Physician numeracy as the basis for an evidence-based medicine curriculum

Most medical schools and postgraduate programs devote some time to teaching evidence-based medicine (EBM). EBM encompasses five essential skills, including constructing a sound clinical question, literature searching, critical appraisal, gaining a full understanding of study results, and integration of results into patient care. Gaining a full understanding of results requires understanding the statistical aspects of and terminology associated with the design, analysis, and results of original research--hereby referred to as physician numeracy. Physicians and physicians-in-training recognize the importance of these concepts but are uncomfortable with and demonstrate poor knowledge of the quantitative aspects of research. This is not surprising since few curricula include physician numeracy. Current approaches to teaching EBM rely on journal clubs, which have not been shown to improve participants' self-perceived EBM skills. In this paper we describe a novel approach to teaching EBM which makes use of five guiding principles: (1) Journal clubs have important limitations, (2) understanding the quantitative aspects of research promotes an in-depth understanding of papers, (3) physician numeracy can form the basis of an EBM course, (4) consumers of original research ought to determine what is useful about a paper rather than whether or not it is useful, and (5) numeracy should encompass only those concepts needed to accurately interpret evidence and apply it to individual patients. An EBM curriculum based on physician numeracy is described, together with the challenges inherent to this approach.