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(Master’s degree, epidemiology stream, thesis and non-thesis programs)

and Occupational Health

McGill University

Document prepared

by the Curriculum Committee

and the Graduate Studies Committee

18 February 2008

18/2/2008 1

Introduction

This document outlines objectives of the core program in epidemiology and biostatistics for MSc

students registered in the epidemiology stream. The document was designed to facilitate the

planning of courses and other learning activities, and to help students identify learning

objectives. The objectives presented here may be met through a variety of learning methods:

course work, the conduct of the thesis or other research or, for the non-thesis MSc degree, the

Biostatistics, and Occupational Health. The document may be disseminated and used without

restriction.

Biostatistics, and Occupational Health. 2008. Core learning objectives in epidemiology and

Online. http://www.mcgill.ca/epi-biostat-occh/grad/epidemiology/requirements/

18/2/2008 2

General learning objectives

The general objective of the core teaching program in epidemiology is to introduce students to

the principles and methods of epidemiologic research to enable them to design, conduct,

analyze, and interpret epidemiologic research. Upon completion of the MSc degree, students

epidemiology, including a general appreciation of broad public health problems in Canada and

internationally.

18/2/2008 3

Section I1

1

It should be noted that despite categorical arrangements in this and subsequent sections, the objectives

in each may all be addressed through coursework, research and other academic activities.

18/2/2008 4

1. General introduction to epidemiology and biostatistics

(Proficiency level: Koepsell and Weiss 2003, Chapters 1 and 2; general introductory epidemiology

and biostatistics textbooks; British Medical Journal papers on qualitative research)

b) Describe case studies in the history of epidemiology and biostatistics, including, for

example, John Snow’s research on cholera, Joseph Goldberger’s work on pellagra, the

c) Contrast epidemiologic and biostatistical research methods with other scientific research

a) Define and distinguish the concepts of health, quality of life, impairment, activity

3. Human populations

a) Define the concepts of population structure and population dynamics and identify factors

18/2/2008 5

b) Define various population models used in epidemiologic research, including closed (or

fixed) populations, open (or dynamic) populations, and stable dynamic populations.

c) Describe and compute measures that characterize population dynamics, including birth

and mortality rates, fertility rates, sex ratio, and dependency ratios.

of cause and discuss these in the context of epidemiologic and biostatistical research.

b) Relate the epidemiologic concepts of exposure, risk factor, and determinant to causal

concepts.

and of confounding.

research.

5. Probability

18/2/2008 6

e) Define variable and random variable, and distinguish discrete and continuous random

variables.

6. Distributions

Students will be able to define the properties and describe the main applications of the

(Proficiency level: Rothman 2002, Chapter 6; Moore and McCabe 2006, Chapter 6)

c) Describe the key concepts and statistical principles involved in point and interval

d) Describe the key concepts and statistical principles involved in hypothesis testing, P-

18/2/2008 7

Section II

18/2/2008 8

8. Sources of data in epidemiology

(Proficiency level: Kelsey 1996, Chapter 3; MacMahon and Trichopoulos 1996, Chapter 3; Koepsell

and Weiss 2003, Chapter 6)

b) Explain and critically assess the processes that document health care related events

leading to the production of miscellaneous data bases, including: paper and electronic

registrations, and mandatory and optional adverse events reports; and vital statistics.

c) Explain the processes that document causes of death and transform the information into

rate, and between incidence and prevalence, and describe conditions under which these

relationships hold.

d) Define and estimate: attack rate, case-fatality, neonatal mortality, infant mortality,

maternal mortality, life expectancy, person-years of life lost, life expectancy in good

18/2/2008 9

e) Address validity, intra-rater reliability, and inter-rater reliability in the development of

questionnaires, scales, physical measurements, biologic tests, and other data collection

assessment methods to better but less feasible methods, can be carried out.

g) Operationalize study variables and discuss basic principles regarding the modeling of

i) Define and distinguish the concepts of sensitivity, specificity, predictive values, likelihood

ratio, and receiver operating characteristic curves; describe the application of these

j) Describe sources of missing data; define and contrast the main methods used to handle

missing data.

a) Define and distinguish risk difference, risk ratio, rate difference, rate ratio, prevalence

b) Interpret the parameters listed above and use them in the appropriate contexts.

c) Describe mathematical relationships between parameters such as, for example, relative

18/2/2008 10

11. Sampling

characteristics of study subjects, data collection methods and instruments, and study

design.

b) Explain the need for sampling and the advantages of various methods of sampling in

epidemiologic studies.

e) Describe relationships and distinctions between the concepts precision, bias, and

a) Describe examples of person, place, and time variables and discuss the contribution of

b) Discuss the distinctions and the relationships between analyses of rates by age, period

c) Define prevalence survey and describe strengths and weaknesses of such surveys.

