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

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.38636.582546.7C (Published 27 October 2005) Cite this as: BMJ 2005;331:1002
  1. Robyn Tamblyn, professor (robyn.tamblyn{at}mcgill.ca)1,
  2. Michal Abrahamowicz, professor2,
  3. Dale Dauphinee, executive director3,
  4. Nadyne Girard, project manager1,
  5. Gillian Bartlett, assistant professor4,
  6. Paul Grand'Maison, assistant dean premedical studies5,
  7. Carlos Brailovsky, professor6
  1. 1 McGill University, Montreal, QC, Canada H3A 1A3
  2. 2McGill University Health Centre-Montreal General Hospital, L10.520, Montreal, QC, Canada H3G 1A4
  3. 3 Medical Council of Canada, Ottawa, ON, Canada K1G 3H7
  4. 4 Clinical and Health Informatics Research Group, McGill University
  5. 5 Faculty of Medicine, University of Sherbrooke, Sherbrooke, QC, Canada J1K 2R0
  6. 6 Centre d'évaluation des sciences de la santé, Université Laval, QC, Canada G1K 7P4
  1. Correspondence to: R Tamblyn
  • Accepted 26 September 2005

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.

Footnotes

  • Embedded Image Web references w1-w30 and additional information are on bmj.com

  • Contributors RT, MA, and DD were responsible for the conception and design of the study. PG, CB, RT, and NG were responsible for the assembly of the study population and database linkages. MA was responsible for the statistical approach. GB and NG were responsible for the analysis. All authors contributed to the interpretation of the results and the preparation of the manuscript. RT and MA are the guarantors.

  • Funding Canadian Institutes of Health Research and Fonds de Recherche en Santé du Québec.

  • Competing interests None declared.

  • Ethical approval This study was approved by McGill University institutional review board and Quebec Access to Information.

  • Accepted 26 September 2005
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