Clinical Epidemiology

Coordinator: Bob Goodman

Welcome to the PCSM Clinical Epidemiology Course, 2016!

The goal of the clinical epidemiology course is to give you a strong foundation in clinical epidemiology and evidence-based medicine, so that you are better prepared to interpret the medical literature and, as a result, better prepared to take care of your patients. But first, what exactly is “clinical epidemiology” or “evidence-based medicine,” for that matter?

Epidemiology is the study of the distribution and determinants of disease in populations, and the application of findings to the health of populations and individuals. Clinical epidemiology is really just epidemiology applied to patients, that is, the study of diagnosis, prognosis, and therapy.  “Modern” clinical epidemiology began with Alvan Feinstein at Yale, who in the 1960’s attempted to create a science based on clinical observation (Ann Intern Med. 1964;61:564-579). Feinstein urged clinicians to improve the scientific quality of clinical data, so as to be able to use the results for quantitative analysis.

Clinical epidemiology was transported from New Haven to Norwood in 1986 by Jerry Paccione who, fresh from a fellowship under Feinstein, began teaching his course to primary care residents at Montefiore. Combining his own inimitable style with Feinstein’s neologisms (e.g., “auxometry”) and Sackett’s now classic textbook, he taught the course for 26 years. Many of the Great Minds of Montefiore have taken this course, including Bob Goodman (1989), Joe DeLuca (1994), Lauren Shapiro (2007), Shwetha Iyer (2009), Erin Goss (2010), Magni Hamso (2011), and Mary Gover (2012). Dr. Paccione taught the course through 2012, after which he moved on to more global endeavors.

Meanwhile, Up North, on the campus of McMaster University in Hamilton, Ontario, a few of Feinstein’s acolytes thought up the idea of “Evidence-Based Medicine,” calling it a “new paradigm” (JAMA 1992;268:2420-25), and subsequently defined it as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”  Though Feinstein is the acknowledged father, this was not exactly the progeny he had envisioned (see Ann Intern Med. 1994;120:799-805).

While we can’t hope to replicate Dr. Paccione’s teaching, we do hope to continue his legacy. The unifying theme of this course is the interpretation and application of evidence—whether this evidence is a physical exam finding, laboratory test result, or NNT from a randomized trial. It is our hope that the course will help lay the foundation and provide the tools for a lifetime of learning and critical evaluation of the medical literature, the ultimate goal being better health for patients, as well as their communities. 

For course objectives, please click on the individual sessions.  Most sessions will have homework to complete in preparation for the session.  Some sessions will also have homework after the session.  The primary text for the course is Fletcher, Fletcher & Fletcher's Clinical Epidemiology: The Essentials, 5th edition.