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OBJECTIVES

CAVEAT: The most important objective is to help you understand the interaction between clinical research and clinical medicine. How does (or should) information previously obtained on groups of patients inform clinical decisions on individuals?

A. Attitudes

1. Increased confidence and comfort approaching journal articles.
2. Preference for evidence over authority.
3. Desire for independent learning.
4. An "ecologic" view of clinical medicine that acknowledges limitations of knowledge and resources.
5. An appreciation of the fun and satisfaction of learning and teaching this material.
   

B. Knowledge

1. Understanding the diagnostic process.
2. Risk (and costs) of diagnostic, screening, and prognostic tests.
3. Interpreting diagnostic data.
4. Quantifying effects of treatments.
5. Bayesian understanding of P-values and confidence intervals.
6. Challenges to evidence-based medicine

C. Skills

1. Calculation of and comfort with sensitivity and specificity.
2. Calculation of posterior probability and test thresholds using likelihood ratios.
3. Calculation of and comfort with risk ratios, odds ratios, number needed to treat.
4. Critical appraisal of clinical research articles.

PREREQUISITES

Designing Clinical Research (Epi 202). Exceptions may be made with the consent of the Course Director, space permitting. The course has a strong clinical component, so will be more challenging for students without any medical background (e.g., some PhDs). If you are in that category, let us know if you have ideas about how we can make the course work better for you.

FACULTY

TEXTBOOKS

We (Tom and Michael) have written a 12-chapter Evidence-Based Diagnosis textbook that is sufficient reading for the course.

Optional additional textbooks

For back-up, you might want to check out at least one of the following books.

Clinical Epidemiology: The Essentials by Robert Fletcher and Suzanne Fletcher. Lippincott Williams and Wilkins. 4th Edition. 2005. This is an excellent book, which (we hope) complements rather than competes with ours. The choice of subject matter and methods of exposition are somewhat different but the content is all valuable, even if you don't necessarily need it for this course.

User's Guide to the Medical Literature: A manual for evidence-based clinical practice edited by Gordon Guyatt, Drummond Rennie, Maureen Mead and Deborah Cook. McGraw Hill Medical. 2008. This is an excellent reference for learning and teaching evidence-based medicine, far beyond what we can teach in this course. It also has the advantages of a web site with many web-based tools, a whole network of people working not only on the material itself, but on how best to teach it (including TN), and an approach that is used throughout the world. There's also an abbreviated version, User's Guide to the Medical Literature: Essentials of Evidence-Based Clinical Practice, by Gordon Guyatt, Drummond Rennie (McGraw Hill Medical, Paperback - 2008).

Other options

These are also good books with somewhat different approaches or less overlap with the course material. There's good stuff in each of them.

Clinical Epidemiology: The Study of the Outcome of Illness by Noel S. Weiss. Oxford University Press. 2006. This is another good book by one of the leaders in the field.

Evidence-based Medicine: How to Practice and Teach EBM by Sharon Strauss, W. Scott Richardson, Paul Glasziou, Rosenberg, and R. Brian Haynes. Churchill Livingstone. 3rd edition. 2005.

Understanding Medical Information by Theresa J. Jordan. McGraw Hill. 2002. This is a very basic book that assumes no prior medical knowledge and hence may be helpful for those with little previous clinical experience.

Should I Be Tested for Cancer?: Maybe Not and Here's Why by H. Gilbert Welch. University of California Press. 2004. Average rating on Amazon 4.95* based on 19 reviews. This is a superb, clearly written book. It is written for lay people, but has plenty of meat for health professionals. I would require it except that it only covers a small subset of the material for the course.

Some of the material can also be found (in abbreviated form) in Hulley et al., Designing Clinical Research, 3rd Edition, particularly in Chapter 12, which is partly based on this course.

The statistical software package Stata (Stata Corporation, College Station, Texas) is used in the program. The TICR Program has arranged for a sizeable discount for UCSF-affiliated personnel via the Stata GradPlan program.

ENROLLMENT

This course is open to a limited number of individuals outside of the ATCR and Master's programs. Preference is given to UCSF-affiliated personnel. We regret that auditing is not permitted. To apply for this course please fill out and submit the application below. Cost and submission information are in the application.

Application (Word doc, 20KB)