Kumar Kusum, Indurkhya Alka
Division of Human Pathology, Michigan State University, East Lansing, MI 48824, USA.
Hum Pathol. 2004 Dec;35(12):1435-9. doi: 10.1016/j.humpath.2004.09.019.
A multi-institutional collaborative longitudinal study was conducted to assess the effect of curricular change (overall curricular format and detailed pathology instruction) and school policy regarding the Step 1 requirement on the United States Medical Licensure Examination (USMLE) Step 1 Total and Step 1 Pathology scores over a period of 6 years (1995 to 2000). Detailed descriptions of instruction (overall curricular format and the format and number of hours of instruction in various areas of pathology) and the school policy of USMLE Step 1 requirement for classes entering in 1993 to 1998 were matched with Step 1 Total scores and Step 1 Pathology scores for 48,166 students from 73 schools who took the corresponding June 1995 to 2000 examination. Hierarchical linear modeling was used for analysis while controlling for students' MCAT-bpv (Medical College Admission Test, composite of biological and physical sciences and verbal reasoning) scores and undergraduate grade point average (GPA). Results indicated that the GPA and MCAT-bpv scores of students significantly impacted their Step 1 Total score and Step 1 Pathology score for each year. The mean MCAT-bpv scores of entering classes showed a steady increase from 1993 to 1998. About this same time, Step 1 Total scores were on the rise (especially for classes entering 1994 to 1996, after which they stabilized). During the same time period (1993 to 1998), there was a substantial move toward integrated instruction of Pathology. The mean Step 1 scores of schools with integrated instruction were slightly higher than those of schools with nonintegrated instruction, but the difference was not significant. Analyses of variance were run to examine the effect of change of curriculum on Step 1 Total and Step 1 Pathology scores. Our analysis does not appear to show a cause-and-effect relationship between changes in curriculum toward integrated instruction and the increasing Step 1 scores during the study period. The MCAT-bpv scores showed an upward pattern during the study period, and given that they are strong predictors of Step 1 scores, it appears that the rising MCAT-bpv scores are a major contributory factor to the upward trend in the scores during the study period. The only clearly significant result at the school level is that a requirement to pass Step 1 before moving on to clinical rotations is positively related to Step 1 Total and Step 1 Pathology scores.
开展了一项多机构合作的纵向研究，以评估课程变化（整体课程形式和详细的病理学教学）以及学校关于美国医师执照考试（USMLE）第一步要求的政策，对1995年至2000年这6年期间USMLE第一步总分和第一步病理学成绩的影响。1993年至1998年入学班级的教学详细描述（整体课程形式以及病理学各个领域的教学形式和时长）以及学校关于USMLE第一步要求的政策，与73所学校的48166名学生在1995年6月至2000年相应考试中的第一步总分和第一步病理学成绩进行了匹配。在控制学生的医学院入学考试生物和物理科学及语言推理综合成绩（MCAT-bpv）和本科平均绩点（GPA）的同时，使用分层线性模型进行分析。结果表明，学生的GPA和MCAT-bpv成绩每年都对他们的第一步总分和第一步病理学成绩有显著影响。1993年至1998年入学班级的平均MCAT-bpv成绩呈稳步上升趋势。大约在同一时期，第一步总分也在上升（尤其是1994年至1996年入学的班级，之后趋于稳定）。在同一时期（1993年至1998年），病理学的教学有向整合教学大幅转变的趋势。采用整合教学的学校的第一步平均成绩略高于采用非整合教学的学校，但差异不显著。进行方差分析以检验课程变化对第一步总分和第一步病理学成绩的影响。我们的分析似乎未显示出在研究期间课程向整合教学的变化与第一步成绩上升之间存在因果关系。在研究期间，MCAT-bpv成绩呈上升趋势，鉴于它们是第一步成绩的有力预测指标，似乎MCAT-bpv成绩上升是研究期间成绩上升趋势的一个主要促成因素。在学校层面唯一明显显著的结果是，在进入临床轮转之前通过第一步考试的要求与第一步总分和第一步病理学成绩呈正相关。
