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.

Following the June-September 2009 wave of 2009 influenza A(H1N1), 13% of the community participants seroconverted, and most of the adult population likely remained susceptible.

BackgroundExcess adiposity is associated with cardiovascular disease (CVD) risk factors such as hypertension, diabetes mellitus and dyslipidemia. Amongst the various measures of adiposity, the best one to help predict these risk factors remains contentious. A novel index of adiposity, the Body Adiposity Index (BAI) was proposed in 2011, and has not been extensively studied in all populations. Therefore, the purpose of this study is to compare the relationship between Body Mass Index (BMI), Waist Circumference (WC), Waist-to-Hip Ratio (WHR), Waist-to-Height Ratio (WHtR), Body Adiposity Index (BAI) and CVD risk factors in the local adult population.Methods and FindingsThis is a cross sectional study involving 1,891 subjects (Chinese 59.1% Malay 22.2%, Indian 18.7%), aged 21–74 years, based on an employee health screening (2012) undertaken at a hospital in Singapore. Anthropometric indices and CVD risk factor variables were measured, and Spearman correlation, Receiver Operating Characteristic (ROC) curves and multiple logistic regressions were used. BAI consistently had the lower correlation, area under ROC and odd ratio values when compared with BMI, WC and WHtR, although differences were often small with overlapping 95% confidence intervals. After adjusting for BMI, BAI did not further increase the odds of CVD risk factors, unlike WC and WHtR (for all except hypertension and low high density lipoprotein cholesterol). When subjects with the various CVD risk factors were grouped according to established cut-offs, a BMI of ≥23.0 kg/m2 and/or WHtR ≥0.5 identified the highest proportion for all the CVD risk factors in both genders, even higher than a combination of BMI and WC.ConclusionsBAI may function as a measure of overall adiposity but it is unlikely to be better than BMI. A combination of BMI and WHtR could have the best clinical utility in identifying patients with CVD risk factors in an adult population in Singapore.

ObjectivesTo (1) identify all available rehabilitation impact indices (RIIs) based on their mathematical formula, (2) assess the evidence for independent predictors of each RII and (3) propose a nomenclature system to harmonise the names of RIIs.DesignSystematic review.Data sourcesPubMed and references in primary articles.Study selectionFirst, we identified all available RII through preliminary literature review. Then, various names of the same formula were used to identify studies, limited to articles in English and up to 31 December 2011, including case–control and cohort studies, and controlled interventional trials where RIIs were outcome variable and matching or multivariate analysis was performed.ResultsThe five RIIs identified were (1) absolute functional gain (AFG)/absolute efficacy/total gain, (2) rehabilitation effectiveness (REs)/Montebello Rehabilitation Factor Score (MRFS)/relative functional gain (RFG), (3) rehabilitation efficiency (REy)/length of stay-efficiency (LOS-EFF)/efficiency, (4) relative functional efficiency (RFE)/MRFS efficiency and (5) revised MRFS (MRFS-R). REy/LOS-EFF/efficiency had the most number of supporting studies, followed by REs and AFG. Although evidence for different predictors of RIIs varied according to the RII and study population, there is good evidence that older age, lower prerehabilitation functional status and cognitive impairment are predictive of poorer AFG, REs and REy.Conclusions5 RIIs have been developed in the past two decades as composite rehabilitation outcome measures controlling premorbid and prerehabilitation functional status, rate of functional improvement, each with varying levels of evidence for its predictors. To address the issue of multiple names for the same RII, a new nomenclature system is proposed to harmonise the names based on common mathematical formula and a first-named basis.