Ongoing advances in knowledge and technology in healthcare has offered new and better ways to solve the key health problems. On the other hand, increasing volume and diversity of information, controversies, and complexities, particularly with the increasing cost of medical care, has required greater knowledge in order to make decisions about the care of individual patients or the delivery of health services.
Evidence based medicine has reduced the emphasis on unsystematic clinical experience and pathophysiological rationale, and instead focused attention on critical appraisal of clinical research, which is considered the source of the evidence .
For health professionals to be able to fully understand the results of research, and to make decisions after critically reviewing the evidence, they need to be equipped with knowledge of biostatistics and epidemiology. Moreover, reading literature and identifying serious flaws in design, analyses and interpretation begins early in the training of health professionals and continues throughout their careers [2, 3].
A clear statement was made during the Edinburgh Declaration of the World Medical Association in 1988; the purpose of the medical education is to produce professionals who are able to understand the needs of their communities and respond accordingly . This requires physicians who are familiar with the community and its health problems and know what is required for their prevention and solutions .
To achieve this, medical students must gain professional skills and theoretical knowledge in how to obtain the reference ranges of "normal values" for various biochemical and physiological measures. These measures are used to make the diagnosis and identify diseased from healthy individuals. Additionally, determining test validity, designing research, and drawing inference requires knowledge of sampling, and calculation of prevalence, rate and proportion, and risk. Without this a doctor may draw disastrous conclusions from his/her clinical experience because he/she has no concept of appropriate scientific method.
The role of biostatistics and epidemiology is well recognized in the curricula of medical schools in developed and developing countries but with great variability from school to school in terms of time allocated, scope, and depth of topics covered. For instance in the majority of medical schools in the USA, biostatistics, which also includes related subjects such as epidemiology, preventive medicine demography, and medical informatics, is taught during the first or second year over more than one term as a component of the public health training . In Ziauddin university in Pakistan, epidemiology, biostatistics, and survey methodology courses are taught in the first two years of medical school . In South Africa biostatistics and research methodology are taught in year 1 and 2 with further reinforcement practiced in year 3 and 4 in some universities , and in 44 medical schools in Turkey, biostatistics is usually taught in the 1st year .
Outcome based medical education could be viewed as the modern model that focuses on measuring student performance rather than on the resources available to the student [10, 11]. Several studies in the field have emphasized the decisive role that students' perceptions and attitudes about a subject play in the achievement of educational outcomes [12–14]. Perception is defined as the process of attaining awareness or understanding of sensory information, which an individual exhibits towards certain processes, situations, objects or persons .
Biostatistics and epidemiology are taught together in year 2 at Universiti Teknology MARA (UiTM) as a short course of 4 weeks. The short course is offered as a communicable disease module under the population health and preventive medicine discipline. The objectives of this course are (1) to enable medical students to understand the language and principles of biostatistics and epidemiology, (2) to highlight the nature and the distribution of disease(s), and (3) to teach students to design their own research projects, as well as to be able to critically read and understand scientific papers in medical journals. Thus it covers basic theoretical concepts about epidemiology and biostatistics along with hands-on sessions of computer application software. The software includes Statistical Package for Social Sciences (SPSS), Power and Sample Size Calculation (PS), and Epi Info. In this module emphasis was given to the understanding of concepts rather than carrying out routine statistical computations.
The module is composed of formal lectures, computer lab sessions for hands-on exercise, directed self learning sessions, problem based learning sessions, and two movies about outbreak investigation and control. The sequence of the topics was carefully observed so that epidemiology and biostatistics were taught in a parallel manner to amalgamate the knowledge of the two topics. Each lecture of biostatistics was followed by a hands-on session when applicable. The hands-on sessions are to train students to do basic statistical analyses using computer software. At the end of each week of the module the students undertake a directed self-learning session. The session is a scenario of a common health problem that includes topics taught in that specific week, and based on that scenario the students have to answer a number of questions that integrate knowledge of epidemiology and biostatistics. Thus, in the same question there may be epidemiological and statistical concepts. Problem based learning sessions are meant to integrate other basic science knowledge in the context of epidemiology and biostatics. "See Additional file 1 "
The main objective of the current study was to assess the perceptions of Year 2 medical students towards the Biostatistics and Epidemiology module. Statistics in most literature is reported to be the cause of negative perception [16–19]. In spite of this, we could not separate biostatistics and epidemiology in the questionnaire because the syllabus is designed in such a way that the two are complemented. We propose that an understanding of student's perceptions provides important elements in the development of enhanced educational strategies leading to better learning outcomes.