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 EPI 204

Clinical Epidemiology
EPI 204 Fall 2018 (3 units)


This course is largely about using information from tests to guide decisions. Although the tests discussed are medical and the decisions are often treatments, the principles apply to any problem of decision making under uncertainty. We will cover the basics of prediction, including:

  • sensitivity, specificity, predictive value
  • likelihood ratios, ROC curves
  • sesire for independent learning.
  • calibration plots, net benefit calculations, decision curves
  • logistic regression, and recursive partitioning (at an introductory level).

Evaluating a test for a medical condition requires knowing the benefits and risks of treating the condition, so we will cover quantifying treatment effects using the results of randomized controlled trials. Additional topics will include:

  • special issues related to the evaluation of screening programs
  • inter-observer agreement, reliability, and measurement error
  • Bayesian understanding of P-values and confidence intervals
  • cognitive bias in diagnosis and decision-making

The course emphasizes solving problems based on published studies in the medical literature and real clinical situations. We developed it for students with medical backgrounds, but students without medical backgrounds have excelled and found the course valuable. We endeavor to explain all clinical terms.


Designing Clinical Research (EPI 202). Exceptions may be made with the consent of the Course Director, space permitting. The course has a strong clinical component, so will be more challenging for students without any medical background. If you are in that category, let us know if you have ideas about how we can make the course work better for you.


1:11 PM 9/11/2017
Course Director:

Michael Kohn, MD, MPP
Phone: 415-514-8142
email: michael.kohn@ucsf.edu

Faculty Section Leader: Thomas Newman, MD
email: newman@epi.ucsf.edu
Benjamin Breyer, MD, MAS
email: benjamin.breyer@ucsf.edu
Martina Steurer-Mueller, MD, MAS
email: martina.steurermuller@ucsf.edu
Miriam Laker-Oketta, MD, MSc
email: drmiriaml@yahoo.co.uk
Teaching Assistant Section Leaders: Kirk Fergus
Kerstin Kolodzie, MD, PhD
Ryan McMahan
Samuel Washington, MD


  1. Lectures: Thursdays: 8:45 to 10:15 AM, September 20 through December 6. Lecture recordings will be available online later in the day. To determine if you have sufficient bandwith to view online lectures, please visit our demonstration site.

  2. Small Group Sections
    Content: Overview and discussion of lectures, and review of homework assignments.
    Time: Thursdays: 1:00 to 2:30 PM. beginning Sept. 20.

All course materials and handouts will be posted on the course's online syllabus.


We are working on the second edition of our 12-chapter Evidence-Based Diagnosis textbook. We will post the required reading from this book as Word documents on the course syllabus site.

Optional textbooks

For back-up, you might want to evaluate at least one of the following books.

Clinical Epidemiology: The Essentials by Robert Fletcher and Suzanne Fletcher. Lippincott Williams and Wilkins. 5th Edition. 2012. This is an excellent book, which (we hope) complements rather than competes with ours. The choice of subject matter and methods of exposition are somewhat different but the content is all valuable, even if you don't necessarily need it for this course.

User's Guide to the Medical Literature: A Manual for Evidence-based Clinical Practice edited by Gordon Guyatt, Drummond Rennie, Maureen Mead and Deborah Cook. McGraw Hill Medical, 2015. This is an excellent reference for learning and teaching evidence-based medicine, far beyond what we can teach in this course. It also has the advantages of a web site with many web-based tools, a whole network of people working not only on the material itself, but on how best to teach it (including TN), and an approach that is used throughout the world. There's also an abbreviated version, User's Guide to the Medical Literature: Essentials of Evidence-Based

Overdiagnosed: Making People Sick in the Pursuit of Health, by H. Gilbert Welch, Lisa Schwartz and Steve Woloshin. Boston: Beacon Press,  2011. This is another great little book full of material covered in this class.  Highly recommended! 

Should I Be Tested for Cancer?: Maybe Not and Here's Why by H. Gilbert Welch. University of California Press. 2006.  This is a superb, clearly written book. It is written for lay people, but has plenty of meat for health professionals. We would require it except that it only covers a small subset of the material for the course.

Other options

These are also good books with somewhat different approaches or less overlap with the course material. There is useful material in each of them.

Clinical Epidemiology: The Study of the Outcome of Illness by Noel S. Weiss. Oxford University Press. 2006. This is another good book by one of the leaders in the field.

Evidence-based Medicine: How to Practice and Teach It by Sharon Strauss, W. Scott Richardson, Paul Glasziou, Rosenberg, and R. Brian Haynes. Churchill Livingstone. 4th edition. 2010.

Understanding Medical Information by Theresa J. Jordan. McGraw Hill. 2002. Out of print but used versions may be available. This is a very basic book that assumes no prior medical knowledge and hence may be helpful for those with little previous clinical experience.

Some of our material can also be found (in abbreviated form) in Designing Clinical Research, by Stephen B. Hulley, MD, MPH et al. Lippincott Williams & Wilkins. 4th Edition. 2013. Chapter 12 is particularly useful and is partly based on this courses.

Stata Statistical Software (Stata Corporation, College Station, TX); version 12 or later is acceptable. A six-month student license for Stata/IC is the least expensive option that will be suitable to complete all course assignments, but Stata/SE is recommended for future robust use. The TICR Program has arranged for a sizeable discount for UCSF-affiliated personnel.

Books may be purchased either through the publisher or a variety of commercial venues (e.g., Amazon.com).


Grading is based equally on homework (including the problem-writing assignment, which counts as 1 homework) and a take-home final exam.

Students not in full-year TICR Programs who satisfactorily pass all course requirements will, upon request, receive a Certificate of Course Completion.

UCSF Graduate Division Policy on Disabilities


This course is open to a limited number of individuals outside of the ATCR and Master's programs. Preference is given to UCSF-affiliated personnel. We regret that auditing is not permitted.

To apply for this course, please fill out and submit the application below. Please see our fees page for cost information. The deadline for application is September 7, 2018. Only one application needs to be completed for all courses desired during the quarter.

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