18/2/2008 11

13. Ecologic studies

epidemiologic research.

c) Define ecologic fallacy and describe circumstances where this bias is likely to occur.

(Proficiency level: Koepsell and Weiss 2003, Chapter 13; Moher et al. JAMA 2001)

experimental studies.

b) Define and describe distinctions between broad types of experimental and quasi-

d) Define and describe the purpose of randomization, placebos, blinding, and intention-to-

g) Apply the CONSORT criteria (JAMA 2001) in the design and critical assessment of a

trial.

18/2/2008 12

15. Non-experimental quantitative studies: cohort studies, case-control studies, and

related designs

(Proficiency level: Koepsell and Weiss 2003, Chapters 5, 14, and 15)

including cohort and case-control studies, and variants of these designs such as nested

mortality studies.

epidemiologic studies, including the definition of exposure, case series, and denominator

(Proficiency level: Koepsell and Weiss 2003, Chapter 15; Rothman 2002, Chapter 5)

Students will be able to define selection bias and identify common situations in which

this type of bias may occur, including referral bias and detection bias in case-control

studies, selection bias in the recruitment of cohort members, and selection bias

18/2/2008 13

17. Information bias

a) Define information bias and describe various sources of information bias such as recall

b) Define and distinguish differential and non-differential misclassification, and describe the

study group.

18. Confounding

b) Identify and apply the various methods available to control for confounding, including

modeling.

c) Discuss the concept of residual confounding and identify circumstances where the

18/2/2008 14

b) Discuss and contrast the concepts of additive and of multiplicative interaction, and relate

c) Estimate and interpret additive and multiplicative interaction parameters taking into

18/2/2008 15

Section III

Statistical analysis

18/2/2008 16

20. General goals and concepts; descriptive and summary statistics

(Proficiency level: van Belle et al. 2004; Moore and McCabe 2006; Rosner 2006)

a) Describe and distinguish various types of data, including continuous, categorical, ordinal,

b) Identify the general goals of statistical analysis, including data description, data

c) Identify and use statistical methods and models appropriate for specific types of study

d) Distinguish and use various kinds of tables and graphs to describe a single variable;

calculate the mean, the median, percentiles, and range of a series of observations;

calculate a proportion (count) and describe it as a mean (sum) of zeros and ones.

e) Distinguish and use various kinds of tables and graphs to show relationships between

estimate it; describe the method of least squares for the estimation of linear regression

parameters; discuss the meaning of a regression line; estimate parameters for simple

regression; and describe how simple linear regression with a binary group indicator can

21. Inference for a single parameter: mean, proportion, rate, and survival probability

intervals for a single parameter: mean, proportion, and rate (person-time denominator).

18/2/2008 17

c) Calculate a Kaplan-Meier survival curve, and obtain Greenwood confidence intervals for

d) Calculate sample sizes required for a given precision in confidence interval estimates.

(Proficiency level: Moore and McCabe 2006, Chapters 2, 7, 10, 11, 12, and 13)

a) Describe and select the appropriate statistical method for the crude and for the adjusted

• weighted averages of stratum-specific risk differences or risk ratios

• Mantel-Haenszel procedure for odds, risks, and rate ratios

• Woolf’s method for odds ratios

a) Describe the principles underlying the use of nonparametric tests, their advantages, and

their disadvantages.

b) Use the sign test, the Wilcoxon rank sum test, the Wilcoxon signed rank test, and the

Kruskal-Wallis test.

