Student performance and grading changes in a systems-based curriculum

Changing from a conventional discipline-based, basic science medical school curriculum to an integrated systems-based curriculum, which was graded on overall performance not by discipline, was associated with a highly significant improvement in an externally administered comprehensive exam at the end of the 2-year basic science program. The reason for the improvement was unclear, but we hypothesized that it was partly due to a change in student study strategy. Anecdotal evidence suggested that students had changed their study habits to spend less time on previously harder-to-pass courses and more time on courses with previously lower failure rates. If this were so, performance in previously harder disciplines might have deteriorated, while performance in previously easier disciplines could have improved.

We examined relative performance in the four discipline-based courses of Systemic Pathology, Microbiology, Pharmacology, and Introductory Clinical Medicine (ICM) in the fourth (and last) semester of the curriculum. We compared failure rates in these four courses for the three cohorts before the change with the three cohorts after.

Pharmacology and Microbiology which had failure rates over twice as high as Systemic Pathology and ICM in the conventional program before the curriculum change showed a deterioration in performance after the change with an approximately threefold rise in internal failure rate. In contrast, Systemic Pathology showed a dramatic improvement with a more than threefold drop in the failure rate, while the ICM clinical skills course, which was largely assessed by a practical exam in all 6 cohorts, showed no change.

The improvement in student performance in an external assessment may be due, at least partly, to a change in the school's internal grading policy which led to a more appropriate balancing of student study strategies. Future studies on the effect of curriculum change should include an assessment of the impact on student study strategies.