Treffer: General competencies of problem-based learning (PBL) and non-PBL graduates / Compétences générales dans le cadre de l'apprentissage par résolution de problèmes et les diplômés n'utilisant pas ces méthodes d'apprentissage

INTRODUCTION: Junior doctors have reported shortcomings in their general competencies, such as organisational skills and teamwork. We explored graduates' perceptions of how well their training had prepared them for medical practice and in general competencies in particular. We compared the opinions of graduates from problem-based learning (PBL) and non-PBL schools, because PBL is supposed to enhance general competencies. METHOD: We analysed the responses of 1159 graduates from 1 PBL and 4 non-PBL schools to a questionnaire survey administered 18 months after graduation. RESULTS: Compared with their non-PBL colleagues, the PBL graduates gave higher ratings for the connection between school and work, their medical training and preparation for practice. According to the graduates, the most frequently used competencies with sufficient coverage during medical training were expert knowledge, profession-specific skills and communication skills. The majority of the PBL graduates, but less than half of the non-PBL graduates, indicated that communication skills had been covered sufficiently. All the graduates called for more curriculum attention on working with computers, planning and organisation, and leadership skills. More PBL graduates than non-PBL graduates indicated that they had learned profession-specific methods, communication skills and teamwork in medical school. DISCUSSION: Overall, the graduates appeared to be satisfied with their knowledge and skills. The results suggest that the PBL school provided better preparation with respect to several of the competencies. However, both PBL and non-PBL graduates identified deficits in their general competencies, such as working with computers and planning and organising work. These competencies should feature more prominently in undergraduate medical education.

AN0016510284;esf01apr.05;2019Jun04.08:18;v2.2.500

General competencies of problem-based learning (PBL) and non-PBL graduates. 

Introduction  Junior doctors have reported shortcomings in their general competencies, such as organisational skills and teamwork. We explored graduates' perceptions of how well their training had prepared them for medical practice and in general competencies in particular. We compared the opinions of graduates from problem‐based learning (PBL) and non‐PBL schools, because PBL is supposed to enhance general competencies. Method  We analysed the responses of 1159 graduates from 1 PBL and 4 non‐PBL schools to a questionnaire survey administered 18 months after graduation. Results  Compared with their non‐PBL colleagues, the PBL graduates gave higher ratings for the connection between school and work, their medical training and preparation for practice. According to the graduates, the most frequently used competencies with sufficient coverage during medical training were expert knowledge, profession‐specific skills and communication skills. The majority of the PBL graduates, but less than half of the non‐PBL graduates, indicated that communication skills had been covered sufficiently. All the graduates called for more curriculum attention on working with computers, planning and organisation, and leadership skills. More PBL graduates than non‐PBL graduates indicated that they had learned profession‐specific methods, communication skills and teamwork in medical school. Discussion  Overall, the graduates appeared to be satisfied with their knowledge and skills. The results suggest that the PBL school provided better preparation with respect to several of the competencies. However, both PBL and non‐PBL graduates identified deficits in their general competencies, such as working with computers and planning and organising work. These competencies should feature more prominently in undergraduate medical education.

Keywords: medical; undergraduate/*methods; problem‐based learning/*methods; clinical competence/*standards; attitude of health personnel; questionnaires; communication/*education; curriculum; computers/ utilisation; education

Many studies have addressed the experiences of junior doctors when they enter the world of clinical practice. Junior doctors complain about excessive workloads, stress, inadequate supervision and insufficient support from senior staff.[[1]] These problems are typically related to the working environment of the hospital. Junior doctors also mention problems associated with their own shortcomings in knowledge, skills and general competencies. A study by Hannon showed that interns considered themselves to be incompetent with respect to the skills and competencies required of an intern.[5] In another study, more than 50% of junior doctors expressed a need for additional training in the technical and management aspects of the work of a doctor prior to the pre‐registration year.[6] Lambert et al. reported that 22% of pre‐registration house officers thought they were inadequately prepared for some of the clinical tasks they were expected to perform, with 80% of subjects in that study saying that they did routine work that did not require a medical qualification.[7] Junior doctors have often reported shortcomings in general competencies. Rolfe et al. found that junior doctors had difficulty setting priorities, lacked experience with organisational skills before qualification and needed additional training in practical procedures.[4] A qualitative study by Prince et al. showed that junior doctors felt confident about their skills and diagnostic knowledge, but had difficulty coping with some of the other aspects of their work, such as the sudden increase in responsibilities, the lack of practical procedural knowledge, contacts with other health care workers and teamwork.[8]