(Proficiency level: Rothman and Greenland 1998, Chapters 20 and 21; Moore and McCabe 2006,

Chapters 11 and 16)

a) Describe and apply the general concepts underlying regression, including: linear

18/2/2008 18

b) Describe and distinguish uses of regression for prediction, adjustment (confounding),

• the intercept and the slope in models with one binary x variable

• differences of means, proportions, or rates in models with one binary x variable

• regression coefficients in models with two x variables

• Co-linearity

• the transformation of variables

• the type of response variable, including: quantitative variables (ordinary linear

regression), binary variables (logistic regression), counts (Poisson regression),

and survival times (Cox regression)

• time-varying covariates

(Proficiency level: Delwiche and Slaughter 2003, UCLA Academic Technology Services, Statistical

Computing Resources, www.ats.ucla.edc/stat)

b) Use spreadsheets for small-scale statistical calculations and simulations, manage simple

d) Program introductory level tasks such as loops and other control structures, arrays,

18/2/2008 19

Section IV

18/2/2008 20

26. Appraisal, synthesis, and use of epidemiologic data

(Proficiency level: Koepsell and Weiss 2003, Chapter 8; Moher et al. Lancet 1999)

a) Conduct critical appraisals of published epidemiologic studies and of their own and other

students’ research.

c) Identify basic elements and issues in the conduct of meta-analysis, including the

selection of studies, the types of data included, quality scales, basic methods of

d) Apply the QUOROM (Lancet 1999) criteria in the design and critical assessment of a

e) Critically use data from published studies to inform researchers and decision-makers

18/2/2008 21

28. Research ethics

(Proficiency level: Introductory tutorial for the Tri-council policy statement: Ethical conduct for

research involving humans)

a) Identify fundamental ethical principles that guide the conduct of research involving

d) Identify ethical issues to consider when selecting participants for a study, including those

e) Define privacy and confidentiality and describe how these can be maintained throughout

f) Define informed consent and describe the elements that should be included in an

g) Describe conditions that may affect a person’s capacity to consent and the

18/2/2008 22

Section V

Note: This section focuses on methods and applications as opposed to substantive knowledge.

A core program in epidemiology and biostatistics should include basic elements in public health,

infectious disease epidemiology, and genetic epidemiology. Readers will recognize that a

myriad of other domains are not included here, including, for example, pharmacoepidemiology,

epidemiology, etc. Please note, however, that substantive knowledge in these various domains

(as opposed to methodologic knowledge) has been included in our core curriculum (see the

18/2/2008 23

29. Public health

Students will demonstrate a general proficiency in public health research, with a specific

a) Screening

• Distinguish between a screening test and a screening program.

• Apply recognized criteria to determine the appropriateness of screening

programs.

• Describe appropriate study designs to evaluate screening programs.

• Identify the presence of length-biased sampling and lead time bias in studies

evaluating screening programs.

b) Cluster investigation

(Proficiency level: Oleckno 2002, Chapter 14; Knox, Chapter 7 in Holland et al, Oxford Textbook

• Describe methodologic challenges in cluster investigation, including the various

sources of bias.

• Describe the advantages and disadvantages of different designs for cluster

investigation.

• Identify the strategies of analysis for cluster investigation.

c) Surveillance

health.

• Describe the major methodologic and analytic challenges of surveillance

systems.

• Describe criteria for deciding whether to include a disease in a surveillance

system.

• Distinguish active and passive surveillance.

• Describe the major components of a surveillance system for infectious and for

chronic diseases.

• Describe capture-recapture methods of disease surveillance.

• Describe sentinel systems of surveillance.

• Describe the data sources for major surveillance systems in Canada, in Quebec

and the United states and describe their limitations.

18/2/2008 24

d) Health promotion

(Proficiency level: Tones, Chapter 7.3 in Detels et al, Oxford Textbook of Public Health 2002)

• Describe basic theories and ideologies central to the notion of health

• Appreciate the social and structural influences and context of health and health-

related practices.

• Discuss values, ethics, and the practice of public health.

e) Environmental health

(Proficiency level: Samet, Chapter 8.1 in Detels et al, Oxford Textbook of Public Health 2002)

“natural” and human-made (physical, chemical, and biologic) on human disease

in communities.

f) Occupational health

(Proficiency level: Samet, Chapter 8.1 in Detels et al, Oxford Textbook of Public Health 2002)

with an emphasis on the study of disease occurrence in worker populations.

