I appreciate Dr. Irani's thoughtful insights from his experience with a physician numeracy curriculum. I certainly understand the first two challenges that he presents. In fact, we indicated in our article that the greatest challenge to adopting a physician numeracy framework is identifying interested and knowledgeable faculty members who can teach the material.
My 10 years of experience in recruiting teaching faculty for small groups have taught me three important lessons. First, physicians who self-identify as having expertise in evidence-based medicine (EBM) typically are most familiar with other EBM skills such as literature searching and framing clinical questions, and far less proficient in physician numeracy. Furthermore, their experience in teaching EBM is often limited to leading journal clubs or other types of experiences in which they play a relatively passive role. Second, epidemiologists and biostatisticians are often highly “numerate” but are not familiar with what medical students and physicians need to know or with how to link numeracy to actual clinical situations. The ideal recruit for our course has been an enthusiastic clinical faculty member with a fondness for numbers and quantitative reasoning who is willing to learn. This, of course, means that there is a tremendous need for faculty development in physician numeracy—the third important lesson.
At our medical school, we are trying in different ways to meet the need for faculty development in physician numeracy. For the course, new facilitators with an interest in physician numeracy are paired with more experienced facilitators for their first year. In many cases, they learn the material along with the students. These “faculty apprentices” then move on to lead their own small groups independently in subsequent years (or with new apprentices). Indeed, this was the path that Dr. Irani followed while training in our institution.
Dr. Irani points out that the question of whether physician numeracy is best taught in small groups or in more traditional ways, such as lectures, remains unresolved. This is definitely an area worth exploring further. For the time being, in our school, we use a hybrid approach that includes both lectures and small groups.
I am hopeful that if there are sufficient faculty development efforts, both in this country and in Dr. Irani's, the number of highly numerate physicians will increase significantly, making the implementation of courses in physician numeracy much easier.
Goutham Rao, MD
Assistant dean for faculty development, University of Pittsburgh School of Medicine (UPSM), Pittsburgh, Pennsylvania; editor-in-chief, Medical Education Development; associate professor of pediatrics, UPSM; and clinical director, Weight Management and Wellness Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; [email protected].