3 34 4 P roblem-based learning curricula have been introduced in many medical schools around the world.1,2 However, their adoption was met with some concern, primarily because of the substantial manpower needed. For example, student contact hours are 3-4 times greater for educators in a problem-based learning curriculum than for educators in a traditional curriculum. As a consequence, the economic viability of problem-based learning becomes a major concern when class sizes exceed 100 students.3 Given the limited resources available, 4 evidence-based evaluation of the effects of problem-based learning during medical school on improving physician competency would certainly strengthen any justification for the adoption of such programs. 5-9Past reviews of problem-based learning focused only on its effects during medical school or postgraduate training.10-16 In addition, 4 of those reviews also studied student and educator preferences and indicated that medical students 11,14,15 and educators 16 generally prefer problem-based learning to traditional teaching methods. The reviews did not study the effects of problem-based learning during medical school on the competencies of practising physicians. Colliver emphasized this lack of evidence when he cautioned that student satisfaction cannot be extrapolated as a predictor of physician competency.17 To our knowledge, there has been only one systematic review, published in 1993, that indirectly reported the effects of problembased learning during medical school on physician competency after graduation. The study was based on a small sample of doctors in their early postgraduate years.16 Since then, many rigorous studies have evaluated the effects of problem-based learning during medical school up to 20 years after graduation. We performed a systematic review of controlled studies to determine whether problem-based learning during medical school leads to greater physician competencies after graduation. MethodsIn our study, we used Maudsley's definition of problem-based learning, which she defined as both a method and philosophy involving problem-first learning via work in small groups and independent study. The effects of problem-based learning during medical school on physician competency: a systematic review Background: Systematic reviews on the effects of problembased learning have been limited to knowledge competency either during medical school or postgraduate training. We conducted a systematic review of evidence of the effects that problem-based learning during medical school had on physician competencies after graduation.

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There are trade-offs between effectiveness and efficiency during inpatient sub-acute stroke rehabilitation with respect to admission functional status and length of stay.

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