title: The Importance of Medical Students' Attitudes Regarding Cognitive Competence for Teaching Applied Statistics: Multi-Site Study and Meta-Analysis.
abstract: BACKGROUND
  The scientific community increasingly is recognizing the need to bolster standards of data analysis given the widespread concern that basic mistakes in data analysis are contributing to the irreproducibility of many published research findings. The aim of this study was to investigate students' attitudes towards statistics within a multi-site medical educational context, monitor their changes and impact on student achievement. In addition, we performed a systematic review to better support our future pedagogical decisions in teaching applied statistics to medical students.
  
  
  METHODS
  A validated Serbian Survey of Attitudes Towards Statistics (SATS-36) questionnaire was administered to medical students attending obligatory introductory courses in biostatistics from three medical universities in the Western Balkans. A systematic review of peer-reviewed publications was performed through searches of Scopus, Web of Science, Science Direct, Medline, and APA databases through 1994. A meta-analysis was performed for the correlation coefficients between SATS component scores and statistics achievement. Pooled estimates were calculated using random effects models.
  
  
  RESULTS
  SATS-36 was completed by 461 medical students. Most of the students held positive attitudes towards statistics. Ability in mathematics and grade point average were associated in a multivariate regression model with the Cognitive Competence score, after adjusting for age, gender and computer ability. The results of 90 paired data showed that Affect, Cognitive Competence, and Effort scores demonstrated significant positive changes. The Cognitive Competence score showed the largest increase (M = 0.48, SD = 0.95). The positive correlation found between the Cognitive Competence score and students' achievement (r = 0.41; p<0.001), was also shown in the meta-analysis (r = 0.37; 95% CI 0.32-0.41).
  
  
  CONCLUSIONS
  Students' subjective attitudes regarding Cognitive Competence at the beginning of the biostatistics course, which were directly linked to mathematical knowledge, affected their attitudes at the end of the course that, in turn, influenced students' performance. This indicates the importance of positively changing not only students' cognitive competency, but also their perceptions of gained competency during the biostatistics course.
authors.affiliation: Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.|Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, United States of America.
authors.forename: Natasa M
authors.initials: NM
authors.lastname: Milic
authors.affiliation: Department of Primary Health Care and Public Health, Faculty of Medicine, University of East Sarajevo, Foca, Bosnia and Herzegovina.
authors.forename: Srdjan
authors.initials: S
authors.lastname: Masic
authors.affiliation: Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Jelena
authors.initials: J
authors.lastname: Milin-Lazovic
authors.affiliation: Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Goran
authors.initials: G
authors.lastname: Trajkovic
authors.affiliation: Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Bukumiric
authors.affiliation: Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Marko
authors.initials: M
authors.lastname: Savic
authors.affiliation: Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Nikola V
authors.initials: NV
authors.lastname: Milic
authors.affiliation: Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Andja
authors.initials: A
authors.lastname: Cirkovic
authors.affiliation: Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Milan
authors.initials: M
authors.lastname: Gajic
authors.affiliation: Department of Public Health, Medical Faculty, University of Pristina, Kosovska Mitrovica, Serbia.
authors.forename: Mirjana
authors.initials: M
authors.lastname: Kostic
authors.affiliation: Department of Public Health, Medical Faculty, University of Pristina, Kosovska Mitrovica, Serbia.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Ilic
authors.affiliation: Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Dejana
authors.initials: D
authors.lastname: Stanisavljevic
mesh_terms: D000124:Achievement; D000367:Age Factors; D001291:Attitude of Health Personnel; D056808:Biostatistics; D016208:Databases, Factual; D006801:Humans; D008433:Mathematics / Q000193:education*; D012737:Sex Factors; D013337:Students, Medical / Q000523:psychology*; D014495:Universities