Many studies have investigated the effectiveness of undergraduate medical education in preparing students for medical practice.[[9]] The focus of most of these studies was students' actual or perceived preparedness with regard to knowledge and skills. As for knowledge and physical examination skills, most junior doctors reported general satisfaction with the way their training had equipped them for medical practice.[[5], [10]]<sups>,</sups>[11] However, only a few studies have addressed how well undergraduate training prepares students regarding general competencies. Clack found that graduates felt ill equipped with respect to patient management skills, including coping with stress, time management, ability to prioritise and resource management.[11]

New educational approaches aim to provide students with general competencies. A prominent exemplar of such an approach is problem‐based learning (PBL), which purports to enhance problem‐solving skills, independent learning and teamwork skills.[16] There is indeed some evidence that graduates from PBL schools are better prepared in terms of general competencies than their colleagues from non‐PBL schools. Busari et al. showed that graduates from a PBL school felt better prepared in psychosocial and interpersonal skills.[10] Antepohl et al. reported that graduates from a PBL curriculum felt well prepared for professional practice in the pre‐registration period and specialty training, especially in terms of skills for communicating with patients, co‐operation with other health professionals and the development of critical thinking and a scientific attitude.[17] Schmidt and Van der Molen showed that alumni of a PBL medical school considered themselves to have been better prepared than their colleagues who had been trained in traditional curricula with respect to the skills needed to collaborate with others, solve problems, run meetings and work independently.[18] There was no difference in general academic knowledge and the ability to write reports or papers.[18]

However, the above‐mentioned studies mainly addressed the competencies that PBL is expected to enhance. They did not look at graduates' competencies from the perspective of the demands of the workplace. The purpose of our study was to explore junior doctors' perceptions concerning the general competencies required for professional practice. As PBL is supposed to enhance those competencies, we compared graduates of a PBL curriculum with graduates of non‐PBL medical schools. For this comparison we used data about graduates from Maastricht Medical School (PBL) and 4 non‐PBL medical schools in the Netherlands, drawn from an existing alumni database.

Methods

Subjects

We analysed the responses to a questionnaire administered 18 months after graduation to 2876 doctors who had graduated in 1999, 2000 and 2001. Responses were available for 1298 graduates (response rate 45.1%) from 1 PBL school and 4 non‐PBL schools. Non‐PBL schools may differ considerably, but when the graduates surveyed in this study were students, the non‐PBL schools in this study all had traditional, lecture‐based curricula that differed more from the small group PBL programme than from one another. After graduation most graduates worked in health care, but a small number ended up in other settings. The data for the 139 graduates who had no job, an unknown job or a job outwith health care were excluded from the analysis. This meant that data for 1159 graduates, including 239 graduates from a PBL school, were available for analysis.

Of the 1159 respondents, 36.9% (n = 428) were male, which reflected the gender distribution throughout the entire cohort. There were no significant differences between the PBL and non‐PBL schools in male : female ratio. The mean age of the participants was 27.9 years (SD 2.5 years). The age distribution did not differ significantly between the schools. Most graduates (62.8%) were in specialty training in a hospital; 14.8% had a job in general practice or a nursing home, 10.3% in public health, 10.3% in research, 0.5% in medical education or health sciences education and 1.4% in health care, but not as a medical doctor. The proportion of graduates practising medicine to graduates with jobs in research or teaching was similar for the PBL graduates (87.9% versus 12.1%) and the non‐PBL graduates (88.3% versus 11.7%).

Questionnaire

The Research Centre for Education and the Labour Market surveys all graduates from Maastricht University 18 months, 5 and 10 years after graduation. It also surveys graduates from all Dutch universities 18 months after graduation. For this purpose, the Centre administers a comprehensive questionnaire containing questions about education, the transition from university to workplace, the current labour market and activities after graduation.