(Proficiency level: Nelson and Masters Williams 2007; Thomas and Weber 2001, Chapter 2;

epidemiology.

b) Identify different types of infectious agents, e.g., viruses, bacteria, and parasites.

c) Identify the major mandatory reportable diseases in Canada and the United

States.

happenings).

18/2/2008 25

31. Genetic epidemiology

a) Describe the justification for considering genetic variants (or other parameters from the

b) Recognize that genetic variants (or other parameters from the genome) have similarities,

c) Describe the advantages and limitations of traditional epidemiologic study designs (with

d) Describe the advantages and limitations of association study designs that use families

18/2/2008 26

Section VI

(Proficiency level: WHO World Health Reports, www.who.int; Statistical Report on the Health of

Canadians, www.statcan.can)

Students will be able to demonstrate a general knowledge of important risk factors and

of the broad causes of morbidity and mortality affecting human populations. In particular,

and the rest of the world; population groups may be considered in terms of socio-

b) Describe the historical evolution of the burden of disease in Canada and the rest of the

world.

c) Describe how various proximal and distal determinants of population health (socio-

economic, lifestyle, environmental, biologic, and health services) influence the levels and

d) Describe how these risk factors influence the occurrence of major diseases of public

disease.

f) Describe major current disease prevention and control efforts in Canada and the world

g)

18/2/2008 27

Section VII

18/2/2008 28

References

In several sections of this document, references illustrating the level of proficiency expected of

students for a given topic are cited. For example, on the topic of interaction, the expected level

of proficiency corresponds to Chapter 9 of Rothman’s textbook Epidemiology, An introduction

(2002). These references are presented for illustrative purposes only and do not represent

prescriptions for material to be used for teaching.

Armitage P, Berry G, Matthews JNS. Statistical methods in medical research. Fourth edition.

Oxford: Blackwell Science Ltd. 2002.

• Mays N, Pope C. Qualitative research: Rigour and qualitative research. BMJ 1995;

311:109-112.

311:251-253.

data. BMJ 2000; 320:114-116.

Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of

Canada, Social Sciences and Humanities Research Council of Canada, Tri-Council Policy

Statement: Ethical Conduct for Research Involving Humans. 1998 (with 2000, 2002 and 2005

amendments).

Delwiche L, Slaughter S. The little SAS book: A primer. Third edition. Cary, North Carolina: SAS

Press. 2003.

Detels, R, et al., eds. Oxford textbook of public health. Fourth edition. Oxford: Oxford University

Press. 2002.

Holland WW, et al., eds. Oxford textbook of public health. Second edition. Oxford: Oxford

University Press. 1991.

Kelsey JL, et al. Methods in observational epidemiology. Second edition. New York: Oxford

University Press. 1996.

Koepsell TD, Weiss NS. Epidemiologic methods. Studying the occurrence of illness. Oxford:

Oxford University Press. 2003.

Little, Brown and Company. 1996.

18/2/2008 29

Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF, QUOROM Group. Improving the

quality of reports of meta-analyses of randomised controlled trials: The QUOROM statement.

Lancet 1999; 354:1896-1900.

Moher D, Schulz KF, Altman D. The CONSORT statement: Revised recommendations for

improving the quality of reports of parallel-group randomized trials. JAMA 2001; 285:1987-1991.

Moore DS, McCabe GP. Introduction to the practice of statistics. Fifth edition. New York: W.H.

Freeman and Company. 2006.

Nelson, KE, Masters Williams CF. Infectious disease epidemiology: Theory and practice.

Second edition. Boston: Jones and Bartlett Publishers. 2007.

Oleckno WA. Essential epidemiology. Principles and applications. Long Grove, Illinois:

Waveland Press. 2002.

2006.

Raven Publishers. 1998.

Szklo M, Nieto FJ. Epidemiology. Beyond the basics. Second edition. Boston: Jones and

Bartlett Publishers. 2007.

Thomas JC, Weber DJ. Epidemiologic methods for the study of infectious diseases. Oxford:

Oxford University Press. 2001.

van Belle G, et al. Biostatistics. A methodology for health sciences. Second edition. Hoboken,

New Jersey: John Wiley & Sons. 2004.

Geneva. 2001.

Websites

http://www.ats.ucla.edu/stat

18/2/2008 30

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