A comparison of student performance on discipline-specific versus integrated exams in a medical school course

Curricular reform is a widespread trend among medical schools. Assessing the impact that pedagogical changes have on students is a vital step in review process. This study examined how a shift from discipline-focused instruction and assessment to integrated instruction and assessment affected student performance in a second-year medical school pathology course. We investigated this by comparing pathology exam scores between students exposed to traditional discipline-specific instruction and exams (DSE) versus integrated instruction and exams (IE). Exam content was controlled, and individual questions were evaluated using a modified version of Bloom's taxonomy. Additionally, we compared United States Medical Licensing Examination (USMLE) step 1 scores between DSE and IE groups. Our findings indicate that DSE students performed better than IE students on complete pathology exams. However, when exam content was controlled, exam scores were equivalent between groups. We also discovered that the integrated exams were composed of a significantly greater proportion of questions classified on the higher levels of Bloom's taxonomy and that IE students performed better on these questions overall. USMLE step 1 exam scores were similar between groups. The finding of a significant difference in content complexity between discipline-specific and integrated exams adds to recent literature indicating that there are a number of potential biases related to curricular comparison studies that must be considered. Future investigation involving larger sample sizes and multiple disciplines should be performed to explore this matter further.