Medical statistics is an important branch of statistics. It is the application of statistical theories and methods in medical and biological research. Medical students are required to take some medical statistics courses to enable them to design, analyze and interpret experimental data in their research areas, or to make and interpret complex clinical decisions for patients. Therefore, the teaching of medical statistics is advocated during the training of all categories of medical students
In China, medical statistics has traditionally been taught at the undergraduate level of medical students, usually as a course or a single unit embedded in a preventive medicine course. In the postgraduate period, medical students learn statistics in a stand-alone compulsory course that introduces systematic statistical knowledge to meet their needs and applications in both research and clinical practice. The contents of the course include descriptive statistics, some important probability distributions, some methods of estimation, hypothesis testing (t-test, analysis of variance, Chi-square test), nonparametric statistics, correlation and regression, factorial experiments, general experimental design, and the application of SPSS software. After completing a basic medical statistics course, medical postgraduates can select advanced statistics courses, such as complicated experimental design, survival analysis and multivariate statistical analysis.
Although medical statistics is very important in the training of medical students, it is considered to be a course that is difficult to teach and learn
. Most students have complained that statistics is more difficult than other subjects in medical training.
Many factors may influence learning statistics, such as a poor mathematical basis or background. However, statistics teachers have paid more attention to improving the cognitive aspects of instruction and little regard has been given to non-cognitive aspects, such as student attitudes toward statistics
. The attitudes represent a summation of emotions and feelings experienced over time in the context of learning a course. Artino
[4, 5] highlighted the importance of designing learning environments and confirmed that medical students’ motivational beliefs and achievement emotions were important contributors to their academic achievement. The existing literature has shown that attitudes play a crucial role in learning statistics. Students’ attitudes can hinder or assist learning statistics, especially negative ones, and can influence directly their understanding of statistical concepts and methods
[6, 7]. They also can affect whether students will develop useful statistical thinking skills and apply statistics knowledge in their future professional careers.
 reported that between 75% and 80% of graduate students tended to develop uncomfortable levels of statistics anxiety. Green
[9, 10] reported a small to moderate relationship between attitudes and achievement in statistics at the post-secondary level. In our teaching experiences, negative affective responses to statistics are common among medical students who have enrolled in a statistics course. We always hear the following feelings or ideas involving this subject: “Statistics is a very difficult course”, “I was terrified when I learned statistics”, “I can’t learn this subject because my mathematics basis is very poor”, and “I will never use it, so I don’t really need to learn it”.
Individual demographic and academic factors and learning backgrounds may influence students’ attitudes toward statistics. Baloglu
 reported that age was a factor influencing statistics anxiety and that previous mathematics experience significantly affected undergraduate students’ levels of statistics anxiety. Onwuegbuzie
 found that gender might influence students’ attitudes toward statistics. Camona
 and Camichael
 also confirmed that students’ previous mathematics experience was an important source of attitudes toward statistics.
A few studies have been conducted to measure and monitor students’ attitudes in the area of statistics
. Several scales measuring attitudes toward statistics have been developed, such as the Attitudes Toward Statistics scale (ATS)
 and the Survey of Attitudes Toward Statistics (SATS)
. The most commonly mentioned and used scale in recent studies was the SATS which was developed and validated by Schau (Additional file
1). The SATS is a cross-cultural tool and it has been confirmed and used with success internationally
[13, 17, 18].
The existing studies have identified and measured attitudes toward statistics in high school and undergraduate students, but no one has focused on postgraduate attitudes, especially among medical postgraduates. Postgraduates have different characteristics to high school students and undergraduates, such as age, educational and professional backgrounds and research experience. To understand current attitudes held by medical postgraduates regarding statistics, we conducted a cross-sectional survey to measure these attitudes and explored their influencing factors. We also explored the relationships between the attitudes with course achievement and monitored their changes through the semester. We hope that this study may contribute to reducing student anxiety about learning medical statistics and to increasing teacher awareness of this topic.