Physician numeracy: Essential skills for practicing evidence-based medicine

Department of Pediatrics, UPMC St. Margaret Family Medicine Residency Program and Center for EBM Education, University of Pittsburgh, PA, USA.
Family medicine (Impact Factor: 1.17). 06/2008; 40(5):354-8.
Source: PubMed


Teaching evidence-based medicine (EBM) has become common in family medicine residency programs. EBM teaching usually takes the form of journal clubs or encouraging residents to use EBM summaries of original articles. Both have significant limitations. Residents and other physicians recognize that understanding statistics is important for interpreting results. Unfortunately, they report low self confidence in this area reflected by studies that show poor skills. Physician numeracy refers to a broad range of mathematical skills needed for practicing medicine, including the statistical knowledge necessary to interpret original research papers. Numeracy should be given much more emphasis in residency curricula and can form the foundation of EBM teaching. Objectives for a numeracy curriculum based on a recent research article and a curriculum using an EBM framework are described.

5 Reads
  • Source
    • "Our data, therefore, not only fit well with earlier studies' findings, but also extend the field to a new domain. The results support the growing body of evidence showing that numeracy plays an important role in medical students' ability to interpret medical data (Sheridan & Pignone , 2002), physicians' capacity to practice evidence-based medicine (Rao, 2008), and clinicians' ability to communicate risk information to patients (Gigerenzer et al., 2008; Nelson, Reyna, Fagerlin, Lipkus, & Peters, 2008). Our data also corroborate earlier indications 3 It is possible that better performance with fewer plans is driven by chance, as participants had a higher probability of guessing correctly when faced with three plans compared with 10 or 20 plans. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In this study, we examined the effect of choice-set size and numeracy levels on a physician-in-training's ability to choose appropriate Medicare drug plans. Medical students and internal medicine residents (N = 100) were randomly assigned to 1 of 3 surveys, differing only in the number of plans to be evaluated (3, 10, and 20). After reviewing information about stand-alone Medicare prescription drug plans, participants answered questions about what plan they would advise 2 hypothetical patients to choose on the basis of a brief summary of the relevant concerns of each patient. Participants also completed an 11-item numeracy scale. Ability to answer correctly questions about hypothetical Medicare Part D insurance plans and numeracy levels. Consistent with our hypotheses, increases in choice sets correlated significantly with fewer correct answers, and higher numeracy levels were associated with more correct answers. Hence, our data further highlight the role of numeracy in financial- and health-related decision making, and also raise concerns about physicians' ability to help patients choose the optimal Part D plan. Our data indicate that even physicians-in-training perform more poorly when choice size is larger, thus raising concerns about the capacity of physicians-in-training to successfully navigate Medicare Part D and help their patients pick the best drug plan. Our results also illustrate the importance of numeracy in evaluating insurance-related information and the need for enhancing numeracy skills among medical students and physicians.
    Health Psychology 07/2010; 29(4):454-9. DOI:10.1037/a0019881 · 3.59 Impact Factor
  • Source
    • "Most psychological, legal, and medical articles on patient–doctor communication assume that the problem lies in the patient's mind. Doctors may be said to pay insufficient attention to their patients' feelings or not listen carefully to their complaints, consult with them only 5 minutes on average, or withhold information—but rarely is it considered that many doctors might be statistically illiterate (e.g., Berwick, Fineberg, & Weinstein, 1981; Rao, 2008). Why do doctors need minimum statistical literacy? "
    [Show abstract] [Hide abstract]
    ABSTRACT: Many doctors, patients, journalists, and politicians alike do not understand what health statistics mean or draw wrong conclusions without noticing. Collective statistical illiteracy refers to the widespread inability to understand the meaning of numbers. For instance, many citizens are unaware that higher survival rates with cancer screening do not imply longer life, or that the statement that mammography screening reduces the risk of dying from breast cancer by 25 % in fact means that 1 less woman out of 1,000 will die of the disease. We provide evidence that statistical illiteracy (a) is common to patients, journalists, and physicians; (b) is created by nontransparent framing of information that is sometimes an unintentional result of lack of understanding but can also be a result of intentional efforts to manipulate or persuade people; and
    Psychological Science in the Public Interest 11/2007; 8:53-96. DOI:10.1111/j.1539-6053.2008.00033.x
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Efficient health care requires informed doctors and patients. The health care system we inherited from the 20th century falls short on both counts. Most doctors and patients do not understand the available medical evidence. We identify seven "sins" that have contributed to this lack of knowledge: biased funding; biased reporting in medical journals, brochures, and the media; conflicts of interest; defensive medicine; and medical schools that fail to teach doctors how to comprehend health statistics. These flaws have generated a partially inefficient system that wastes taxpayers' money for unnecessary or even potentially harmful tests and treatments, and for medical research that is of limited relevance for the patient. Raising taxes or rationing care are often thought to be the only alternatives in the face of exploding health care costs. Yet there is a third option through promoting health literacy: getting better care for less money. The 21st century should become the century of the patient. Governments and health institutions need to change course and provide honest and transparent information, creating better doctors, better patients, and, ultimately, better health care.
Show more


5 Reads
Available from