Dataset Information

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

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.

SUBMITTER: Tamblyn R

PROVIDER: S-EPMC1273455 | biostudies-literature | 2005 Oct

REPOSITORIES: biostudies-literature

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Publications

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

Tamblyn Robyn R Abrahamowicz Michal M Dauphinee Dale D Girard Nadyne N Bartlett Gillian G Grand'Maison Paul P Brailovsky Carlos C

BMJ (Clinical research ed.) 20051020 7523

<h4>Objective</h4>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.<h4>Design</h4>Historical cohort comparison study.<h4>Setting</h4>Sherbrooke University and three traditional medical schools in Quebec, Canada.<h4>Participants</h4>751 doctors from four gradu ...[more]

PMID: 16239292

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Project description:BACKGROUND:Community health worker (CHW) interventions to manage childhood illness is a strategy promoted by the global health community which involves training and supporting CHW to assess, classify and treat sick children at home, using an algorithm adapted from the Integrated Management of Childhood Illness (IMCI). To inform CHW policy, the Government of Tanzania launched a program in 2011 to determine if community case management (CCM) of malaria, pneumonia and diarrhea could be implemented by CHW in that country. METHODS:This paper reports the results of an observational study on the CCM service delivery quality of a trial cohort of CHW in Tanzania, called WAJA. In 2014, teams of data collectors, employees of the Ministry of Health and Social Welfare trained in IMCI, assessed the IMCI skills rendered by a sample of WAJA on sick children who presented to WAJA with illness signs and symptoms in their communities. The assessment included direct observations of WAJA IMCI episodes and expert re-assessment of the same children seen by WAJA to assess the congruence between the assessment, classification and treatment outcomes of WAJA cases and those from cases conducted by expert re-assessors. RESULTS:In the majority of cases, WAJA correctly assess sick children for CCM-treatable illnesses (malaria, pneumonia, and diarrhea) and general danger signs (90% and 89%, respectively), but too few correctly assess for physical danger signs (39%); on classification in the majority of cases (73%) WAJA correctly classified illness, though more for CCM-treatable illnesses (83%). In majority of cases (78%) WAJA treated children correctly (84% of malaria, 74% pneumonia, and 71% diarrhea cases). Errors were often associated with lapses in health systems support, mainly supervision and logistics. CONCLUSION:CCM is a feasible strategy for CHW in Tanzania, who, in the majority of cases, implemented the approach as well as IMCI expert re-assessors. Nevertheless, for CCM to be effective, in Tanzania, a strategy to implement it must be coordinated with efforts to strengthen local health systems.

Dataset Information

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

Objective

Design

Setting

Participants

Outcome measures

Results

Conclusion

Publications

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

Similar Datasets

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