|Year : 2017 | Volume
| Issue : 1 | Page : 10-14
A study of attitudes of teaching faculty and postgraduate residents at a tertiary care teaching hospital toward biostatistics
Devavrat G Harshe1, Deepti A Abraham2
1 Department of Psychiatry, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Kolhapur, Maharashtra, India
2 Department of Psychiatry, SSIMS Medical College, Hospital and Research Centre, Davangere, Karnataka, India
|Date of Web Publication||2-Feb-2017|
Devavrat G Harshe
Shree Plot No 43, Unit No 2, Ambai Defence Colony, Sagarmal, Kolhapur - 416 008, Maharashtra
Source of Support: None, Conflict of Interest: None
Context: Medical research is being encouraged in India and biostatistics is a vital tool. It is important to understand the attitudes toward biostatistics before teaching programs and workshops are conducted to empower clinicians with this vital tool. Materials and Methods: Eighty consenting participants were cross-sectionally assessed on a semi-structured questionnaire and two validated Likert type questionnaires on attitudes toward biostatistics. Results: Participants reported biostatistics to be the most difficult subject in the MBBS curriculum. Participants felt that their training in biostatistics so far was inadequate and ineffective. They reported that biostatistics would be better understood if taught by someone with a medical background and in 3rd MBBS. They accepted that biostatistics should be an important part and skill present in every member of a research team. Participants reported the wish to learn basic biostatistical skills to be able to perform and design their own research projects. Conclusions: There are negative attitudes toward biostatistics in faculty as well as residents and improvements in teaching techniques, as well as teaching policies, are necessary to bring about the necessary change.
Keywords: Attitudes, medical, statistics
|How to cite this article:|
Harshe DG, Abraham DA. A study of attitudes of teaching faculty and postgraduate residents at a tertiary care teaching hospital toward biostatistics. Muller J Med Sci Res 2017;8:10-4
|How to cite this URL:|
Harshe DG, Abraham DA. A study of attitudes of teaching faculty and postgraduate residents at a tertiary care teaching hospital toward biostatistics. Muller J Med Sci Res [serial online] 2017 [cited 2017 Mar 23];8:10-4. Available from: http://www.mjmsr.net/text.asp?2017/8/1/10/199362
| Introduction|| |
Every year, thousands of graduate students complete the MBBS curriculum in India. The aim of this syllabus is to equip every student with enough knowledge and skills of basic health sciences and faculties, which will prove vital in day-to-day practice, diagnosing common ailments, providing emergency lifesaving treatment, and recognizing the time and need for further referral to a specialty center. With this aim, the syllabus contains basic sciences such as anatomy, physiology, and biochemistry to paraclinical, diagnostic sciences such as pathology and microbiology and finally the clinical branches from general medicine to neuromedicine, from general surgery to plastic surgery and so on!
An important aspect of a doctor's job is to understand and assimilate the provided data, analyze findings and engage in research activities. An important tool necessary for all these tasks is biostatistics! Biostatistics also is vital in understanding certain epidemiological principles, such as incidence, prevalence, odds ratios, risk ratios, and number needed to treat. Biostatistics is also important for postgraduate residents for their dissertation and various research projects. Evidence shows ,,,, that despite all this motivation to learn and master biostatistics, clinicians have not shown the inclination to do so.
Currently, the statistics on research in India are not encouraging. It ranks 12th among the countries engaged in medical research and our publication share globally is <2%. Considering this, research in academic departments has started to gear up and “publish or perish” seems to be the new mantra. It is estimated that there are ~100,000 undergraduate students in India with ~1% of them are involved in a research project at a given time. Even the residents are conducting various research projects apart from their dissertations. For all those interested in research, biostatistics is more than a stepping-stone but is like a key to understand the literature, results, statistics, and principles of clinical research.
A positive attitude and an open mind are necessary to learn and assimilate any new subject or skill. Thus, it becomes vital to assess first the attitudes, beliefs, and misconceptions about a particular subject or issue among the stakeholders. Keeping all this in mind, this study was planned with the aim of studying and comparing the interest and attitude toward biostatistics as a subject in residents and faculty at a tertiary care teaching hospital.
| Materials and Methods|| |
The study was conducted at a tertiary care teaching hospital. The Institutional Ethics Committee approved the study protocol. All consenting residents and faculty registered at the tertiary care teaching hospital in various clinical, paraclinical and nonclinical departments (n = 80) were recruited in the study. Interns and undergraduate students were excluded from the study. Participants were assessed cross-sectionally on self-rated, structured questionnaires for their attitudes and beliefs toward biostatistics as mentioned below.
Semi-structured pro forma
A self-designed, semi-structured pro forma was used to gather data regarding the sociodemographic details, professional details and data regarding interest and liking of various subjects in the undergraduate course. Semi-structured pro forma included a visual analog scale for participants to rate their interest or liking toward various subjects taught in their undergraduate training. Participants were also asked to report their interest and performance in mathematics during their schooling. Professional details included data on a number of publications and number of research methodology workshops attended.
