Introduction Medical education in the United States has changed dramatically in the last few decades. Medical schools have moved away from a traditional, didactic, and discipline‐based curriculum to a more integrative, active, and student‐centered curriculum. Another common change has been the shift from a graded curriculum to a pass‐fail curriculum. While much research has documented overall performance, especially on high stakes examinations, little research has been conducted on gross anatomy laboratory performance. Aim This study examines the effects of curricular change, including decreased contact hours and shift to a pass‐fail curriculum, on gross anatomy laboratory performance. Methodology Gross anatomy laboratory examinations were reviewed retrospectively in two cohorts: one cohort that was in the previous, nonintegrated curriculum with a graded (i.e., A, B, F) curriculum; and a second cohort that was part of the first integrated class with a pass‐fail curriculum. For the pass‐fail curriculum in particular, the standard for passing was notably lower than that for the graded curriculum. Each of the students’ examinations were de‐identified. Only identification questions (i.e., ones that asked “Identify the tagged structure”) were reviewed. Questions that were common between the two cohorts were used for analysis. An independent samples t‐test was performed on the data, and Cohen’s d effect size was calculated. Significance was ascribed for p<0.05. Results There were 69 questions that were similar between all the laboratory examinations from the pre‐curricular reform and post‐curricular reform cohorts. There was an approximately even number of questions from muscles, nerves, vessels, and additional structures on the cadaveric specimens and plastic models used on the examinations. It was found that the post‐curricular reform cohort scored significantly lower (mean = 67.05 ± 22.35) than the pre‐curricular reform cohort (mean = 79.89 ± 19.56) p<0.001, d = 0.61. Discussion and Conclusion The results of the study demonstrate that students within the new curriculum, with reduced contact hours and a pass‐fail curriculum, performed significantly poorer than students in the non‐integrated curriculum. Students may have felt that the gross anatomy laboratory experience was lower stakes compared to their other coursework, especially since the passing standard for the post‐curricular reform cohort was markedly lower than the that of the pre‐curricular reform cohort.

With many medical schools having undergone significant curricular reform, including those who have transitioned to a pass/fail curriculum model, residency programs have little quantitative data with which to compare individual medical students who apply to their programs. For these programs, the primary source of quantitative data is a student’s USMLE Step 1 exam score, because it provides a common measurement across medical schools with different curricula. This circumstance puts an immense amount of pressure on this one exam, sparking discussions at medical schools across the nation about the “Step 1 Climate” ( Chen et. al., 2019). In 2016, Indiana University School of Medicine – Bloomington (IUSM‐BL) underwent curricular reform. The new curriculum uses a pass/fail system for all courses. Given the emphasis placed on the Step 1 exam, I am interested in learning more about student perceptions of the Step 1 exam, specifically how it impacts their relationship with the IUSM‐BL curriculum. First‐ and second‐year medical students at IUSM‐BL were interviewed using a 30–60‐minute semi‐structured interview format. The questions were designed to obtain student perceptions of the USMLE Step 1 exam and its relationship to the current medical school curriculum at IUSM‐BL. Interview questions included the following: 1) Having students explain the Step 1 exam and its importance in their future education, 2) Explanations of how students are studying for the Step 1 exam, 3) Perceptions of how well the IUSM‐BL curriculum is preparing students for the Step 1 exam. A thematic analysis of the interview transcripts was performed to determine commonalities in responses. Resultant themes indicate that the USMLE Step 1 exam is ever‐present in the minds of our medical students. They stress the overemphasis on this exam for their future residency applications, and suggest some ideas for ways to alleviate the emphasis placed on the Step 1 exam. This study will contribute to answering the larger questions surrounding the effect of the Step 1 exam on students and medical education. Student Perspectives on the “Step 1 Climate” in Preclinical Medical EducationDRChenKCPriestJNBattenLEFragosoBIReinfeldBM.LaitmanAcademic Medicine94302204

Many medical schools have undergone curricular reform in the past decade. With these reforms, the time spent teaching anatomy has decreased. Did these curricular changes impact medical student anatomical knowledge? At Indiana University School of Medicine (IUSM) a new curriculum was implemented in Fall 2016. In this study, we examine how curricular reform may have impacted student performance at one of the medical campuses, IUSM‐Bloomington (IUSM‐BL). At IUSM‐BL, the pre‐curricular reform year‐long human gross anatomy course was condensed into an integrated semester‐long course (called Human Structure). Human Structure integrates gross anatomy, histology, and embryology. In order to assess if these medical curricular changes have impacted student anatomical knowledge at IUSM‐BL, we compare pre‐curricular reform and post‐curricular reform class performance on anatomy practical lab exams – specifically, among lower order (pure identification) questions versus higher order (function, innervation, embryological origin) questions. Pre‐curricular reform data was comprised of first year medical students from academic year 2015–2016 (~36 students). Post‐curricular reform data was comprised of first year medical students from both Fall 2016 (~36 students) and Fall 2017 (~36 students). Copies of de‐identified lab practical exams from all of these years were collected for analysis. Once lab practical exam questions are coded as higher order or lower order, overall exam performance across all questions will be divided into a lower order average and a higher order average. Independent‐samples t‐tests will then be completed for each question grouping to compare performance on higher and lower order questions before and after curricular reform. Data is in the process of being coded and analyzed. This study will provide demonstrable evidence about the impact of curricular reform on medical student anatomical knowledge.This study has been approved by Indiana University – Bloomington IRB protocol #1507464902This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Many medical schools have undergone curricular reform recently. With these reforms, time spent teaching anatomy has been reduced, and there has been a general shift to a pass/fail grading system. At Indiana University School of Medicine (IUSM), a new curriculum was implemented in fall 2016. The year‐long human gross anatomy course taught in 2015 was condensed into an integrated, semester‐long course starting in 2016. Additionally, the grading scale shifted to pass/fail. This study examined first‐year medical student performance on anatomy practical laboratory examinations—specifically, among lower‐order (pure identification) questions and higher‐order (function, innervation) questions. Participants included medical students from a pre‐curricular reform cohort (year 2015, 34 students) and two post‐curricular reform cohorts (years 2016, 30 students and 2017, 33 students). A Kruskal–Wallis ANOVA test was used to determine differences of these questions among the three cohorts. Additionally, 40 of the same lower‐order questions that were asked on gross anatomy laboratory examinations from medical student cohort year 2015 and year 2016 were further analyzed using an independent samples t‐test. Results demonstrated that the pre‐curricular reform cohort scored significantly higher on both lower‐order (median = 81, p < 0.001) and higher‐order questions (median = 82.5, p < 0.05) than both post‐curricular reform cohorts. Additionally, when reviewing the selected 40 similar questions, it was found that the pre‐curricular reform cohort averaged significantly higher (82.1 ± 16.1) than the post‐curricular reform cohort from 2016 (69.3 ± 21.8, p = 0.004). This study provides evidence about the impact of curricular reform on medical student anatomical knowledge.