senior medical students knowledge and attitudes towards biostatistics faculdade de medicina da...

SENIOR MEDICAL STUDENTS KNOWLEDGE AND ATTITUDES TOWARDS BIOSTATISTICS

Faculdade de Medicina da Universidade do Porto

Introdução à Medicina – 2007/2008Class 8

IntroductionIntroduction AimsAims MethodsMethods

Study ParticipantsStudy Participants Data Collection MethodsData Collection Methods Survey DescriptionSurvey Description Variables DescriptionVariables Description Stastical AnalysisStastical Analysis

ResultsResults DiscussionDiscussion Acknowledgments Acknowledgments AuthorsAuthors

For this, we used an adapted survey used on an

American study - «Medicine Residents’ Understanding

of the Biostatistics and Results in the Medical

Literature» JAMA, 2007.- which had the same goals as our

study.

Biostatistics is an important and often disregarded

aspect of medical education.

In this way, we developped a study, enquiring senior

medical students attending to our college – Faculdade de

Medicina da Universidade do Porto (FMUP) – in order to

understand:

►their medical literature reading habits;

►the relevance they give to biostatistics;

►their capacity to analyse and interpretate biostatistic

data.

Main aims: Main aims: To understand students attitudes towards biostatistics, namely their

medical literature reading habits;

To evaluate senior medical students on their knowledge on

analysing biostatistics data;

To identify which factors have influence on their knowledge on

biostatistics and on their medical journals reading habits.

SecondarySecondary aims: aims: Compare our results with the results obtained in the study we based

on. (“Medicine Residents' Understanding of the Biostatistics and

Results in the Medical Literature”; JAMA; 2007).

Study participants were selected among the 5Study participants were selected among the 5thth year medical year medical

students of Faculdade de Medicina da Universidade do Porto.students of Faculdade de Medicina da Universidade do Porto.

7 classes

(194 students)

4 classes

selected

(class 2, 3, 5 e 6)

Potential

sample:

87 students

As we had a small response rate in

our last presentation, we decided

to enlarge our sample to all the

medical students attending to the

5th year

Potential

sample: 194 students

After the changes we made to the sample and with a

response rate of 41%, our analysed sample is

composed by 80 medical students attending to 5th year

of Faculdade de Medicina da Universidade do Porto, in

which:

35 (43,8%) are men;

45 (56,3%) are women.From the 194 students on the 5th year, 120 (62%) are women

and 74 (38%) are men. So, even though the fact our

population have more women than men, men’s response rate

(47,3%) is higher than women’s response rate (37,5%).

We delivered the paper based questionnaire through the

cooperation of some 5th year students - group I, and also through

AEFMUP (Associação de Estudantes da Faculdade de Medicina da

Universidade do Porto) - group II.

We delivered the paper based questionnaire through the

cooperation of some 5th year students - group I, and also through

AEFMUP (Associação de Estudantes da Faculdade de Medicina da

Universidade do Porto) - group II.

During the background research we found in the article

«Medicine Residents’ Understanding of the Biostatistics «Medicine Residents’ Understanding of the Biostatistics

and Results in the Medical Literature» (and Results in the Medical Literature» (JAMAJAMA, 2007) , 2007) a

survey which focused the same aspects that based our

project.

During the background research we found in the article

«Medicine Residents’ Understanding of the Biostatistics «Medicine Residents’ Understanding of the Biostatistics

and Results in the Medical Literature» (and Results in the Medical Literature» (JAMAJAMA, 2007) , 2007) a

survey which focused the same aspects that based our

project.

We analysed, translated and adapted this

questionnaire and used it as our data

collection instrument.

We analysed, translated and adapted this

questionnaire and used it as our data

collection instrument.

Group I Group II

Totaln (%) n (%)

Number of surveys recieved

30 (37,5%) 50 (62,5%) 80 (100%)

GenderMales 12 (27,9%) 31 (72,1%) 43

Female 18 (46,6%) 19 (53,4%) 37

MedicalLiteratureReadingHabits

I do not read. 23 (45,1%) 28 (54,9%) 51

Foreign Journals 5 (20%) 20 (80%) 25

National Journals 2 (50%) 2 (50%) 4

KnowledgeLevel

[10,14[ 11 (35,5%) 20 (64,5%) 31

[14,17] 4 (28,6%) 10 (71,4%) 14

]17,20] 15 (42,9%) 20 (57,1%) 35

The response

rate through 5th

year medical

students was

38,0% and the

response

through AEFMUP

was 43,5%.

AEFMUP was a more efficient method of

delivering surveys, and getting a higher

percentage of solved surveys.

This survey This survey is divided in two different sectionsis divided in two different sections and is and is

composed by eighteen questionscomposed by eighteen questions::

First Section:First Section:

Individual Questions:

- subjective character;

- regarding attitudes.

Second Section:Second Section:

Multiple-choice questions :

- objective character;

- regarding knowledge.

