Influence of curriculum type on student performance in the United States Medical Licensing Examination Step 1 and Step 2 exams: problem-based learning vs. lecture-based curriculum.

INTRODUCTION: The results of the United States Medical Licensing Examination Step 1 and 2 examinations are reported for students enrolled in a problem-based and traditional lecture-based curricula over a seven-year period at a single institution. There were no statistically significant differences in mean scores on either examination over the seven year period as a whole. There were statistically significant main effects noted by cohort year and curricular track for both the Step 1 and 2 examinations. These results support the general, long-term effectiveness of problem-based learning with respect to basic and clinical science knowledge acquisition. CONTEXT: This paper reports the United States Medical Licensing Examination Step 1 and Step 2 results for students enrolled in a problem-based and traditional lecture-based learning curricula over the seven-year period (1992-98) in order to evaluate the adequacy of each curriculum in supporting students learning of the basic and clinical sciences. METHODS: Six hundred and eighty-nine students who took the United States Medical Licensing Examination Step 1 and 540 students who took Step 2 for the first time over the seven-year period were included in the analyses. T-test analyses were utilized to compare students' Step 1 and Step 2 performance by curriculum groups. RESULTS: United States Medical Licensing Examination Step 1 scores over the seven-year period were 214 for Traditional Curriculum students and 208 for Parallel Curriculum students (t-value = 1.32, P=0.21). Mean Step 2 scores over the seven-year period were 208 for Traditional Curriculum students and 206 for Parallel Curriculum students (t-value=1.08, P=0.30). Statistically significant main effects were noted by cohort year and curricular track for both the Step 1 and Step 2 examinations. CONCLUSION: The totality of experience in both groups, although differing by curricular type, may be similar enough that the comparable scores are what should be expected. These results should be reassuring to curricular planners and faculty that problem-based learning can provide students with the knowledge needed for the subsequent phases of their medical education.

Non-cognitive characteristics of medical students: entry to problem-based and lecture-based curricula.

The effectiveness of problem-based learning (PBL) versus lecture-based learning (LBL) continues to be debated all over the world. These arguments have often been based on students' cognitive measures of performance. Little emphasis has been placed on non-cognitive factors that may directly or indirectly affect the medical school performance of students in either curriculum. The purpose of this study was to (1) document possible differences in student cognitive and non-cognitive characteristics at entry between the two curricula and (2) to explore the relationships that exist between cognitive and non-cognitive factors. Data were obtained from three medical school classes (n = 281). The results indicate that students who entered the PBL curriculum at this medical school had higher total Medical College Admission Test and undergraduate grade point average than students who entered the LBL curriculum. Students who entered the PBL curriculum were also more self-sufficient and were more likely to do well in individualistic and less structured settings. There were no strong correlations between cognitive and non-cognitive variables. Before conclusions can be drawn about the effectiveness of either PBL or LBL curricula, we need to document patterns in entry characteristics to control for a priori differences that affect student performance.

Ratings of students' performances in a third-year internal medicine clerkship: a comparison between problem-based and lecture-based curricula.

PURPOSE: To compare clinical performances in a third-year medicine clerkship between studies from a problem-based learning (PBL) curriculum and students from a traditional, lecture-based learning (LBL) curriculum. METHOD: The study participants were 88 PBL students and 364 LBL students rotating through a common third-year internal medicine clerkship at the Bowman Gray School of Medicine at Wake Forest University, classes of 1991-1995. Faculty and housestaff assessed the students' performances using four clinical rating scales. The student also completed the medicine student ("shelf") test of the National Board of Medical Examiners (NBME). RESULTS: On average, the PBL students received significantly higher ratings from housestaff and faculty on all four rating scales. No difference in scores on the NBME medicine shelf test was observed. CONCLUSION: The results support the hypothesis that preclinical PBL curricula as found at the Bowman Gray School of Medicine may enhance third-year students' clinical performances.