Effect of a community oriented problem based learning curriculum on quality of primary care delivered by graduates: historical cohort comparison study.

Full Abstract

OBJECTIVE: To assess whether the transition from a traditional curriculum to a community oriented problem based learning curriculum at Sherbrooke University is associated with the expected improvements in preventive care and continuity of care without a decline in diagnosis and management of disease. DESIGN: Historical cohort comparison study. SETTING: Sherbrooke University and three traditional medical schools in Quebec, Canada. PARTICIPANTS: 751 doctors from four graduation cohorts (1988-91); three before the transition to community based problem based learning (n = 600) and one after the transition (n = 151). OUTCOME MEASURES: Annual performance in preventive care (mammography screening rate), continuity of care, diagnosis (difference in prescribing rates for specific diseases and relief of symptoms), and management (prescribing rate for contraindicated drugs) assessed using provincial health databases for the first 4-7 years of practice. RESULTS: After transition to a community oriented problem based learning curriculum, graduates of Sherbrooke University showed a statistically significant improvement in mammography screening rates (55 more women screened per 1000, 95% confidence interval 10.6 to 99.3) and continuity of care (3.3% more visits coordinated by the doctor, 0.9% to 5.8%) compared with graduates of a traditional medical curriculum. Indicators of diagnostic and management performance did not show the hypothesised decline. Sherbrooke graduates showed a significant fourfold increase in disease specific prescribing rates compared with prescribing for symptom relief after the transition. CONCLUSION: Transition to a community oriented problem based learning curriculum was associated with significant improvements in preventive care and continuity of care and an improvement in indicators of diagnostic performance.

Author information

Author/s: Tamblyn, Robyn (R); Abrahamowicz, Michal (M); Dauphinee, Dale (D); Girard, Nadyne (N); Bartlett, Gillian (G); Grand'Maison, Paul (P); Brailovsky, Carlos (C);

Affiliation: McGill University, Montreal, QC, Canada H3A 1A3. robyn.tamblyn(-atsign-)mcgill.ca

Journal and publication information

Publication Type: Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't

Journal: BMJ (Clinical research ed.) (BMJ), published in England. (Language: eng)

Reference: 2005-Oct; vol 331 (issue 7523) : pp 1002

Dates: Created 2005/10/28; Completed 2005/11/14; Revised 2008/11/20;

PMID: 16239292, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: BMJ. 2005 Oct 29;331(7523):977-8. (PMID: 16254276)

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