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Outcome measures in medical education
- Ueli Bollag (14 November 2005)
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Ueli Bollag, paediatric and general practitioner 3012 Bern, Switzerland
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In the early nineties when problem based learning (PBL) had been firmly established already (1), outcome measures were concerned with undergraduate medical education. Several studies demonstrated that students in undergraduate PBL curricula integrate their knowledge of basic science concepts into clinical problems better than students in conventional curricula (2,3). Additional direction was given to PBL through the incorporation of its educational tenets into clinical practice and health care to the people (4). Tamblyn et al are to be commended for the effort of comparing the effect of the new training strategies on the quality of care in clinical practice (5). However, as the commentators rightly say, the proof for the superiority of community oriented PBL over traditional learning depends on a long list of factors which have to be controlled for, such as consensus on what constitutes a better doctor, on patients’ and doctors’ characteristics (age, sex, educational and cultural background), etc (6).The variables chosen by the Canadian authors, are subject to local preferences, e.g. breast cancer screening as a valid indicator of good preventive work. Their conclusions can be criticised on the basis of selected end-points, e.g. continuing care: the rate of admission to hospital probably depends more on health system regulations than the type of learning. To me, there are more important advantages of community oriented problem based learning over traditional learning. Although self-evident these are difficult to prove in terms of outcome and effect on patient care. First, PBL follows the real sequence of events, from the recognition of symptoms and signs, through hypothesis testing to the formulation of the problem(s) and a comprehensive management plan. Second, tutorials in small groups which are typical to PBL curricula encourage students to communicate with colleagues including tutors thus promoting reflective thinking and acting within a health team. Third, learning on the basis of real problems automatically calls for a continued interest in the basic sciences impinging on the clinical problem, not only during the initial pre-clinical years of study but throughout the study and practice period. Finally, the early contact with people and the community helps to confer an understanding of psycho-social determinants of health. References 1 Barrows HS, Tamblyn RM. Problem-Based Learning. An Approach to Medical Education. New York: Springer, 1980 2 Patel VL, Groen GJ, Norman GR. Effects of conventional and problem-based medical curricula on problem solving. Acad Med 1991;66:380-9. 3 Schmidt HG, Machiels-Bongaerts M, Hermans H, ten Cate TJ, Venekamp R, Boshuizen HPA. The development of diagnostic competence: comparison of a problem-based, an integrated, and a conventional medical curriculum. Acad Med 1996;71:658-64. 4 Bollag U, Schmidt HG, Fryers T and Lawani J. Medical education in action: community-based experience and service in Nigeria. Medical Education 1982;16:282-89. 5 Tamblyn R, Abrahamowicz M, Dauphine D, Girard N, Bartlett G, Grand’Maison P, Brailovsky C. Effect of a community oriented problem based learning curriculum on quality of primary care delivered by graduates: historical cohort comparison study. BMJ 2005;331:1001-5. 6 Schuwirth L, Cantillon P. The need for outcome measures in medical education. BMJ 2005;331:977-8. Competing interests: None declared |
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