Odette Wegwarth
Statistical Illiteracy in Residents: What They Do Not Learn Today Will Hurt Their Patients Tomorrow
health care providers highly rated sources health information1 thus responsibility helping patients understand potential benefits harms medical prevention intervention falls largely upon physicians physicians fulfill task news front encouraging eddy2 reported already three decades ago 95 100 physicians overestimated probability breast cancer positive mammography test result order magnitude recently bramwell colleagues3 found 1 21 obstetricians able estimate probability unborn child actually syndrome given positive test confident estimates furthest away correct response naylor et al4 showed physicians rated effectiveness treatment much higher benefit described terms relative risk reductiona medical intervention results 34 relative decrease incidence fatal nonfatal myocardial infarctionthan described absolute risk reductiona medical intervention results 14 decrease incidence fatal nonfatal myocardial infarction25 vs 39 none 20 german gynecologists aware serious risk mammography overdiagnosis asked specifically harms screening program5 survey 50 australian physicians 8 able understand explain number needed treat others6 70 412 us primary care physicians based recommendation favor screening test 5year survival rates although misleading metric context screening7 studies document phenomenon considerable number physicians statistically illiterate understand statistics disciplinegiven evidence corroborating statistical innumeracy many fully licensed physicians results study anderson colleagues8 statistical illiteracy residents reported issue journal graduate medical education may come surprise 12 4713 surveyed obstetricsgynecology residents able correctly answer 2 simple questions medical statistics one meaning p value assessing positive predictive value mammography screening practical relevance latter question particularly striking uninformed 88 residents say first patient asks chance truly breast cancer given positive mammogramstatistically illiterate physicians doomed rely statistically illiterate conclusions local custom mostly inaccurate promises pharmaceutical sales representatives leaflets price innumeracy paid patients undergo medical procedures without correctly informed expect schwartz colleagues9 investigated stratified sample 479 american women underwent regular mammography screening 92 believed screening could harm woman without breast cancer fact every woman saved breast cancer death mammography 10 healthy women would diagnosed without screening wrongly diagnosed breast cancer treated unnecessarily it10 results representative study 9 european countries 10 000 participants amplify depressing evidence us study frequent consultation physician correlated better understanding screening benefit rather overestimating it11what study anderson et al8 identifies achilles heel physicians statistical illiteracy medical training nearly 75 surveyed residents considered statistical education adequate time nearly 90 surveyed residents got 2 simple statistical questions wrong far back 1937 editorial lancet stressed importance statistics medicine criticized physicians educational blind spot yet 75 years later still ongoing initiative association american medical colleges address statistical literacy medical school education12 medicine holds longstanding antagonism toward statistics many profession dismiss medical statistics impersonal irrelevant individual patient imagining oneself situation abovementioned patient positive mammogram makes clear personal individually relevant medical statistics fortunate patient physician statistically literate physician would able tell chance breast cancer positive mammogram 10 may allay worry awaiting results testing odds meeting physician regrettably lowensuring future patients receive counseling need responsibility medical educators undoubtedly need improve quality teaching medical statistics also vital responsibility every medical student licensed physician remain curious statistical issues yet understood demand take seriously highquality statistical education medical schools residency programs specialty organizations change physician expectations odds patients benefit greatly