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Measures of Central Tendency

EM FINAL EXAMS Critical Appraisal · Statistics Measures of Central Tendency Three ways to name the “typical” value — and the shape of the data decides which one to trust. Definition The single value that best represents a dataset. The mean is the arithmetic average (best for symmetric data, but sensitive to outliers); the median […]

EM FINAL EXAMS Critical Appraisal · Statistics

Measures of Central Tendency

Three ways to name the “typical” value — and the shape of the data decides which one to trust.

Definition

The single value that best represents a dataset. The mean is the arithmetic average (best for symmetric data, but sensitive to outliers); the median is the middle value (robust, best for skewed data); the mode is the most frequent value. Always pair a centre with a measure of spread — SD/variance go with the mean, IQR/range with the median.

The picture
mode median mean → long tail (outliers) Right-skewed: mode < median < mean The tail drags the mean — the median holds

On skewed data the tail drags the mean outward, while the median stays near the typical value.

What it shows

A right-skewed distribution — most values low, a long tail of high values. The three measures separate: the mode sits at the peak, the median just to its right, and the mean is dragged furthest out toward the tail by the outliers.

How to read it

When the three lines coincide the data are symmetric and the mean is fine. When they fan apart the data are skewed: the further the mean drifts from the median, the worse the skew, and the more the median should be your headline number. For a right skew the order is mode < median < mean.

Why it matters

Quoting the wrong centre misleads. ED length of stay, waiting times and costs are right-skewed by a few very long stays, so a mean overstates the typical patient’s experience. Spotting which measure a paper used — and whether it fits the data’s shape — is a basic appraisal reflex.

Key
  • Mean = average · symmetric data · pair with SD
  • Median = middle value · skewed/outliers · pair with IQR
  • Mode = most frequent · rarely useful for continuous data
Pitfall
Pitfall Using the mean (and SD) on skewed data or data with outliers — the tail drags it away from the typical value, so the median represents the data better. And never report a centre without its matching measure of spread.
emfinalexams.com · FRCEM / MRCEM revision
EM trial in the wild

Everyday ED examplelength of stay is the classic right-skewed metric: most patients are seen and discharged quickly, but a long tail of admitted or “boarding” patients stretches the top end. The honest summary is the median (IQR); a quoted “mean LOS” is inflated by those long-stay outliers and flatters the department. If a paper reports a mean ± SD for length of stay, cost or waiting time, suspect the distribution was never checked — the median almost certainly tells a different story.

Examiner traps
  • Using the mean on skewed or outlier-laden data — the median is the truer “typical” value.
  • Reporting a centre with no measure of spread (SD/variance for the mean, IQR/range for the median).
  • Treating the mode as meaningful for continuous data — it rarely is.
Quick check

A billionaire walks into a bar — what happens to the mean versus the median income of the drinkers?
Answer: The mean leaps up (one huge outlier drags the average), while the median barely moves — the median is robust to outliers, which is exactly why it suits skewed data.

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