The learning strategy developed by Duke-NUS educators, called TeamLEAD, incorporates Team-Based Learning principles. Lectures, readings and e-learning on a given topic are completed before class; in-class activity focuses on assuring understanding, applying principles, and solving problems within student teams facilitated by faculty. The study compared Duke-NUS students' results on the National Board of Medical Examiners Comprehensive Basic Science Examination (CBSE) and United States Medical Licensing Examination (USMLE) Step 1 with those of US medical students. The Duke and Duke-NUS curriculum is unique in that the basic science foundation is taught in one year, typically half the time devoted at other US medical schools. At the end of their basic science instruction, the first three student cohorts from Duke-NUS performed comparably to US students on the CBSE At the end of their second year (devoted to clinical work), the Duke-NUS students scored significantly higher than the US students (66.5±7.8 vs. 61.0±11.0) (p<.0.05; 95% CI [65.1 to 67.9]). The first two years of Duke-NUS student also scored significantly higher than US students on the USMLE Step 1 (228.4±20.7 vs. 222±24) (p<.028; 95% CI [223.5 to 233.3]). In less curricular time, Duke-NUS students achieved the standards of basic science knowledge achieved by US medical students. Duke-NUS students at the end of their second (clinical) year, performed significantly higher than the US students. Medical Science Educator © IAMSE 2012Volume 22(2) 64

Background: Students' ability to retain content in medical school has always been a concern. At Duke-NUS Medical School, we modified our Team-Based Learning (TBL) classes known as TeamLEAD, a learning strategy for first year basic science content, to include an open/closed-book option in the readiness assurance phase to engage teams in deeper discussion. We hypothesize that the open-book option allows students to engage in deeper learning in their teams, which leads to an improvement in retention ability for each individual student at the end of their first year basic science curriculum.