Purpose
Physicians need a strong understanding of statistics to practice modern medicine. Not only must they understand the probability of diagnosing and treating patients, but they must also be able to communicate risk effectively to patients, maximize quality of care through the review of outcome data, critically evaluate new treatments to detect biases, and practice evidence-based medicine. The objective of this study was to consider changes in statistical education and assessment over time and identify opportunities for innovation in assessment as medical education continues to place greater emphasis on competency-based educational models.

Methods
We performed a state-of-the-art review of peer-reviewed and grey literature to meet our objectives. We identified relevant sources via a keyword-based search of MEDLINE sources. We also used backward citation tracking from articles in our initial search, followed by a review of well-known third-party resources (e.g., ScholarRx). Systematic data extraction enabled us to track changes over time in the teaching and evaluation of statistical competency among medical students.

Results
Our findings indicate that statistical education in the medical school context has shifted over time from being typically taught as a stand-alone course with extensive contact hours to an integrated component of the pre-clerkship curriculum spread across courses, blocks, or topics. However, assessment remains predominantly reliant on multiple-choice questions, with minimal evidence of a transition to performance-based evaluations or clinical demonstrations of statistical skills.

Conclusions
While medical education is increasingly adopting a competency-based model of teaching and assessment of learning outcomes, the teaching of statistics in this domain lags. Physicians must effectively apply statistical concepts in daily practice, yet demonstrating knowledge is not the same as demonstrating the ability to use statistics in real-world contexts. To ensure the graduation of statistically competent physicians, medical educators must innovate to align statistical training with a model of competency-based medical education.