## Problem Description:

The data analysis assignment addresses a study conducted by Bennett et al. (1987), focusing on a controlled trial aimed at teaching the critical appraisal of clinical literature to final-year clinical clerks. The study evaluates the impact of a short course on tutors and clerks at two teaching hospitals, emphasizing the critical appraisal of clinical articles related to diagnostic tests and treatments. The goal is to enhance the ability of clinical clerks to evaluate and make informed decisions in specific clinical situations.

### Questions and Answers:

Here is the abstract for a study conducted by Bennett et al. (1987).

We carried out a controlled trial of teaching the critical appraisal of clinical literature among final-year clinical clerks. Tutors at two of four teaching hospitals were offered a short course in the critical appraisal of clinical articles that describe diagnostic tests and treatments and were assisted in identifying and appraising specialty-specific articles that described those diagnostic tests and treatments that clinical clerks were sure to encounter during their clerkship tutorials. Tutors and clerks at the other two hospitals received no special intervention and served as controls. Experimental and control clinical clerks completed pretests and posttests of their ability to take and defend a stand on whether to apply specific diagnostic tests and treatments in specific clinical situations. Experimental clerks demonstrated both statistically and "clinically" significant increases in their critical appraisal skills, improving 37% on the diagnostic test exercise and 8% on the treatment exercise; control students' scores deteriorated for both.

**Reference:
**

Bennett, K. J., Sackett, D. L., Haynes, R. B., Neufeld, V. R., Tugwell, P., & Roberts, R. (1987). A controlled trial of teaching critical appraisal of the clinical literature to medical students. Journal of the American Medical Association, 257(18), 2451-2454.

**1. Type of T-test Used:
**

Bennett et al. (1987) utilized a two-sample t-test.

**2. Assumptions for T-test:
**

The assumptions for a T-test are that the observations come from a normal distribution with an unknown variance.

**3. Agreement with the T-test Type:
**

Yes, I agree with Bennett et al.'s choice of a two-sample t-test. The decision is justified by the presence of two independent samples with no pairing. Additionally, the authors did not conclude the equality of variance, supporting the use of the t-test.

**4. Null and Alternative Hypotheses:
**

Null Hypothesis (H0): μ₁ = μ₂ Alternative Hypothesis (H1): μ₁ > μ₂

**5. Conclusion for t = 2.00, df = 20, p > .08:
**

We fail to reject the null hypothesis, indicating that there is insufficient evidence to claim a significant difference between the two means.

**6. Conclusion for t = 2.859, df = 40, p < .05:
**

Using a conventional significance level of .05, we conclude that μ₁ is not equal to μ₂. The observed difference is statistically significant.

**7. Scenario-based Questions:
**

A medical education student plans to compare the means of a standardized exam across six years of student cohorts. As a biostatistics student, consider the following suggestions:

**8. Suggestions for the Student:
**

Instead of conducting multiple T-tests, consider using analysis of variance (ANOVA) to assess mean differences across multiple groups. This approach provides a comprehensive analysis and reduces the risk of Type I errors.

**9. Potential Issues with Multiple T-tests:
**

Conducting numerous T-tests increases the chance of Type I errors, leading to false-positive results. ANOVA offers a more robust approach to compare means.

**Recommendation:** Recommend exploring ANOVA as it allows for a holistic examination of mean differences across multiple cohorts, providing a more reliable statistical analysis.

**10. Resource and Age Interaction:
**

If you agree with multiple t-tests: Multiple t-tests should be implemented with an adjusted significance level, such as a Bonferroni adjustment or Scheffe’s test. Concerns about false-positive rates need to be addressed.

**If you disagree: **The multiple t-test approach should be avoided due to concerns about false positive rates. Instead, consider implementing an adjusted significance level like Bonferroni adjustment or Scheffe’s test to enhance the robustness of the statistical analysis.

**Follow-up Test for ANOVA:** If the medical education student chooses to use ANOVA, a post hoc Bonferroni-adjusted t-test should be conducted to determine the significance of the differences among individual pairs of means.

**Individual Pairs of Means: **With ANOVA and multiple comparison tests, there are six different t-tests to be considered.

**11. Performance Test Means:
**

**Interaction between Age and Resource:**Yes, there is an interaction between age and resource based on the means.**Main Effect for Type of Resource:**No, there is no main effect for the type of resources.

**12. Teaching Reading Methods:
**

**H0 & Ha: H0: μ₁ = μ₂ = μ₃, H1: **At least one of the mean is different.

**Conclusion Based on Results: **As the significance is less than 0.05, we can reject the null hypothesis.

**Hypothetical Study for Two-way ANOVA:** In a study where students are not only exposed to different teaching methods but are also divided into different classes across various teaching methods, a two-way ANOVA would be appropriate.

**Significance of Interaction in Two-way ANOVA: **Not necessarily, as both main effects being statistically significant doesn't guarantee the significance of interactions.

**13. Serial Measurements Paper:
**

**Statistical Procedure for Decrease Over Time: **The most common statistical procedure used is the two-sample t-test.

**Why This Procedure Is Wrong: **This procedure is incorrect because, in serial measurements, the same set of individuals is being measured over time, rendering the samples not independent, violating the assumption of the two-sample t-test.

**Correct Data Analysis: **The data should be analyzed using a paired t-test, which accounts for the dependence between measurements on the same set of individuals over time.

**Research Question:**Whether different teaching techniques result in different outcomes.**Research Hypothesis:**The different techniques result in different mean outcomes.**Null Hypothesis:**μ₁ = μ₂ (There is no difference in mean outcomes between the two teaching techniques.)**Alternative Hypothesis:**μ₁ ≠ μ₂ (There is a significant difference in mean outcomes between the two teaching techniques.)**Independent Variable:**Type of treatment (Categorical variable).**Dependent Variable:**Score in the essay (Numerical variable).**Test of Significance:**T-test of significance.**Chosen Probability Level: .**05 (Conventional value for testing significance).

**Data Analysis:
**

**Excel Analysis Output:
**

Welch Two Sample t-test data: x and y t = 0.69043, df = 17.968, p-value = 0.4987 alternative hypothesis: true difference in means is not equal to 0 95 percent confidence interval: -2.043306 4.043306 sample estimates: mean of x mean of y 8.6 7.6

**T-Test Output:
**

t-Test: Two-Sample Assuming Unequal Variances

Variances | Variable 1 | Variable 2 |
---|---|---|

Mean | 8.6 | 7.6 |

Variance | 10.9333333 | 10.0444444 |

Observations | 10 | 10 |

Hypothesized Mean Difference | 0 | |

df | 18 | |

t Stat | 0.69043096 | |

P(T<=t) one-tail | 0.24936506 | |

t Critical one-tail | 1.73406361 | |

P(T<=t) two-tail | 0.49873012 | |

t Critical two-tail | 2.10092204 |

**P-Value:** The P-value is 0.498.

**Results Interpretation:** The P-value is greater than the chosen significance level of 0.05. Therefore, we fail to reject the null hypothesis. The analysis suggests that there is no statistically significant difference in the mean outcomes between the two teaching techniques. In other words, the type of advance organizer used does not seem to have a significant impact on the students' performance in the objective test on immunology.