156 – Statistical Literacy 2012

Getting the Gist of Health Risks

at University of Colorado Denver School of Medicine

Many clinicians admit to having difficulty with numbers. When tested on their ability to interpret health statistics they have performed poorly. There is increasing awareness that numeracy, a person’s ability to draw meaning from numbers, is important in medical decision making and central to clinical judgment. Three powerful forces combine to promote numeracy as a core competency of modern patient care: 1) the consensus around informed patient decisionmaking; 2) the ascendency of evidence-based medicine; and 3) the increasing focus on high-value care. Nonetheless, interpreting health statistics receives scant attention in medical education and quality improvement efforts. Several key statistical skills such as understanding the difference between relative and absolute risk and understanding that prevalence of a disease influences the value of a test have been shown to be important for clinical judgment. We call these skills - and other quantitative skills fundamental to patient care - Clinician Numeracy (CN). CN can be defined as “the ability to use numbers and numeric concepts in the context of taking care of patients.� CN includes 3 domains: primary numeric skills, interpretive numeracy, and applied numeracy. CN is fundamental to the practice of everyday medicine because it affects the conclusions clinicians draw from the tests they order and the medical literature they read. The applied numeracy domain deals directly with patient care tasks. These tasks include: 1. risk communication tasks such as using numbers to communicate probabilistic information about potential harms and benefits to patients and 2. decision making tasks like balancing harms and benefits to make a given medical decision. Unfortunately, we cannot currently assess CN because there is no valid measure to test these skills in clinicians. Indeed, measuring the range of skills inherent in the domains of CN may be too much for a single measure. Nonetheless, a way of assessing these skills would be useful. A valid measure would help determine to what extent CN affects clinical performance and provide a means of testing improvement in these skills with educational interventions. Fortunately, a modern theory of medical decision making with a growing body of support (fuzzy trace theory) provides a potential avenue of assessing essential numeracy skills. This theory asserts that medical decisions are most often based on gist-based intuition or “simple, bottom-line representations of the meaning of information or experience.� We have developed a conceptual model utilizing this theory to show how CN might be related to medical decision making and health outcomes via the ‘risk gist.’ We present preliminary work on the development of the Critical Risk Interpretation Test which seeks to evaluate the appropriateness of a clinician’s risk gist. Finally, we discuss how the conceptual framework we have developed allows us to test hypotheses regarding the effect of risk gist on risk communication tasks and medical decision making.