test. The survey was completed by 277 of 367 residents (75.5%) in 11 residency programs. The overall mean percentage correct on statistical knowledge and interpretation of results was 41.4% (95% confidence interval [CI], 39.7%-43.3%) vs 71.5% (95% CI, 57.5%-85.5%) for fellows and general medicine faculty with research training (P < .001). Higher scores in residents were associated with additional advanced degrees (50.0% [95% CI, 44.5%-55.5%] vs 40.1% [95% CI, 38.3%-42.0%]; P < .001); prior biostatistics training (45.2% [95% CI, 42.7%-47.8%] vs 37.9% [95% CI, 35.4%-40.3%]; P = .001); enrollment in a university-based training program (43.0% [95% CI, 41.0%-45.1%] vs 36.3% [95% CI, 32.6%-40.0%]; P = .002); and male sex (44.0% [95% CI, 41.4%-46.7%] vs 38.8% [95% CI, 36.4%-41.1%]; P = .004). On individual knowledge questions, 81.6% 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%) or the results of a Kaplan-Meier analysis (10.5%). Seventy-five percent indicated they did not understand all of the statistics they encountered in journal articles, but 95% felt it was important to understand these concepts to be an intelligent reader of the literature. Most residents in this study lacked the knowledge in biostatistics needed to interpret many of the results in published clinical research. Residency programs should include more effective biostatistics training in their curricula to successfully prepare residents for this important lifelong learning skill.
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            Use of statistical analysis in the New England Journal of Medicine.

            A sorting of the statistical methods used by authors of the 760 research and review articles in Volumes 298 to 301 of The New England Journal of Medicine indicates that a reader who is conversant with descriptive statistics (percentages, means, and standard deviations) has statistical access to 58 per cent of the articles. Understanding t-tests increases this access to 67 per cent. The addition of contingency tables gives statistical access to 73 per cent of the articles. Familiarity with each additional statistical method gradually increases the percentage of accessible articles. Original Articles use statistical techniques more extensively than other articles in the Journal. Research studies based on a longitudinal design make heavier use of statistics than do those using a cross-sectional design. The tabulations in this study should aid clinicians and medical investigators who are planning their continuing education in statistical methods, and faculty who design or teach courses in quantitative methods for medical and health professionals.
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              The statistical content of published medical research: some implications for biomedical education.

              Medical students and doctors need training in biostatistics. The use of analytic statistics in a leading general medical journal is reported. Of 760 consecutive research and review articles, 42% use statistical methods beyond elementary descriptive statistics. Critical reading of the medical literature requires an understanding of many statistical methods. The frequency of use of such methods may help identify those which should receive greater attention in instructional programmes within the medical curriculum. Based on the frequencies and our understanding of the importance of broad statistical concepts, recommendations are developed for the basic course in biostatistics. The integration of several more advanced statistics modules into clinical training is also suggested. The use is recommended of clinically oriented textbooks in biostatistics and current journal articles to help make instruction in statistics more relevant for preclinical students, and to help clinicians appreciate the applications of statistics to their work.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2013
                30 October 2013
                : 8
                : 10
                : e77301
                Affiliations
                [1 ]Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, United States of America
                [2 ]George Warren Brown School of Social Work and the Division of Public Health Sciences, Department of Surgery, School of Medicine, both at Washington University in St. Louis, St. Louis, Missouri, United States of America
                [3 ]Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, United States of America
                National Taiwan University, Taiwan
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: GAC LA. Performed the experiments: MB RS. Analyzed the data: MB LA. Contributed reagents/materials/analysis tools: GAC consulted on analysis. Wrote the paper: LA GAC MB RS. Compilation and cleaning of the dataset: MB RS. Interpretation of findings and contributed to analysis plan: GAC LA.

                [¤a]

                Current address: Department of Epidemiology, Saint Louis University, College for Public Health & Social Justice, St. Louis, Missouri, United States of America

                [¤b]

                Current address: National Cancer Institute, Bethesda, Maryland, United States of America

                [¤c]

                Current address: Department of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, United States of America

                Article
                PONE-D-13-26017
                10.1371/journal.pone.0077301
                3813707
                24204794
                e82b18ae-7b90-4b99-80a5-e666b7333e02
                Copyright @ 2013

                This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

                History
                : 18 June 2013
                : 31 August 2013
                Page count
                Pages: 6
                Funding
                This study was not grant-funded. However, portions of the investigators' time for unfunded research projects were supported by several sources: the National Cancer Institute of the National Institutes of Health under award number P30CA091842-11S1 (GAC); CRP-03-194-07 American Cancer Society Cissy Hornung Clinical Research Professorship (GAC, LDA); and the Barnes Jewish Hospital Foundation (LDA, MB, RS). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the American Cancer Society.
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