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Clinical Epidemiology
EPI 204 Fall 2016 (3 units)



OBJECTIVES

The most important objective is to help you understand the interaction between clinical research and clinical medicine. How does (or should) information previously obtained on groups of patients inform clinical decisions on individuals? The specific objectives of this course are:

A. Attitudes

  • Increased confidence and comfort approaching journal articles.
  • Preference for evidence over authority.
  • Desire for independent learning.
  • An "ecologic" view of clinical medicine that acknowledges limitations of knowledge and resources.
  • An appreciation of the fun and satisfaction of learning and teaching this material.

B. Knowledge

  • Understanding the diagnostic process.
  • Understanding measures of interobserver agreement.
  • Risk (and costs) of diagnostic, screening, and prognostic tests.
  • Interpreting diagnostic data; quantifying information and refining probability estimates from results of dichotomous and continuous tests.
  • Common biases of studies of diagnostic, prognostic and screening tests.
  • Quantifying effects of treatments using experimental and observational studies.
  • Bayesian understanding of P-values and confidence intervals.
  • Challenges to evidence-based medicine.

C. Skills

  • Calculation of and comfort with sensitivity and specificity.
  • Calculation of posterior probability and test thresholds using likelihood ratios.
  • Calculation of and comfort with risk ratios, odds ratios, number needed to treat.
  • Critical appraisal of clinical research articles.
PREREQUISITES

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.

FACULTY

Course Director:

Tom Newman, MD, MPH
Phone: 415-514-8007
email: newman@epi.ucsf.edu

Faculty Section Leader: Benjamin Breyer, MD, MAS
email: benjamin.breyer@ucsf.edu
Joshua Galanter, MD, MAS
email: joshua.galanter@ucsf.edu
Martina Steurer-Mueller, MD, MAS
email: martina.steurermuller@ucsf.edu
Teaching Assistant Section Leaders: Christine Ferrara, MD, PhD
email: christine.ferrara@ucsf.edu
  Thomas Gaither, BA
email: thomas.gaither@ucsf.edu
  Rajkumar Kalapatapu, MD
email: rajkumar.kalapatapu@ucsf.edu
  Kian Niknam, BS
email: kian.niknam@ucsf.edu

FORMAT

  1. Lectures: Thursdays: 8:45 to 10:15 AM, Sept. 15 through Dec. 1. 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. 15.

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

TEXTBOOKS

We have written a 12-chapter Evidence-Based Diagnosis textbook that is the main required reading for the course.

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

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.

ENROLLMENT

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. Cost and submission information are in the application.

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 August 29, 2016. Only one application needs to be completed for all courses desired during the quarter.

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