Effect of a community oriented problem based learning curriculum on quality of primary care delivered by graduates: historical cohort comparison study
Open accessAbstract
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.
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- Authors
- Tamblyn, R., Abrahamowicz, M., Dauphinee, D., Girard, N., Bartlett, G., Grand'Maison, P., & Brailovsky, C.
- Affiliations
- McGill University (CA)
- Medical Council of Canada (CA)
- Université Laval (CA)
- Corresponding author
- Tamblyn, Robyn
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2005-10-20
- Volume
- 331
- Issue
- 7523
- Pages
- 1002
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC1273455
- OpenAlex
- W2071248069
- Cited by
- 91
- References
- 28
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 5 · 2023: 1 · 2022: 3 · 2021: 4 · 2020: 6 · 2019: 2 · 2018: 4 · 2017: 2 · 2016: 5 · 2014: 1 · 2013: 5 · 2012: 4
- FWCI
- 31.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship@McGill (McGill) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Social Sciences › Education › Problem and Project Based Learning
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- medical curriculum, primary care quality, preventive medicine, mammography screening, continuity of care, prescribing patterns, disease diagnosis, medical graduates
- MeSH terms
- Aged, Clinical Competence, Community Medicine, Continuity of Patient Care, Curriculum, Delivery of Health Care, Education, Medical, Graduate, Female, Humans, Mammography, Practice Patterns, Physicians', Primary Health Care, Quebec, Referral and Consultation, Problem-Based Learning
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