We only analysed responses to questions that were relevant to our research question (i.e. questions pertaining to medical education as preparation for practice and the connection between training and work). Graduates from 3 of the 8 Dutch medical schools had received a slightly different questionnaire, which did not include the main items of interest to our study. This meant that the responses of graduates from 5 medical schools were available for analysis.

The questionnaire asked graduates to rate the quality of their undergraduate training and their preparation for practice on a scale of 1−10. The responses to items asking graduates about the connection between their training and their current job were rated on a 4‐point scale (good, sufficient, moderate or poor). The questionnaire also contained 14 items enquiring about general workplace competencies developed by an independent institution, the Research Centre for Education and the Labour Market, and standardised for graduates from different schools (medicine, law, economics, etc.). Two of the workplace competencies, handling figures and international orientation, were left out of the analysis because they were considered to have no particular relevance to medicine, which was confirmed by graduates' responses to those items. This left 12 competencies for inclusion in the analysis. The graduates were asked to indicate on a 5‐point scale how frequently they used these competencies in their work and where they had mostly learned them (medical school, workplace, or elsewhere). Graduates were also asked to name a maximum of 3 competencies that had received adequate coverage in the undergraduate curriculum and a maximum of 3 competencies that they felt had been underrepresented in the curriculum.

Data analysis

The results are presented separately for PBL graduates and non‐PBL graduates. Because not all items were answered by all respondents, the number of responses (n) is given in each table. Means and standard deviations were calculated for perceived quality of training and preparation for practice. Student's t‐tests were used to analyse the differences between PBL graduates and non‐PBL graduates. The results on the connection between school and work are expressed as the percentages of the total number of responses in the 4 response categories (good, sufficient, moderate or poor). Differences between the PBL school and the non‐PBL schools were analysed with the Mann–Whitney test for non‐parametric data. Means (scale 1–5) and SDs are reported for the extent to which junior doctors used certain competencies. Differences were analysed with a t‐test. Coverage of competencies in the curriculum and the setting where competencies had been acquired are reported as the percentage of the total number of graduates reporting sufficient or insufficient coverage and having acquired a competency in medical school, at work or elsewhere. We used cross tabulations and chi‐squared tests to analyse differences between schools with respect to where graduates had learned these competencies.

Results

General opinions about medical school

Problem‐based learning graduates rated the quality of their training and preparation for practice significantly more highly than did graduates from the other schools (Table 1).

1 Graduates' opinions about the quality of undergraduate medical training and preparation for practice on a scale of 1–10

<table><thead valign="bottom"><tr><th valign="bottom" /><th>PBL graduates</th><th>Non&#8208;PBL graduates</th></tr><tr><th><italic> n</italic></th><th>Mean (SD)</th><th><italic> n</italic></th><th>Mean (SD)</th></tr></thead><tbody valign="top"><tr><td>Quality of training</td><td>229</td><td>7.6 (0.8)</td><td>878</td><td>7.1 (0.8)*</td></tr><tr><td>Preparation for practice</td><td>227</td><td>7.3 (1.1)</td><td>872</td><td>6.5 (1.3)*</td></tr></tbody></table>

1 *  Significant difference between PBL versus non‐PBL medical schools (P < 0

2 .. 001).

The connection between school and work

The majority of both PBL graduates (84.1%) and non‐PBL graduates (76.8%) indicated that the connection between their training and their current job was good (Table 2). The ratings of the PBL graduates were higher than those of the other graduates, but the differences were statistically not significant.

2 Graduates' opinions about the connection between school and work (4‐point scale)

<table><thead valign="bottom"><tr><th /><th>PBL graduates <italic>n</italic>&#8195;=&#8195;239</th><th>Non&#8208;PBL graduates <italic>n</italic>&#8195;=&#8195;917</th></tr></thead><tbody valign="top"><tr><td>Good</td><td>84.1%</td><td>76.8%</td></tr><tr><td>Sufficient</td><td>14.2%</td><td>20.2%</td></tr><tr><td>Moderate</td><td>1.7%</td><td>2.4%</td></tr><tr><td>Poor</td><td>0.0%</td><td>0.2%</td></tr></tbody></table>

General competencies

The competencies with the highest reported frequency of usage were expert knowledge, profession‐specific skills and communication skills (Table 3). Teamwork, independence and accuracy were also used frequently. Statistically significantly higher usage by PBL graduates was found for expert knowledge, profession‐specific skills and communication skills.

