title: Numeracy among trainees: are we preparing physicians for evidence-based medicine?
abstract: BACKGROUND
  In the era of evidence-based medicine, all physicians who communicate with patients need numerical literacy (numeracy). Single-institution studies suggest imperfect numeracy among medical students. Therefore, we sought to examine numeracy and understanding of risk analysis among medical students and surgical residents at several institutions.
  
  
  METHODS
  Following a validated 3-item numeracy questionnaire, 308 medical students and 50 surgical residents from 4 institutions were asked whether they would recommend adjuvant chemotherapy for a patient based on presented survival data. Main outcome measures included numeracy, understanding of risk with a question requiring simple calculation of risk reduction, and confidence in understanding risk reduction using a Likert score (0 = no confidence and 7 = complete confidence). Binary logistic regression analysis identified predictors of misunderstanding of risk and Pearson correlation coefficients measured differences in confidence by level of training and numeracy.
  
  
  RESULTS
  Students across institutions did not differ demographically and were grouped by educational level. Of all participants, 69.0% had perfect basic numeracy (score = 3), with no significant difference in numeracy across training levels (p = 0.433). Mean (standard deviation) confidence in recommending treatment increased from 4.5 (1.6) for first-year medical students to 4.8 (1.1) for fourth-year medical students, and 4.9 (1.5) for surgical residents (p = 0.580). Controlling for other demographics, poorly numerate students had a 7-fold increased likelihood (odds ratio: 7.330; 95% confidence interval: 1.384-38.809) of misunderstanding risk compared with more numerate students.
  
  
  CONCLUSIONS
  A significant number of students at various levels of medical training lack numeracy skills, which increases misunderstanding and miscommunication of risk that can be communicated to patients and families. This deficiency could potentially affect patient safety and care.
authors.affiliation: Wills Eye Institute at Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address: timothyvjohnson@gmail.com.
authors.forename: Timothy V
authors.initials: TV
authors.lastname: Johnson
authors.affiliation: Department of General Surgery, Beth Israel Deaconess Medical Center, Harvard School of Medicine, Boston, Massachusetts.
authors.forename: Ammara
authors.initials: A
authors.lastname: Abbasi
authors.affiliation: Department of Ophthalmology, Tulane University, New Orleans, Louisiana.
authors.forename: Evan D
authors.initials: ED
authors.lastname: Schoenberg
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Rachel
authors.initials: R
authors.lastname: Kellum
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Lisa DeAnn
authors.initials: LD
authors.lastname: Speake
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Spiker
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Anna
authors.initials: A
authors.lastname: Foust
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kreps
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Chad W M
authors.initials: CW
authors.lastname: Ritenour
authors.affiliation: American Cancer Society, Atlanta, Georgia.
authors.forename: Otis W
authors.initials: OW
authors.lastname: Brawley
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
mesh_terms: D000328:Adult; D003479:Curriculum; D003657:Decision Making; D004504:Education, Medical, Undergraduate; D019317:Evidence-Based Medicine / Q000193:education*; D005260:Female; D006801:Humans; D058980:Information Literacy; D008297:Male; D018570:Risk Assessment; D013223:Statistics as Topic; D013337:Students, Medical; D055815:Young Adult
keywords: Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; decision making; medical education; medical students; numerical health literacy; risk assessment