Survey of Attitudes Toward Statistics-28
Survey of Attitudes Toward Statistics-28 (SATS-28),, is a 28 item scale developed by Schau et al. We obtained consent from Candace Schau through E-mail before using the scale in the study. SATS-28 assesses the attitudes toward biostatistics across four domains; affect (positive and negative attitudes toward statistics), cognitive competence (attitudes about knowledge and skills in statistics), value (attitudes about how much value statistics hold in daily and professional life), and difficulty (attitudes about difficulty of statistics as a subject). The rater has to rate each item on a scale from 1 to 7 with 1 being strongly disagree and 7 being strongly agree. Each domain contains certain negatively worded items with reverse scoring instructions. From validation studies have shown high Cronbach's alpha values for four subscales (0.72–0.90). Higher the score on SATS-28 or any subscale, more positive the attitude toward biostatistics.
Clinician's attitudes toward biostatistics in medicine
We also used the questionnaire used by West and Ficalora. Consent was obtained from Dr. Collin West before using the questionnaire in the study. It is an 18-item questionnaire adapted from various standardized questionnaires. It tests the attitude of the rater across four domains; (1) general perceptions, (2) perceptions of knowledge and training, (3) perceptions of biostatistics and research and (4) perceptions of biostatistics and evidence-based medicine.
Collected data were pooled in a spreadsheet and analyzed. Sociodemographic and professional status was analyzed with descriptive statistics. Chi-square and Fisher's exact tests were used to compare dichotomous and qualitative variables. Spearman's correlation was used to assess the relationship between quantitative variables. Statistical significance was assumed at P < 0.05
| Results|| |
The study sample consisted of 80 participants with males (69%; 55/80) outnumbering females (31%; 25/80).
The study sample consisted of equal distribution of residents (49%) and faculty (51%). Nearly, two-third of the study population (67.5%; 54/80) was from clinical departments, followed by paraclinical (29%; 23/80) departments [Table 1].
Seven-one percent of the study sample had published one or more original research articles, and 46% had published one or more case reports.
Attitudes toward medical education, research, and biostatistics as a subject
Seventeen percent of the study sample reported absolutely no interest in research, whereas 13% reported having a definite interest in research. There was no significant difference in the attitude toward research across gender (χ2 = 4.353, P = 0.226), education (χ2 = 1.337, P = 0.720), specialty (χ2 = 59.940, P = 0.067), designation (χ2 = 19.662, P = 0.352) and history of attending a research methodology workshop (χ2 = 3.972, P = 0.680). Interest in research was reported significantly more frequently by those who were published authors than those who were not (90 vs. 66%, χ2 = 10.867, P = 0.014).
Participants reported the highest levels of interest and liking in general medicine and surgery, whereas preventive and social medicine (PSM) and biostatistics were reported as subjects of least liking and interest during undergraduate education [Figure 1]. Females reported significantly higher interest and liking than males in dermatology (71 vs. 59, t = 2.085, P = 0.040) and obstetrics-gynecology (77 vs. 61, t = 2.593, P = 0.011) during their undergraduate training. No significant difference was observed in perceived interest and liking for any other subject across gender, education and designation, publication status. Reported interest and liking in biostatistics did not differ across gender and designation.
|Figure 1: Perceived level of interest in subjects in undergraduate curriculum on a visual analogue scale (0 – no liking or interest in the subject to 100 – most liked subject/subject with highest level of interest)|
Click here to view
Sixty-five percent of the study participants reported that biostatistics should be taught in or after the 7th term of MBBS.
Male participants reported significantly higher scores than females on affect and cognitive competence subscales of SATS-28 [Table 2]. SATS subscale scores did not correlate significantly with age.
|Table 2: Mean Survey of Attitudes Toward Statistics-28 scores between gender and professional designations (n=80)|
Click here to view
Attitudes toward biostatisticians and biostatistics as a skill
Sixty percent of the participants reported that they skip the “results” section of a research paper and jump to conclusions directly. Seventy percent of the study participants thought only a biostatistician should carry out statistical analyses in a research project. Thirty percent of the study participants reported they would like to perform bio-statistical operations if given proper training, and 30% had carried out the statistical analyses of their research projects at least once. Thirty percent of the participants reported that biostatisticians should be given authorship credit in a research project.
Only 15% of the participants believed that their training in biostatistics so far is adequate, and 48% reported that the biostatistics course or workshop they last attended was not effective. Seventy percent believed that biostatistician is an important part of a research team, whereas 85% believed that even the members of research team should have basic biostatistical skills [Table 3].
|Table 3: Attitudes toward biostatistics as a skill (n=80) on questionnaire used by West and Ficalora|
Click here to view
| Discussion|| |
This study plays an important part and finds the key attitudes and beliefs medical professionals and students have about biostatistics as a subject and biostatistics as a skill.