3 Graduates' opinions about how often they use competencies in their work (scale 1–5: 1 = I do not use this competency, 5 = I use this competency a lot)

<table><thead valign="bottom"><tr><th valign="bottom">Competencies</th><th>PBL</th><th>Non&#8208;PBL</th></tr><tr><th><italic>n</italic></th><th>Mean (SD)</th><th><italic>n</italic></th><th>Mean (SD)</th></tr></thead><tbody valign="top"><tr><td>Expert knowledge</td><td>238</td><td>4.56 (0.65)</td><td>910</td><td>4.44 (0.73)*</td></tr><tr><td>Profession&#8208;specific skills</td><td>237</td><td>4.41 (0.71)</td><td>907</td><td>4.24 (0.85)&#8224;</td></tr><tr><td>Com,pu,ter skills</td><td>239</td><td>2.99 (1.11)</td><td>906</td><td>3.14 (1.10)</td></tr><tr><td>Communication skills</td><td>239</td><td>4.76 (0.53)</td><td>907</td><td>4.67 (0.60)*</td></tr><tr><td>Teamwork skills</td><td>239</td><td>4.33 (0.70)</td><td>906</td><td>4.22 (0.84)</td></tr><tr><td>Planning and organisation skills</td><td>239</td><td>3.90 (0.91)</td><td>903</td><td>3.88 (0.89)</td></tr><tr><td>Leadership skills</td><td>238</td><td>2.95 (1.13)</td><td>904</td><td>2.87 (1.07)</td></tr><tr><td>Independence</td><td>239</td><td>4.37 (0.67)</td><td>905</td><td>4.34 (0.70)</td></tr><tr><td>Creativity</td><td>238</td><td>3.41 (1.07)</td><td>904</td><td>3.31 (1.03)</td></tr><tr><td>Initiative</td><td>239</td><td>4.05 (0.79)</td><td>906</td><td>3.96 (0.76)</td></tr><tr><td>Dealing with change</td><td>239</td><td>4.03 (0.86)</td><td>906</td><td>3.95 (0.93)</td></tr><tr><td>Accuracy</td><td>238</td><td>4.41 (0.80)</td><td>905</td><td>4.41 (0.72)</td></tr></tbody></table>

Not all graduates mentioned the maximum of 3 competencies with either sufficient or insufficient coverage by the curriculum. No competency in either category was mentioned by 6% of the PBL graduates and 9% of the non‐PBL graduates (Table 4).

4 Percentage of graduates of PBL and non‐PBL schools that considered coverage of competencies in medical school to have been sufficient or insufficient

<table><thead valign="bottom"><tr><th>Competencies</th><th>Sufficient</th><th>Insufficient</th></tr><tr><th>PBL</th><th>Non&#8208;PBL</th><th>PBL</th><th>Non&#8208;PBL</th></tr></thead><tbody valign="top"><tr><td>Expert knowledge</td><td>72.0%</td><td>82.9%</td><td>8.4%</td><td>3.9%</td></tr><tr><td>Profession&#8208;specific skills</td><td>52.7%</td><td>49.0%</td><td>13.0%</td><td>17.5%</td></tr><tr><td>Computer skills</td><td>1.3%</td><td>7.0%</td><td>46.0%</td><td>33.5%</td></tr><tr><td>Communication skills</td><td>82.8%</td><td>41.1%</td><td>3.3%</td><td>28.2%</td></tr><tr><td>Teamwork skills</td><td>18.8%</td><td>7.8%</td><td>7.5%</td><td>16.7%</td></tr><tr><td>Planning and organisation skills</td><td>3.8%</td><td>2.9%</td><td>35.6%</td><td>32.9%</td></tr><tr><td>Leadership skills</td><td>2.1%</td><td>0.7%</td><td>31.4%</td><td>29.5%</td></tr><tr><td>Independence</td><td>23.0%</td><td>13.3%</td><td>7.5%</td><td>15.5%</td></tr><tr><td>Creativity</td><td>1.3%</td><td>0.5%</td><td>11.7%</td><td>13.0%</td></tr><tr><td>Initiative</td><td>1.3%</td><td>2.0%</td><td>7.9%</td><td>9.7%</td></tr><tr><td>Dealing with change</td><td>1.7%</td><td>2.6%</td><td>19.7%</td><td>10.9%</td></tr><tr><td>Accuracy</td><td>3.3%</td><td>12.7%</td><td>9.2%</td><td>2.3%</td></tr></tbody></table>

