ACEing Cognitive Integration: Evidence from a Structural Equation Model

Area of Science:

• Medical Education
• Cognitive Science
• Curriculum Development

Background:

• Medical education reform emphasizes integrating basic sciences with clinical applications.
• Cognitive integration is crucial for developing clinical reasoning and expertise.
• The Active-Learning, Competency-Based, Excellence-Driven (ACE) curriculum aims to foster this integration.

Purpose of the Study:

• To evaluate the extent to which the ACE curriculum promotes cognitive integration in medical learners.
• To assess the relationship between foundational knowledge and clinical skills/knowledge.
• To examine the mediating role of developmental clinical skills and knowledge.

Main Methods:

• Structural equation modeling was used to analyze data from graduating classes of 2023-2025 (N=630) at KUSOM.
• Examined the relationship between foundational knowledge (course exams) and clinical skills assessment.
• Assessed the mediation by developmental clinical skills and developmental clinical knowledge (NBME Subject Exam) on USMLE Step 2 CK scores.

Main Results:

• Foundational knowledge strongly correlated with clinical skills assessment, fully mediated by developmental clinical skills.
• Foundational knowledge strongly correlated with USMLE Step 2 CK scores, fully mediated by developmental clinical knowledge.
• Higher foundational knowledge predicted better performance on clinical skills assessments.

Conclusions:

• The ACE curriculum appears successful in promoting cognitive integration.
• Foundational knowledge acquired early is strongly linked to later clinical competence.
• The curriculum design supports the development of connections between basic science and clinical practice.