Curricular Reform in Two Medical School Tracks and the Impact on USMLE Scores

Purpose: The University of Arizona College of Medicine underwent several curricular revisions that began in 2006. These changes included (1) moving from a traditional to a systems-based curriculum, (2) adding a second campus location, and (3) altering the duration of clinical clerkships. We examined whether these curricular revisions impacted student performance on the United States Medical Licensing Examination (USMLE) step 1 and step 2 Clinical Knowledge (CK) examinations. Method: We examined curricular changes that took place from academic years 2006–2010 (classes of 2010–2014) compared to the previous traditional-based curriculum in two different medical school tracks under one university system. Academic years 2002–2005 served as control, and ten different curricular groups were examined. An ANOVA was conducted for each step exam, and all pairwise differences were examined using Tukey’s honest significant differences. Statistical significance was established at p < 0.05. Results: The first year of the revised preclerkship curriculum resulted in lower step 1 scores compared to the previously traditional curriculum. However, statistically significant mean increases in step 1 and 2 scores were found for curricular groups that experienced the revised preclerkship curriculum, a return to six-week clerkship rotations, and had completed all 4 years at one specific campus on one specific medical track. Conclusion: With the integration of basic and clinical sciences in the first 2 years and modifications to the clerkship rotations, the content of the curriculum was taught with more regard to what will ultimately benefit the practicing physician. This curricular reform led to higher scores particularly on the step 2 USMLE exam.