The most frequently mentioned competencies with adequate coverage were: expert knowledge, profession‐specific skills and communication skills. The non‐PBL graduates mentioned expert knowledge more often than did their PBL colleagues (82.9% versus 72.0%). Communication skills were ranked among the adequately covered competencies by the majority of the PBL graduates (82.8%), but only by a minority of the non‐PBL graduates (41.1%).

The top 3 competencies with insufficient coverage were the same for both groups: namely, working with computers, planning and organisation skills, and leadership skills. Graduates of the PBL school mentioned those competencies more often than their non‐PBL colleagues. More than a quarter of non‐PBL graduates (28.2%) put communication skills in this category, whereas only a very small percentage of PBL graduates (3.3%) did so.

Most graduates stated that knowledge had been acquired in medical school, whereas profession‐specific skills, ability to work in a team and planning and organisation skills had been learned in the workplace (Table 5). Significant (P < 0.01) differences between PBL and non‐PBL graduates were found for profession‐specific skills, communication skills and teamwork. Compared with the non‐PBL graduates, more PBL graduates indicated that they had acquired profession‐specific skills in medical school and fewer indicated that they had learned those competencies in the workplace. More than half of the PBL graduates indicated that they had acquired communication skills mainly in medical school, whereas only a quarter of the other graduates gave this response. About half of all the graduates indicated that teamwork had been learned at work. The percentage of students who said they had learned teamwork mainly in medical school was significantly higher among the PBL graduates than among the non‐PBL graduates.

5 Graduates' opinions about where they had learned competencies (at school, at work, elsewhere or not applicable). Numbers represent percentages of graduates that indicated school, work or other as the place where they acquired the competency

<table><thead valign="bottom"><tr><th>Competencies</th><th>PBL graduates</th><th>Non&#8208;PBL graduates</th></tr><tr><th><italic>n</italic></th><th>School</th><th>Work</th><th>Other</th><th>N/A</th><th><italic>n</italic></th><th>School</th><th>Work</th><th>Other</th><th>N/A</th></tr></thead><tbody valign="top"><tr><td>Expert knowledge</td><td>232</td><td>67.7</td><td>31.0</td><td>1.3</td><td>0.0</td><td>884</td><td>64.5</td><td>33.8</td><td>1.5</td><td>0.2</td></tr><tr><td>Profession&#8208;specific skills</td><td>232</td><td>39.7</td><td>57.3</td><td>2.6</td><td>0.4</td><td>882</td><td>24.7</td><td>72.1</td><td>2.2</td><td>1.0*</td></tr><tr><td>Computer skills</td><td>234</td><td>12.0</td><td>31.6</td><td>49.1</td><td>7.3</td><td>881</td><td>8.5</td><td>36.5</td><td>46.1</td><td>8.9</td></tr><tr><td>Communication skills</td><td>232</td><td>53.9</td><td>23.3</td><td>22.0</td><td>0.9</td><td>875</td><td>22.4</td><td>36.1</td><td>38.5</td><td>3.0*</td></tr><tr><td>Teamwork skills</td><td>232</td><td>19.4</td><td>53.0</td><td>27.2</td><td>0.4</td><td>881</td><td>5.8</td><td>57.7</td><td>32.3</td><td>4.2*</td></tr><tr><td>Planning and organisation skills</td><td>231</td><td>8.2</td><td>53.2</td><td>34.2</td><td>4.3</td><td>883</td><td>6.0</td><td>49.9</td><td>38.8</td><td>5.2</td></tr><tr><td>Leadership skills</td><td>232</td><td>2.2</td><td>47.0</td><td>31.9</td><td>19.0</td><td>886</td><td>2.1</td><td>47.7</td><td>31.3</td><td>18.8</td></tr><tr><td>Independence</td><td>232</td><td>15.9</td><td>46.6</td><td>34.9</td><td>2.6</td><td>884</td><td>9.2</td><td>51.9</td><td>36.0</td><td>2.9</td></tr><tr><td>Creativity</td><td>230</td><td>7.4</td><td>28.7</td><td>51.7</td><td>12.2</td><td>882</td><td>4.1</td><td>30.2</td><td>51.7</td><td>14.1</td></tr><tr><td>Initiative</td><td>230</td><td>10.0</td><td>38.3</td><td>48.7</td><td>3.0</td><td>883</td><td>5.3</td><td>40.2</td><td>48.5</td><td>6.0</td></tr><tr><td>Dealing with change</td><td>231</td><td>8.7</td><td>42.0</td><td>42.9</td><td>6.5</td><td>880</td><td>5.3</td><td>51.7</td><td>37.0</td><td>5.9</td></tr><tr><td>Accuracy</td><td>228</td><td>19.7</td><td>36.0</td><td>39.5</td><td>4.8</td><td>882</td><td>20.1</td><td>38.3</td><td>37.6</td><td>4.0</td></tr></tbody></table>

