Statistics, a missing link in our school and college education for aspiring health professionals

Illustration: TBS

When I was a college student, we were divided into three groups: one would take biology as the main subject, while the others would take either statistics or computer science (some colleges had different arrangements for optional subjects). Most students used to choose higher mathematics as the 'fourth subject.' Students aspiring to be doctors chose, of course, biology, and the common perception was that statistics is for the aspiring engineers, and biology for the future doctors. 

We grew with the notion that statistics is irrelevant for doctors. Still, We only may need it if someone fails to enter the medical college and ends up in other subjects. There was hardly any chance for a medical aspirant student to get familiar with statistics. This air of apathy, if not hatred, for statistics, defined, and perhaps still defines, the psyche of the medical aspirants. Later, in fact, much at an irreversibly advanced stage of my career, I realized how harmful this stat-abhorrence turned out in my career progress and learning curve.  

In our medical college curriculum, there is no opportunity to learn statistics either. One only learns briefly the definition of 'mean,' 'median,' and 'mode' and, if lucky, a few more rudimentary concepts as part of the 'Community Medicine' subject, and that's all the knowledge one acquires on statistics in medical colleges. 

As we know, statistics is the most important subject for quantitative research. Without a sound knowledge of statistics, it is almost impossible to carry out simple research work, let alone develop a research career. When I pursued my doctoral studies at Johns Hopkins Bloomberg School of Public Health, I shared dorms with medical students. All of them had a good knowledge of statistics. They used it to read scientific journal articles, conduct clinical research, and make data-driven clinical decisions. We, the Bangladeshi colleagues, jokingly remarked, "In the USA, one cannot become a doctor without doing research, while in Bangladesh, one cannot do research, being a doctor."

This very wrong decision of depriving a large proportion of our students of an essential subject for research has a far-reaching consequence. I cannot speak for other disciplines, but as a public health researcher, with a background in medicine, I can share about the health sector. In any discipline or profession, lifelong learning is the key in the current times. To update oneself with the recent developments, one needs to refer to the innovations, scientific discoveries, and new knowledge in that field. 

Without appreciation and understanding of statistics, it is difficult to stay abreast of the latest scientific discoveries and developments. Very few of our medical doctors, with rare exceptions, of course, can decipher the statistical tables, graphs, or data presented in peer-reviewed scientific journals. This situation is a hindrance to evidence-based medical practice. 

Every year, many medical graduates opt for higher studies. There is a thesis part in all types of degrees, such as MS, MD, FCPS, MPhil, etc. All of these post-graduate students suddenly find themselves thrown in front of a totally unknown beast, 'statistics.' Due to the lack of any familiarity with this subject since the high school or college days, and a lack of training in medical colleges, these students face dire straits.

The limited class hours in research methods in post-graduate courses and the ineptitude of the faculty members add insult to injury. As a result, most of these students are forced to adopt different unfair means in the thesis, which could be the most exciting and valuable part of their post-graduate training.

Many of these students plagiarize from older theses, falsify data without even collecting or analysing them, or just employ some clandestine agencies lurking in Nilkhet or Aziz Supermarket to 'help' the distressed post-graduate students get out of the soup. With a hefty amount, these unprincipled academic agents fabricate data, do sham analysis, and produce a thesis report for the students. Without proper training in statistics, many of the evaluators themselves, too, fail to identify or rectify the problem.

Some of these students, who are more enthusiastic, or do not have the money to employ an academic agent, or simply want to adhere to academic ethics, take a longer route to make amends for the mistake made not by them but by our education policy-makers. They spend their valuable post-graduate time hopping from short courses to short courses on research methods, biostatistics, epidemiology, etc. 

Some even get themselves enrolled into a totally different degree program, most commonly a Masters in Public Health (MPH), which is quite expensive in most private universities. It also has two big problems for the MPH programs (although some universities do not bother about it as long as the money keeps pouring in).

Dr Taufique Joarder. Illustration: TBS

First, these students are actually not interested in public health discipline; they are there only to hone their statistics capacity and eventually apply to their original field of study. This approach wastes the money and time of the post-graduate students. Second, this clogs up space for genuine public health enthusiasts, who might be desperate to enroll in a public health program of their choice.

Another obvious ramification for not having the option to study statistics is that our health studies are not developing due to the lack of research activities. With a sparse population (compared to Bangladesh) of 11,193,470, we know that Cuba has developed two advanced Covid-19 vaccines. Soberana 2 is in the third phase trial, while Abdala is already in population-level use in Cuba and a few other countries, with remarkable efficacy. 

This example indicates their proficiency in biomedical research, which we could not even get close to, in the absence of our lack of a research culture in the health field, especially clinical health research. Should we blame our medical graduates for this or deduce we, as a nation, have inherent incompetence in research? No, this ineptness in biomedical, clinical, and health research stems from the wrong decision our educations installed at a budding stage of our educational development.  

I want to end this article by sharing my personal journey on navigating the conundrum of biostatistics; and recommending suggestions for our education decision-makers. I was lucky as I did not want to be a clinician after medical graduation. I am fortunate because, otherwise, I had to go door to door, like most post-graduate clinical students, to learn the basics of research methods. 

In every step of my public health education, i.e., during my MPH course, doctoral studies, and even beyond, while conducting independent research, I failed to overcome the shortcomings I acquired from my high school or college days. I keep on trying, cursing my luck not having had the opportunity to build my basics in statistics. 

Bangladesh is on its course to achieve middle-income country status. In doing so, it must develop its own national research portfolio. According to the Global Innovation Index 2020, Bangladesh occupies the 116th position among 131 countries, which is unfortunate. Research in general and biomedical, clinical, and public health research in particular demands our future leaders in these fields are equipped with the right basic skills from the early days. Exclusion of an essential subject like statistics in high school and college education will not help build a biomedical, clinical, public health research stock for a middle-income-status-aspiring country like Bangladesh.

Dr Taufique Joarder is the Health Policy and Systems Researcher, Vice-Chairperson, Public Health Foundation, Bangladesh