This survey This survey is divided in two different sectionsis divided in two different sections and is and is

composed by eighteen questionscomposed by eighteen questions::

First Section:First Section:

Two are related with participants description (gender and final grade

of Introdução à Medicina);

Six about attitudes and interest on biostatistics;

Four questions in which participants have to evaluate themselves

about their abilities on biostatistics.

Second Section:Second Section:

Six to test their knowledge by analyzing data, graphics and their

critical position about methods used in several studies.

Survey adjusts: introduction of Q2 (final grade of Introdução à

Medicina);

in Q3 (medical literature reading habits), we

included the discreteness between national and

international journals;

introduction of Q8 (importance given to the

teaching of Biostatistics in the medical curriculum);

As the original survey was too long, we shortened

it by eliminating questions regarding their

knowledge.

Our study variables are based on the questions composing the

survey.

General Variables :

Gender – Q1 (nominal categorical);

Final grade of the subject Introdução à Medicina – Q2 (ordinal

categorical).

Then, we divided the subsequent variables in two groups: the

ones related to attitudes and others related to knowledge on

biostatistics.

Attitudes Related Variables :

one nominal (Q3) and five ordinal categorical variables (Q4, Q5, Q6, Q7,

Q8) related to the interest on biostatics;

four ordinal categorical variables (Q9, Q10, Q11, Q12) related to

students self-evaluation on their abilities on the matter.

Knowledge Related Variables :

six ordinal categorical variables (Q13, Q14, Q15, Q16, Q17, Q18) that

arise from the second part of our survey.

From all these categorical variables, we created three

continuous ones, which are: knowledge test grade (Q13, Q14,

Q15, Q16, Q17, Q18); interest grade (Q4, Q5, Q6, Q7, Q8) and

self-evaluation grade (Q9, Q10, Q11, Q12). All these variables

were rated in a scale of 0 to 20.

The variable Medical literature reading habits (Q3) is

dependent of all other variables with which is

related on [TABLE1] of the Results section.

The same is applied to the variable Knowledge (final

grade of survey’s second part) on [TABLE2] of the

same section.

In the relation between the Interest on Biostatistics

(Q4) and the Importance given to this subject (Q8),

Q4 is dependent of Q8.

SPSS 15.0 for WindowsSPSS 15.0 for Windows®® ― analysis of collected ― analysis of collected

data through the survey;data through the survey;

Tests used in data analisys: Tests used in data analisys:

► Mann-Whitney test; Mann-Whitney test;

► Chi-square test; Chi-square test;

► T-Student testT-Student test;;

► One Way ANOVAOne Way ANOVA..

Significant relations found:

Medical journals reading habits (Q3) and Interest on learning more

about biostatistics (Q4) – p=0,003 [TABLE 1];

Importance given to biostatistics in Medicine Curriculum (Q8) and

Interest on learning more about biostatistics (Q4) – p=0,001;

Importance given to biostatistics in Medicine Curriculum (Q8) and

Knowledge – p=0,028 [TABLE 2];

Interest on learning more about biostatistics (Q4) and Knowledge –

p=0,015 [TABLE 2 and GRAPHIC 1].

Characteristic

Medical Literature Reading habits

Read Do no readp-value

n (%) n (%)

Q4a

I disagree 6 (7.5%) 29 (36.3%)

0.03****Neutron

10

(12.5%)14 (17.5%)

I agree13

(16.3%)8 (10%)

Q5b

I disagree 7 (8.8%) 19 (23.8%)

0.371****Neutron 16 (20%) 20 (25%)

I agree 6 (7.5%) 11 (13.8%)

Q6c

I disagree 3 (3.8%) 1 (1.3%)

0.327****Neutron 5 (6.3%) 11 (13.8%)

I agree21

(26.3%)39 (48.8%)

Q7d

I disagree 4 (5%) 3 (3.8%)

0.295****Neutron 6 (7.5%) 7 (8.8%)

I agree19

(23.8%)41 (51.3%)

Q8e

I disagree 4 (5%) 6 (7.5%)

0.779****Neutron 5 (6.3%) 12 (15%)

I agree 20 (25%) 33 (41.3%)

* T-test** One way ANOVA*** Mann-Whitney Test**** Chi-Square Testa “If I had a chance, I would live to learn more about biostatistics.”b “I can understand almost all of the statistical terms I encounter in journal articles.”c “I believe that biostatistics is valid scientific methodology.”d “To be an intelligent reader of literatute, it is necessary to know something about biostatistics.”.e “Biostatistics teaching is important on the medical curriculum.”.

TABLE 1 - Medical Literature Reading Habits (Q3) related with the remain variables from the survey first section which regards attitudes (Q4-Q8).

