We examined the effects of several problem-based learning (PBL) tutorials on the development of clinical abilities among medical students. In 1988, 2 years before our university implemented the PBL tutorial curriculum, one to three trial tutorials were used for a portion of the students in the 1st through 3rd years to identify a suitable tutorial education system for Japanese students. To examine the effects of these trial tutorials, we sent questionnaires to graduates who had participated in the trial tutorials and to those who had not. We found that graduates who had participated in the trial tutorials were more likely than graduates who had not to report logical thinking capabilities during their undergraduate years and clinical problem-solving abilities at the end of their internship. The results suggest that the use of one or more tutorials is effective in helping students develop logical thinking and problem-solving ability.

Positive self-esteem helps students build and maintain self-efficacies to affect later clinical practice. We examined the outcome of problem-based-learning (PBL) curriculum by evaluating self-efficacy in terms of sustained learning and clinical competencies among medical school graduates.
1) We compared practicing doctors who either had PBL tutorial experience or who had not by a questionnaire survey.
2) The subjects self-evaluated whether they had achieved expected abilities (1) at the end of undergraduate years, (2) during 2-year internship, and (3) at present.
3) Among 1, 502 doctors surveyed (response rate=36.0%), doctors with PBL tutorial experience had higher selfefficacy (odds ratio>2.1) in their clinical abilities than doctors without it, especially during the school years.
4) In the later 2 periods, doctors with PBL experience had higher self-efficacy in communication skills.
5) PBL tutorial foster self-efficacy in clinical abilities, especially in communication skills, during earlier clinical career.

INTRODUCTIONIn this study, we compared the choice of medical specialty and subspecialty interest among problem-based-learning (PBL) graduates and non-PBL graduates.

MATERIALS AND METHODSQuestionnaires were mailed to a total of 1398 female doctors who graduated from Tokyo Women's Medical University (TWMU) between 1989 and 2003. The response rate was over 30%, giving 248 respondents who had undergone a PBL curriculum (PBL+) and 220 subjects who had not (PBL-). Current specialty of the graduates were compared between the PBL+ and PBL-, and also compared with the general Japanese female doctors (Control 1 and 2) of similar age groups. Respondents were analysed in terms of their interests in subspecialty medical care or general medical practise, which includes comprehensive medical care, primary care and basic medicine. Internal medicine doctors working in the university hospitals were compared with those working outside the university hospitals. Internal medicine doctors were also compared with specialists in ophthalmology, otolaryngology, dermatology and psychiatry. Subjects were compared by odds ratio (OR) to examine group difference in the field of interest. OR >2.0 was considered statistically significant.

RESULTSMost doctors in all groups chose internal medicine. More PBL+ internal medicine doctors showed interests in comprehensive medical care and primary care; more PBL+ internal medicine doctors working outside university hospitals showed interest in comprehensive medical care and primary care when compared with those who were working in the university hospitals. The PBL- graduates did not show such a characteristic.

CONCLUSIONSMore PBL+ graduates who chose internal medicine showed interest in holistic medical practices such as primary care and community medicine and more PBL+ specialists showed sustained interest in their respective fields.

Adult ; Career Choice ; Education, Medical, Undergraduate ; Female ; Humans ; Internal Medicine ; statistics & numerical data ; Japan ; Problem-Based Learning ; statistics & numerical data