No abstract

Background In 2010, coincident with the 100th anniversary of Flexner’s sentinel report, the Carnegie Foundation published an updated review of North American medical education and challenged medical schools to initiate further educational reforms. Specific recommendations pertained to a) ensuring standardized outcomes while allowing for individualized processes, b) integrating foundational knowledge with clinical experience, c) cultivating habits of inquiry and innovation and d) professional identity formation. As we approach the 10-year anniversary of this latest report, we sought to determine what type of curricular revisions have been emerging within the past decade and what types of challenges have been encountered along the way? Methods In 2018, an electronic survey was sent to all 166 Liaison Committee on Medical Education (LCME) accredited North American Medical Schools, using the points of contact (educational deans) that were listed in a publicly available, Association of American Medical Colleges database. Free text comments were grouped into themes using the constant-comparative technique. Results Sixty unique responses yielding a 36.14% response rate. The distribution of responses was proportionally representative of the distribution of public vs. private, old vs. new vs. established North American medical schools. Self-reported curricular changes aggregated into five main themes: Changes in curricular structure/organization, changes in curricular content, changes in curricular delivery, changes in assessment, and changes involving increased use of technology/informatics. Challenges were predominantly focused on overcoming faculty resistance, faculty development, securing adequate resourcing, change management, and competition for limited amounts of curricular time. Conclusions Changes in curricular organization, content, delivery, assessment and the use of technology reflect reforms that are broad and deep. Empowering faculty to “let go” of familiar constructs/processes requires strong leadership, particularly when initiating particularly disruptive curricular changes, such as relocating the Step 1 examination or shifting to a competency-based curriculum. While North American medical schools are responding to the calls for action described in the second (2010) Carnegie Foundation report, the full vision has yet to be achieved. Electronic supplementary material The online version of this article (10.1186/s12909-019-1680-1) contains supplementary material, which is available to authorized users.

Purpose Schools undergoing curricular reform are reconsidering the optimal timing of Step 1. This study provides a psychometric investigation of the impact on United States Medical Licensing Examination Step 1 scores of changing the timing of Step 1 from after completion of the basic science curricula to after core clerkships. Method Data from four schools that recently moved the examination were analyzed in a pre–post format using examinee scores from three years before and after the change. The sample included scores from 2008 through 2016. Several confounders were addressed, including rising national scores and potential differences in cohort abilities using deviation scores and analysis of covariance (ANCOVA) controlling for Medical College Admission Test (MCAT) scores. A resampling procedure compared study schools’ score changes versus similar schools’ in the same time period. Results The ANCOVA indicated postchange Step 1 scores were higher compared with prechange (adjusted difference = 2.67; 95% confidence interval: 1.50–3.83, P < .001; effect size = 0.14) after adjusting for MCAT scores and rising national averages. The average score increase in study schools was larger than changes seen in similar schools. Failure rates also decreased from 2.87% (n = 48) pre change to 0.39% (n = 6) post change (P < .001). Conclusions Results suggest moving Step 1 after core clerkships yielded a small increase in scores and a reduction in failure rates. Although these small increases are unlikely to represent meaningful knowledge gains, this demonstration of “noninferiority” may allow schools to implement significant curricular reforms.