Cognition, comprehension and application of biostatistics in research by Indian postgraduate students in periodontics.

BACKGROUND: Biostatistics is an integral part of research protocols. In any field of inquiry or investigation, data obtained is subsequently classified, analyzed and tested for accuracy by statistical methods. Statistical analysis of collected data, thus, forms the basis for all evidence-based conclusions. AIM: The aim of this study is to evaluate the cognition, comprehension and application of biostatistics in research among post graduate students in Periodontics, in India.
MATERIALS AND METHODS: A total of 391 post graduate students registered for a master's course in periodontics at various dental colleges across India were included in the survey. Data regarding the level of knowledge, understanding and its application in design and conduct of the research protocol was collected using a dichotomous questionnaire. A descriptive statistics was used for data analysis.
RESULTS: Nearly 79.2% students were aware of the importance of biostatistics in research, 55-65% were familiar with MS-EXCEL spreadsheet for graphical representation of data and with the statistical softwares available on the internet, 26.0% had biostatistics as mandatory subject in their curriculum, 9.5% tried to perform statistical analysis on their own while 3.0% were successful in performing statistical analysis of their studies on their own.
CONCLUSION: Biostatistics should play a central role in planning, conduct, interim analysis, final analysis and reporting of periodontal research especially by the postgraduate students. Indian postgraduate students in periodontics are aware of the importance of biostatistics in research but the level of understanding and application is still basic and needs to be addressed.

INTRODUCTION

The application of mathematics in biology has become increasingly popular in recent years as the application of mathematical statistics to the explanation of various biological processes has proven fruitful. Biostatistics includes epidemiology, design and analysis of clinical trials in human and veterinary medicine, population genetics, biological sequence analysis, ecology and much more. In this era of evidence-based practice, people working in scientific research find it mandatory to apply concepts of biostatistics into their work if they want to share their results with the scientific community.[1]

Biostatistics can be defined as “The science of statistics applied to the analysis of biological or medical data”. It is an integral part of clinical research process and it plays a central role in planning, conduct, interim analysis, final analysis and reporting of clinical trials. Most health care professionals agree that biostatistics is a necessary tool for evaluating scientific literature and is an important part of evidence-based practice. However, assessment of statistical knowledge of medical clinicians has shown minimal improvement during the past decades, suggesting that little is known about how to accomplish such improvement.[2]

A good understanding of biostatistics and epidemiology can improve clinical decision-making, program evaluation and medical research with regard to both individuals and groups of people.[3] A review by of the available literature revealed a sole source of evidence (Maha et al. 2009) on this subject as it relates to dentistry.[4]

Periodontal research, right from its inception as a specialization, deals with outcome assessment and comparative analysis of population variables, materials, and basic sciences. As such, it includes a wide range of epidemiological and clinical studies and therefore, requires a thorough understanding of biostatistics, which would better equip the practicing clinician to critically review the literature and formulate an informed decision on the validity of novel diagnostic methods and the effectiveness of treatment modalities. This is the reason that courses on biostatistics and epidemiology have been included in all guidelines of contemporary postgraduate periodontic education aiming to provide relevant familiarity and competence.

There are about 282 dental colleges in India, of which around 122 colleges provide a master's degree in periodontics. As a mandatory requirement for the fulfillment of master's degree, several dissertations and studies are being completed every year in the specialty of periodontics. These research protocols require the application of statistics ranging from simple descriptive analysis to complicated, multifactorial comparisons and correlations. Nearly all of these statistical analyses are performed by qualified statisticians and very rarely, by the investigators themselves. Therefore, the present study was aimed at evaluating the cognition, comprehension and application of biostatistics in research among Indian postgraduate students in periodontics.

MATERIALS AND METHODS

The study involved 391 postgraduate students registered for a mandatory master's degree in periodontics at various postgraduate dental institutions across India between May 2007 and June 2009. Students belonged to 1st , 2nd and 3rd year of the master's program. The study protocol was reviewed by the institutional review board and was approved by the ethical committee of Mamata Educational Society.

A questionnaire was formulated for which the responses had to be dichotomous (Yes/no). This questionnaire consisted of 12 questions [Box 1] primarily aimed to assess the level of Knowledge (Q.NO. 1, 2, 10 and 11), understanding (Q.NO. 3, 4, 7 and 12) and the application of Biostatistics (Q.NO. 5, 6, 8 and 9) by the participating postgraduate students in their research. The questionnaires were sent to the postgraduate students through e-mail. All 391 students responded to the study. As the survey assessed qualitative parameters such as knowledge and level of understanding, the responses were analyzed using descriptive analysis. Strict confidentiality regarding identity of students was ensured. No contact/correspondence with students which might influence the quality of their inputs, was made.

Box 1

Questionnaire used for the study

RESULTS

The results obtained are summarized in Table 1.

Table 1

Opinions of the respondents who took part in the study

Three hundred and ten students (79.2%) were aware of the importance of biostatistics in research, [Figure 1]. Three hundred forty two students (88.2%) admitted that they have knowledge in biostatistics while 257 (65.7%) of them had basic knowledge. Three hundred forty six students accept that knowledge about biostatistics is a must for postgraduate trainees and 253 students said that biostatistics is part of their curriculum [Figure 2]. Two hundred thirty six students conducted at least one study requiring statistical analysis during their course at the time of replying to the questionnaire.