The first and foremost finding was the very low interest and liking reported by participants for both biostatistics as well as PSM during their undergraduate training. PSM again is a subject, which focuses on epidemiological and statistical aspects of health-related issues, which may explain the lack of interest and liking, reported. Nearly 40% of the participants thought that biostatistics is more difficult than any other subject taught during MBBS. Postgraduate residents have reported biostatistics to be a difficult subject in existing literature  and so have dentists., Studies have shown attitudes toward biostatistics to be predicted by performance in mathematics at school. Even in this study, the cognitive competence and affective subscale scores of SATS were higher in those who had more interest in mathematics at school. A silver lining to all this was, majority of the participants accepted that biostatistics is an important part in a research project, and even the members of a research project should have a basic knowledge about biostatistics.
Next important observation was about teaching biostatistics. Majority of the participants felt that their training in biostatistics was inadequate, and teaching was not effective. Participants also felt that it would have been better if their biostatistics teacher had had a medical background. A feeling shared by a sample of Indian dentists. In the UK based study, participants reported that biostatistics curriculum should be relevant to and applicable to future clinical practice. Nearly 70% of our participants thought that biostatistics should not be taught in the 3rd term of MBBS, but in the 7th term or later. In India, biostatistics lectures are usually taken in 2nd MBBS and first term of 3rd MBBS. 2nd MBBS curriculum includes largely paraclinical subjects, and a student is very recently exposed to clinical subjects. Therefore, it is quite difficult for students to understand and master the concepts of incidence, prevalence, odds ratios, sensitivity, specificity, and risk ratios. A change in medical, educational policy may prove to be the key to this problem.
This study also evaluated the consequences of these negative attitudes toward biostatistics. More than half the participants reported skipping the “results” section of a manuscript and jumping straight to the discussion part. Reasons reported were, (1) unable to understand the statistical terms, (2) same information can be obtained by reading the discussion part and most importantly (3) getting scared and/or intimidated by the statistical terms. Thus, it is necessary to conduct more biostatistics workshops with the aim of (1) providing necessary knowledge and skills in students and faculty and (2) clearing the misconceptions and anxiety toward biostatistics.
Small sample size was a limitation in the study.
| Conclusion|| |
Thus to conclude, there are negative attitudes toward biostatistics as a subject, but positive attitudes toward learning and mastering biostatistics as a skill. Majority of the participants felt their training in biostatistics was inadequate and were enthusiastic to learn. Participants suggested that teaching biostatistics by someone with a medical background and scheduling the lectures 3rd MBBS onward will be a helpful and more productive way of learning biostatistics.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
| References|| |
Berwick DM, Fineberg HV, Weinstein MC. When doctors meet numbers. Am J Med 1981;71:991-8.
Reznick RK, Dawson-Saunders E, Folse JR. A rationale for the teaching of statistics to surgical residents. Surgery 1987;101:611-7.
Wulff HR, Andersen B, Brandenhoff P, Guttler F. What do doctors know about statistics? Stat Med 1987;6:3-10.
Altman DG, Bland JM. Improving doctors' understanding of statistics. J R Stat Soc A 1991;154(Pt 2):223-67.
O'Donnell CA. Attitudes and knowledge of primary care professionals towards evidence-based practice: A postal survey. J Eval Clin Pract 2004;10:197-205.
Gupta BM, Bala A. A scientometric analysis of Indian research output in medicine during 1999-2008. J Nat Sci Biol Med 2011;2:87-100.
Pawar DB, Gawde SR, Marathe PA. Awareness about medical research among resident doctors in a tertiary care hospital: A cross-sectional survey. Perspect Clin Res 2012;3:57-61.
Dauphinee TL, Schau C, Stevens JJ. Survey of attitudes toward statistics: Factor structure and factorial invariance for females and males. Struct Equ Modeling1997;4:129-41.
Schau C, Stevens J, Dauphinee T, Del Vecchio A. The development and validation of the survey of attitudes toward statistics. Educ Psychol Meas 1995;55:868-76.
Hilton SC, Schau C, Olsen JA. Survey of attitudes toward statistics: Factor structure invariance by gender and by administration time. Struct Equ Modeling2004;1:92-109.
West CP, Ficalora RD. Clinician attitudes toward biostatistics. Mayo Clin Proc 2007;82:939-43.
Zhang Y, Shang L, Wang R, Zhao Q, Li C, Xu Y, et al.
Attitudes toward statistics in medical postgraduates: Measuring, evaluating and monitoring. BMC Med Educ 2012;12:117.
Batra M, Gupta M, Dany SS, Rajput P. Perception of dental professionals towards biostatistics. Int Sch Res Notices 2014;2014:291807.
Shetty AC, Al Rasheed NM, Albwardi SA. Dental professionals' attitude towards biostatistics. J Dent Oral Hyg 2015;7:113-8.
Zimprich D. Attitudes towards statistics among swiss psychology students. Swiss J Psychol 2012;71:149-55.
Miles S, Price GM, Swift L, Shepstone L, Leinster SJ. Statistics teaching in medical school: Opinions of practising doctors. BMC Med Educ 2010;10:75.
[Table 1], [Table 2], [Table 3]