5 *  Significant difference between PBL and non‐PBL graduates, P < 0.01.

Discussion

The purpose of this study was to explore junior doctors' perceptions regarding their training in the general competencies required in practice and compare the perceptions of PBL graduates with those of non‐PBL graduates. Although differences between non‐PBL schools may be substantial, the non‐PBL schools in this study offered very similar curricula at the time of the data collection for this study, in that their programmes were predominantly lecture‐based and teacher‐centred, in contrast to the PBL school's small group, student‐centred programme. Thus, it seems safe to assume that the differences between the PBL school and the other schools exceeded those between the non‐PBL schools.

The majority of the respondents from these 5 Dutch medical schools appeared satisfied with the connection between school and work. The graduates from the PBL medical school gave significantly higher ratings for the quality of their medical training than did the graduates from the traditional schools.

Competencies considered to be of great importance by all the respondents were expert knowledge, profession‐specific skills, communication skills, teamwork skills, independence and accuracy. There were some small, albeit significant, unexpected differences between PBL and non‐PBL graduates. Various explanations are possible for the differences between the 2 groups of students with respect to the perceived working environment: different schools may attract students with different profiles; schools may differ in the extent to which certain competencies are dealt with in the curriculum, and students may hold different jobs after graduation. Further research will need to establish whether there is a relationship between the type of curriculum and these differences in graduates' perceptions.

Graduates of both PBL and non‐PBL courses agreed on the competencies that had received either sufficient (expert knowledge, profession‐specific methods and communication skills) or insufficient (working with computers, planning and organisation, and leadership skills) coverage in the undergraduate curriculum.

There was considerable variation in the responses to the question about the setting where the competencies had been acquired. Not surprisingly, most graduates indicated that knowledge had mainly been acquired in medical school. The fact that profession‐specific skills had mainly been learned in the workplace can be explained by the fact that undergraduate medical training prepares students for general skills and methods, whereas many specific skills and methods are learned during specialty training.

A striking difference between the PBL and the non‐PBL graduates was that the first group had learned communication skills primarily in medical school, where the curriculum had provided adequate coverage of those skills, whereas many of the non‐PBL graduates had learned communication skills on the job or elsewhere. This is not surprising in the light of the extensive communication skills component of the Maastricht undergraduate curriculum.[19] One may wonder, however, whether this result can be attributed to characteristics inherent in PBL or whether it is due to the longitudinal communication skills programme at the Maastricht Skillslab.

