Narayanan Roshni, Nugent Rebecca, Nugent Kenneth
From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, and the Department of Statistics, Carnegie Mellon University, Pittsburgh, Pennsylvania.
South Med J. 2015 Oct;108(10):629-34. doi: 10.14423/SMJ.0000000000000354.
Accreditation Council for Graduate Medical Education guidelines require internal medicine residents to develop skills in the interpretation of medical literature and to understand the principles of research. A necessary component is the ability to understand the statistical methods used and their results, material that is not an in-depth focus of most medical school curricula and residency programs. Given the breadth and depth of the current medical literature and an increasing emphasis on complex, sophisticated statistical analyses, the statistical foundation and education necessary for residents are uncertain.
We reviewed the statistical methods and terms used in 49 articles discussed at the journal club in the Department of Internal Medicine residency program at Texas Tech University between January 1, 2013 and June 30, 2013. We collected information on the study type and on the statistical methods used for summarizing and comparing samples, determining the relations between independent variables and dependent variables, and estimating models. We then identified the typical statistics education level at which each term or method is learned.
A total of 14 articles came from the Journal of the American Medical Association Internal Medicine, 11 from the New England Journal of Medicine, 6 from the Annals of Internal Medicine, 5 from the Journal of the American Medical Association, and 13 from other journals. Twenty reported randomized controlled trials. Summary statistics included mean values (39 articles), category counts (38), and medians (28). Group comparisons were based on t tests (14 articles), χ2 tests (21), and nonparametric ranking tests (10). The relations between dependent and independent variables were analyzed with simple regression (6 articles), multivariate regression (11), and logistic regression (8). Nine studies reported odds ratios with 95% confidence intervals, and seven analyzed test performance using sensitivity and specificity calculations. These papers used 128 statistical terms and context-defined concepts, including some from data analysis (56), epidemiology-biostatistics (31), modeling (24), data collection (12), and meta-analysis (5). Ten different software programs were used in these articles. Based on usual undergraduate and graduate statistics curricula, 64.3% of the concepts and methods used in these papers required at least a master's degree-level statistics education.
The interpretation of the current medical literature can require an extensive background in statistical methods at an education level exceeding the material and resources provided to most medical students and residents. Given the complexity and time pressure of medical education, these deficiencies will be hard to correct, but this project can serve as a basis for developing a curriculum in study design and statistical methods needed by physicians-in-training.
毕业后医学教育认证委员会的指南要求内科住院医师培养医学文献解读技能并理解研究原则。一个必要的组成部分是理解所使用的统计方法及其结果的能力，而这部分内容并非大多数医学院课程和住院医师培训项目的深入重点。鉴于当前医学文献的广度和深度以及对复杂、精密统计分析的日益重视，住院医师所需的统计学基础和教育尚不明确。
我们回顾了2013年1月1日至2013年6月30日期间在德克萨斯理工大学内科住院医师培训项目的期刊俱乐部讨论的49篇文章中所使用的统计方法和术语。我们收集了关于研究类型以及用于汇总和比较样本、确定自变量与因变量之间关系以及估计模型的统计方法的信息。然后我们确定了学习每个术语或方法的典型统计学教育水平。
总共14篇文章来自《美国医学会内科杂志》，11篇来自《新英格兰医学杂志》，6篇来自《内科学年鉴》，5篇来自《美国医学会杂志》，13篇来自其他期刊。20篇报告了随机对照试验。汇总统计包括均值（39篇文章）、类别计数（38篇）和中位数（28篇）。组间比较基于t检验（14篇文章）、χ²检验（21篇）和非参数排序检验（10篇）。使用简单回归（6篇文章）、多元回归（11篇）和逻辑回归（8篇）分析自变量与因变量之间的关系。9项研究报告了具有95%置信区间的比值比，7项研究使用敏感性和特异性计算分析检验效能。这些论文使用了128个统计术语和上下文定义的概念，包括一些来自数据分析（56个）、流行病学 - 生物统计学（31个）、建模（24个）、数据收集（12个）和荟萃分析（5个）的内容。这些文章使用了10种不同的软件程序。基于通常的本科和研究生统计学课程，这些论文中使用的64.3%的概念和方法至少需要硕士学位水平的统计学教育。
解读当前医学文献可能需要广泛的统计方法背景知识，其教育水平超出了大多数医学生和住院医师所接受的知识和资源范围。鉴于医学教育的复杂性和时间压力，这些不足将难以纠正，但本项目可作为开发培训中医生所需的研究设计和统计方法课程的基础。