Figure 1

Response to questions evaluating the awareness (cognition) of subjects about biostatistics

Figure 2

Response to questions evaluating the level of understanding (comprehension) of subjects about biostatistics

When it comes to the application of biostatistics, 244 students consulted a statistician regarding their study but only 208 students have participated in the statistical analysis along with their statistician. On an average, 342 students were aware and were familiar with the use of MS-EXCEL spreadsheet for graphical representation of data and softwares for statistical analysis of data available on the internet [Figure 1]. Thirty seven students had attempted to perform statistical analysis for a study on their own, among which only 12 were successful [Figure 3].

Figure 3

Response to questions evaluating the application of biostatistics by subjects

DISCUSSION

Statistics fulfills a substantial role in the scientific method taking into account the organization, description, analysis and interpretation of the data and thus becomes a valuable tool in evidence based dentistry. When used judiciously and appropriately, biostatistics sheds additional light and clarity upon subjects under study. Its proper use converts scientific assumptions into proven facts. On the other hand, misuse can result in confusion and variation because the results or conclusions of the studies are without merit.

Articles in dental publications frequently include both descriptive and inferential statistics. To a great extent, authors (and editors) of dental publications rely upon professional statisticians who are experts in the field and have more than just a casual familiarity with dentistry.[56] However, biostatistics is yet to be implemented as a mandatory subject in the curriculum of a life scientist in India. During the regular studies at bachelor and master level, most dental students consider biostatistics as an obstacle tending to make their education more difficult. However, once they begin with the master's and later on with a Ph.D. thesis, they realize the importance of biostatistics.[1] Thus we aimed to evaluate the knowledge (cognition), level of understanding (comprehension), and application of biostatics, among postgraduate students in periodontics, in India.

Similar to the present study many surveys have been conducted to record the knowledge of health care professionals on biostatistics and epidemiology, as well as to identify influencing factors in medical sciences. These surveys have mainly targeted specializing physicians and have shown that even those who are more familiar with the literature and research principles have limited biostatistical knowledge and an impaired capacity to understand a number of epidemiological basics.[7]

The results of the present study show that among 391 students who participated in the study, the understanding of importance of biostatistics among periodontic postgraduate students seemed to be adequate (80%), the level of knowledge of statistical methods seemed to be basic among the majority of the participants (66%). The application of biostatistics by the postgraduate students themselves was poor (12%). In other words, most of them depend upon professional statisticians for statistical aspect of their studies or publications. In a recent survey conducted by Best and Laskin among oral and maxillofacial surgery residents, it was shown that they lacked knowledge in biostatistics and the interpretation of research and so were unprepared to interpret the results of published clinical research.[8]

In the present study 64.7% students said that biostatistics is part of their curriculum and only about half of the participating students (55-65%) were familiar with the use of MS-EXCEL spreadsheet and softwares for statistical analysis of data. A survey conducted by Sundefeld et al.[9] to assess the inclusion of biostatistics in schools of dentistry in Brazil concluded that the teaching of biostatistics must be incentivated in all schools of dentistry in Brazil.

The present study also throws light on the lack of self application of biostatistics by periodontic postgraduate students and their dependence on professional statisticians which might be due to incomplete knowledge on biostatistics. A recent survey by West and Ficalora demonstrated that only a small percentage (17.6%) of medical students, internal medicine residents, and internal medicine teaching faculties believe that they have adequate training in biostatistics, while even fewer (14.6%) feel adequately prepared to conduct a statistical analysis.[10] These results throw light on the need to introduce biostatistics as a mandatory science in postgraduate curriculum. Lectures and continuing dental education programs highlighting the importance, increasing the knowledge and application of biostatistical principles by postgraduate students in research should be conducted both at a basic and advanced level. This would encourage more statistically designed research and benefit the postgraduate students to analyze study results with minimal guidance from external sources.

Certain limitations exist in this study. First, there is scope for bias while filling the questionnaire. Secondly, the parameters assessed were qualitative and thus were analyzed only descriptively. Further more detailed interceptive analytical studies addressing role of biostatistics in biomedical fields are required. Lastly, this study was addressed exclusively to periodontic postgraduate students. Nonetheless, the results might be generalized to dental specialty training, since biostatistics at the graduate level is usually taught within the core course program, and as such is directed to postgraduate students in general. The validity of this hypothesis is confirmed by the results of a recent survey, where the statistical knowledge of dental postgraduate students was not influenced by the curriculum of a specific dental specialty.[4]

CONCLUSION

Indian postgraduate students in periodontics are aware of the importance of biostatistics in research however the level of comprehension and application needs to be addressed and improved to a higher level. Biostatistics should play a central role in planning, conduct, interim as well as final analysis and reporting of periodontal research especially by the postgraduate students. Its intelligent use in research design and/or in the evaluation of the dental literature that we read can help us differentiate between the “gold” and the “dross.”