The setting in which teamwork was mostly learned also differed between the 2 groups of graduates, with more PBL graduates mentioning medical school as the place where they had learned to work in a team. Nevertheless, the majority of graduates indicated that teamwork skills had been learned on the job and not in school. A possible explanation is that until they enter clinical practice, junior doctors have never really worked in a team. Although the tutorial groups in the PBL curriculum resemble teams to some extent, they do not really need to function as a team. They discuss problems and the outcomes of self‐study in the group, but they study independently and do not have to rely on other students for passing examinations. Another setting that might be seen as offering experience in teamwork refers to clinical clerkships. However, as clerks, students are not seen as full team members with responsibilities of their own, nor do they have to direct others. Other studies of teamwork have produced variable results. Mann and Kaufman reported no significant differences in perceptions of preparation for teamwork.[20] Hannon found that junior doctors perceived themselves as adequately prepared for teamwork in a general sense, but insufficiently so for certain skills, such as using strategies to facilitate teamwork.[5] A recent study by Willis et al. showed some differences between graduates from traditional and innovative curricula in that it found some evidence that the innovative course enhanced students' awareness of their own limitations and abilities to act as professionals alongside other team members.[21] In order to prepare students better for working in a team, teamworking skills should receive explicit attention in the undergraduate curriculum.

Although PBL is purported to enhance students' general competencies, such as independence and the planning and organisation of work, we found no significant differences between the 2 types of school in these competencies.

All graduates appeared to be satisfied with their education as far as knowledge and skills were concerned. The greater satisfaction with communication skills expressed by the PBL graduates may be due to curriculum factors not specifically related to PBL characteristics. An unexpected result was that no differences were found between the 2 types of school for the ability to work independently, the development of which is a characteristic outcome of PBL.

A cause for concern is the apparent failure of medical schools to provide students with adequate preparation with respect to many general competencies that doctors need in their day‐to‐day work, such as working independently and accurately. Using computers, planning and organising work, and leadership skills were identified as competencies with insufficient exposure in the curriculum. This is consistent with a Dutch national report on medical education, which concluded that undergraduate medical training is 'too focused on individual acquisition of theoretical knowledge, and despite the explicit attention for interpersonal, communication and social skills in the new curricula... this development is in need of further expansion'.[22] The CanMEDS project included general competencies in its description of the required skills for doctors,[23] but there is not much evidence that medical schools have adapted their curricula to equip students with those skills. In order to improve the transition from school to practice, medical educators should give a more prominent place in the curriculum to other competencies besides knowledge. Skills such as teamworking and planning and organising work should be incorporated into undergraduate training.

A limitation of this study is that the results are based on self‐assessment. However, although self‐assessment does not always provide objective information, there is some evidence that it is more reliable than asking experts or colleagues.[24] The response rate was low (45%), but quite reasonable for a large population survey. We are confident that the number of responses was sufficiently large to obtain representative information. The overriding conclusion is that junior doctors need more preparation for the general competencies required in practice. Specific attention to such competencies in undergraduate medical training appears to be effective. The results of this study show that PBL really does enhance the level of skill displayed in general competencies such as communication skills and teamwork. However, other competencies, such as planning and organising work, are in need of more explicit attention in undergraduate medical training.

<bold>Contributors: </bold> this study is part of KP's thesis. She carried out the research and wrote the first draft of the paper. All authors contributed to the design of the study and the writing of the paper.

<bold>Acknowledgements: </bold> none.

<bold>Funding: </bold> none.

<bold>Conflicts of interest: </bold> none.

<bold>Ethical approval: </bold> ethical approval was not sought.

Overview

What is already known on this subject

Junior doctors perceive themselves as having shortcomings in their knowledge, skills and general competencies.

What this study adds

Graduates from a PBL medical school indicated more often than their non‐PBL colleagues that profession‐specific skills, communication skills and the ability to work in a team had been acquired in medical school.

Both PBL and non‐PBL graduates identified deficits in their general competencies, such as planning and organising work.

Suggestions for further research

Junior doctors apparently need more preparation for general competencies required in practice. How can medical training enhance these general competencies?

By Katinka J A H Prince; Patrick W L J Van Eijs; Henny P A Boshuizen; Cees P M Van Der Vleuten and Albert J J A Scherpbier

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