Those who revealed to be more interest on learning more about biostatistics are the ones who have

medical literature reading habits

CharacteristicKnowledge Levels

n (%)Mean

(SD)p-value

Gender

Male 35 (43.8)10.2

(3.3) 0.164*

Female 45 (56.3) 9.3 (3.1)

Grade of Introdução a Medicina

I did not have this subject 1 (1.3) 11.1

0.132**

[10, 14[ 11 (13.8) 8.0 (2.8)

[14, 17] 63 (78.8) 9.9 (3.3)

]17, 20] 5 (6.3)10.0

(3.1)

Medical Literature Reading Habits

I do not read 51 (63.8) 9.9 (3.1)

0.131**Foreigner Journals 27 (33.8) 9.5 (3.4)

National Journals 2 (2.5) 5.6 (1.6)

Interest on Biostatistics

[4, 12[ 22 (27.5) 8.7 (2.8)

0.076*[12, 20] 57 (71.3)

10.1

(3.2)


TABLE 2- Knowledge level related with all the variables that arisen from the first part of the survey; regarding sample characteristics (Q1, Q2), attitudes (Q3-Q8); and the variables created to measure interest and confidence.

These variables do not have a significant

relation, which means that knowledge on biostatistics is not

influenced by students’ interest on learning more

about it.

CharacteristicKnowledge Levels

n (%)Mean

(SD)p-value

Q4a

I disagree/Neutron 59 (73.8) 9.2 (2.9)0.015*

I agree 21 (26.3) 11.0 (3.4)

Q5b


I agree 17 (22.0) 9.1 (3.3)

Q6c


I agree 60 (75.0) 9.8 (3.3)

Q7d


I agree 60 (75.0) 10.0 (3.2)

Q8e


I agree 53 (66.3) 10.3 (3.3)

Self-evaluation

[4, 12[ 46 (57.5) 9.8 (3.3)0.685***

[12, 20] 34 (42.5) 9.5 (2.9)


TABLE 2- Knowledge level related with all the variables that arisen from the first part of the survey; regarding sample characteristics (Q1, Q2), attitudes (Q3-Q8); and the variables created to measure interest and confidence.

Knowledge on biostatistics is influenced by the importance given

to it.

GRAPHIC1: Relation between knowledge and interest on biostatistics (Q4).

Those students who reveal to have higher interest on

learning more about biostatistics are the ones who obtained better results on the

knowledge test.T-Students Test -

p=0,015

We can not make a correct comparison

between the studies, but it

seems that there is not many

differences between American and Portuguese’s medical students

knowledge on biostatistics.

Questio

nsObjective

Correct Answers (%)

FMUP’s

students

JAMA

article

Q13-a Identify continuous variables 82,5 43,7

Q13-b Identify continuous variables 51,3 41,5

Q13-c Identify continuous variables 73,8 32,9

Q14Recognize the purpose of

double-blind studies88,8 87,4

Q15-a Identify ANOVA 46,3 47,3

Q15-b Identify Chi-Square Test 26,3 25,6

Q15-c Identify T-Student Test 46,3 58,1

Q16Interpret 95% CI and

statistical significance2,5 11,9

Q17Determine which test has

more specificity56,3 56,7

Q18

Interpret odds ratio in

multivariate regression

analysis

35 37,4[TABLE3]: Percentage of correct answers to the common question of our study and the American study «Medicine Residents’ Understanding of Biostatistics and Results in the Medical Literature» (JAMA, 2007).

The main conclusion we take was that it is not the medical literature reading habits, but the interest on learning more about biostatistics that has influence

on the level of knowledge.

At the same time, medical journals reading habits is related to the students’ interests.

So, this allows us to say that students which are more interested are the ones who read more medical journals and the ones who knows more about

biostatistics.

Our study limitations are: small sample constituted only by medical

students from the 5th year and from a single

medical school – Faculdade de Medicina da

Universidade do Porto;

the possibility that students may have not paid

the correct attention while they were

answering the survey;

The comparison between our study and the American

study published on JAMA – «Medicine Residents’

Understanding of the Biostatistics and Results in the

Medical Literature» (2007) – thought the application of

statistical tests is impracticable because:

our target population is slightly different from theirs, as we

enquired senior medical students, while their target population

referred mostly to interns;

their sample was divided in several groups with different

characteristics ;

the survey we used was not exactly the same they used, as we

find the need to adapt the latter to a Portuguese context .

We would like to thank to all the 5th year

medical students that cooperate with us.

Without their help and availability this work

wouldn’t be possible.

Subject’s Main Professor: Altamiro da Costa Pereira,

MD, PhD

Adviser: Armando Pinto, PhD

Ana Carolina Araújo Ana Margarida MesquitaAna Mafalda David Ana Sofia CorreiaClara GomesJoana SilvaJoão AfonsoJosé Pedro SalvadorMaria Gabriel JacobMarta GomesNádia FakirRicardo MatosRui MoraisSolange Gonçalves

Class 8

senior medical students knowledge and attitudes towards biostatistics faculdade de medicina da...

Documents

medical literature jama

medical journals

biostatistics faculdade

students attitudes

th year students group

analysing biostatistics

th year of faculdade

th year potential sample