Changes to an Active Learning Curriculum in Osteopathic Medical Education: Effects on Exam Outcomes and Board Scores

With the introduction of McMaster University's problem-based, self-directed learning and cognitive integration in the medical school curriculum, learning in small groups has been gaining popularity with medical schools worldwide. Problem-based learning (PBL) places emphasis on the value of basic medical sciences as the basis of learning medicine using clinical problems. For a successful outcome, a PBL curriculum needs to have a student-centered learning environment, problem-based design and facilitation, and assessment of learning in PBL domains. We describe a PBL program that has been used for undergraduate medical education, including changes made to learning resources and assessment. The changes required input from both faculty educators and students, and success depended on buy-in into the process. One of the changes included implementing the use of standard textbooks, which students use as the primary source of information during self-directed learning. Another change was the use of several reliable, valid, and cost-effective high-stakes written exams from internal and external sources, to promote spaced retrieval of biomedical facts and clinical contexts. By making these and other changes, we have been able to achieve pass rates and board scores which are consistently above the national average for 12 years. We conclude that in order to ensure sustainable successful outcomes, it is important to keep our program dynamic by making improvements in the PBL domains and assessment methods, taking into consideration students' course evaluations of the learning environment.