The strategic impact of a changing curriculum and learning environment on medical students' academic performance.

In recent years, the administration of Meharry Medical College, School of Medicine (SOM), Nashville, Tennessee, recognized the need to modify the curriculum to help improve student academic performance especially on the National Board of Medical Examiners (NBME) US Medical Licensing Examination (USMLE) steps 1 and 2. Thus, a number of changes occurred with respect to the traditional curriculum in the SOM, resulting in an integrated organ system-based curriculum design. The change in the learning environment was studied to determine the impact on performance after the introduction of the integrated organ system-based curriculum as compared to that of the traditional curriculum. With the utilization of a cadre of variables, it was believed that the strategic impact anticipated would provide a predictive validity profile to assist in the identification of students "at risk" of failure so that proactive intervention methodology could be made available to facilitate the students' successful progression during matriculation in the SOM. The purpose of this study was to analyze whether students trained with the integrated organ systems curriculum perform better than students trained with the traditional medical school curriculum on the medical education preclinical subject board examinations, and the NBME USMLE steps 1 and 2 examinations. From the 584 students studied in the control group (graduation classes for years 2005, 2006, and 2007) and the intervention group (graduation classes for years 2008, 2009, and 2010), significant improvement in performance on the NBME USMLE steps 1 and 2 examinations was noted following the introduction of the integrated organ system-based curriculum particularly among "at-risk" students. Data access availability from the School of Medicine of Meharry Medical College automatically gave reason for a preferential comparative relationship and study of the resulting strategic impact on cohorts graduating in years 2005-2010. Thus, this longitudinal retrospective review was to determine whether or not students' academic performance profiles might provide some valid predictive information to help identify "at-risk" students early in their pursuit of a health professions career.