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Residents may need training in interpreting statistics


Doctors' decisions are constantly affected by new findings presented in medical journals. However, a recent study from researchers at the Yale School of Medicine shows that physicians just out of medical school have difficulty interpreting the statistics presented in medical articles, possibly affecting how they understand and apply the new findings to clinical practice. Researchers took several journals, including The New England Journal of Medicine, and presented actual summaries, charts, and tables in the form of multiple choice questions to nearly 300 internal medicine residents from more than 10 different residency programs. The new doctors received scores of 41 percent on average on the test, implying that there were significant deficits in their understanding of the statistics presented in the journal articles. The residents who had been trained in biostatistics or who had a degree in public health performed better than those without that training. "The study shows that most residents lack the necessary background in biostatistics to interpret medical research," said lead author Dr. Donna Windish.

BOTTOM LINE: Most internal medicine residents have difficulty interpreting statistics in medical journals, potentially reducing the quality of care they offer their patients.

CAUTIONS: The researchers examined only internal medicine residents - they have yet to study residents from other specialties, such as surgery, pediatrics, and obstetrics-gynecology. Experienced doctors, who might or might not have a better grasp on statistics from their years of experience, were not studied.

WHAT'S NEXT: Since residents with training in statistics did better on the exam, the research group plans to test a new statistics curriculum in a residency program to see whether this affects the residents' ability to interpret journal articles.

WHERE TO FIND IT: The Journal of the American Medical Association, Sept. 5.


Primary care doctors may be less attentive in treatment

Depressed patients being treated by primary care physicians often get mediocre care, according to a new study. Researchers with the RAND Corporation, a nonprofit research organization, enlisted 1,131 depressed patients from 45 primary-care practices across 13 states for their two-year study. Every six months, researchers examined how closely the doctors adhered to treatment guidelines and how much the participants' depressive symptoms improved. They found that the primary care doctors were good at detecting depression - successfully identifying it 80 percent of the time - but were not as good at adhering to treatment guidelines or following up with patients after diagnosis. Only 46 percent of the participants (and 26 percent of elderly patients) received minimal treatment - either psychotherapy or antidepressants. Quality of care especially affected recovery among patients with the most serious symptoms. Primary care providers often don't get the full picture of the depression and don't identify commonly associated problems such as alcoholism and suicidal tendencies, according to the study's senior author, Dr. Lisa V. Rubenstein.

BOTTOM LINE: "Though primary care providers detect depression and pay attention to it, they don't adhere to guidelines in follow-up treatment," said Rubenstein, who is also a physician at the Veterans Affairs Greater Los Angeles Healthcare System.

CAUTIONS: The study is based on data reported by patients whose recall of the care they received could be less than perfect.

WHAT'S NEXT: Rubenstein said she hopes the study will encourage primary care providers to offer better follow-up treatment for their depressed patients, perhaps by getting trained nurses to check on them.

WHERE TO FIND IT: Annals of Internal Medicine, Sept. 3.


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