Fully integrated medical curriculum proves beneficial for minority students

Of all the licensing exams along the way to becoming an M.D., the Step 1 is notorious for having the worst national passage rate. By adopting a fully integrated medical curriculum in lieu of the traditional academic model, the University of Texas Medical Branch (UTMB) has seen a dramatic drop over the course of a decade in the failure rate, with underrepresented minority students benefiting the most, according to new research that will be presented April 30, 2010 at the annual meeting of the American Educational Research Association.

Comparing the final three classes of students taught under the traditional curriculum (1995-1997) with three classes that studied under the new integrated model (2003-2005), UTMB researchers showed an overall decrease in the Step 1 failure rate from 7.7 percent to two percent. Nationally, for all students, the failure rate for the exam in the periods studied was six to seven percent.

Among underrepresented minorities during the same two timeframes at UTMB, the Step 1 failure rate decreased by 80 percent, from 16.5 percent to 3.3 percent. African American students showed the greatest improvement, with the failure rate decreasing by 94 percent, from 25 percent to 1.6 percent.

What began as quest to modernize an old-fashioned, traditional approach to medical instruction has become "a proven model for medical education, transforming lives as much as overhauling curriculum," according to the study's lead investigator, Steven Lieberman, M. D., Vice Dean for Academic Affairs and Professor of Internal Medicine. Since 2005, UTMB has held the highest overall medical board passage rate in the state, with nearly 98 percent of students passing.

The U. S. Department for Health & Human Services projects a shortage of 100,000 physicians by 2020, including minority physicians who currently account for only six percent of practicing doctors. These findings presage a more effective course of recruiting and training doctors who will both reflect a diverse society and return to provide care in underserved geographic regions, Lieberman said.

This UTMB knows well: as one of the oldest medical schools in the U.S., founded in 1891 with a heritage of serving underserved and at-risk populations, it continues to be among the most diverse academic medical institutions in the nation. From 2000-2008, its medical school ranked first in the number of Hispanic graduates and tenth in the number of African American graduates among American medical schools.

UTMB orchestrated its sweeping curriculum changes in 1998, which included pairing first-year medical students with patients in community clinics - a change that speeded up student-patient interaction to the beginning of their academic careers. The integrated medical curriculum is a hybrid of instructional methods with an emphasis on problem-based learning, which focuses students on solving real problems versus rote memorization and lecture-based learning. These changes, coupled with a "safety net" of student support, has made a substantial impact on students' success, most notably among at-risk students and underrepresented minorities, Lieberman said.
"We use a nontraditional approach to education that is student-centered, meaning their time is structured so that they are learning in an interactive environment - in small groups, guiding discussions, asking questions, visiting patients - not just sitting in a lecture hall," Lieberman said.

"This helps preserve students' thirst for an intellectual challenge and their altruistic motivations for becoming a doctor in the first place - qualities often lost in the competitive landscape of medical school. The result of this self-directed learning is greater academic success and, we believe, better future doctors," he added.

Closing the Achievement Gap
These findings build on a 2008 UTMB study published in Academic Medicine that showed all students who studied under the integrated medical curriculum model fared much better on the Step 1 exam even when they entered with below average MCAT scores (20-25 out of possible 45). On average, the low MCAT students' scores on the Step 1 exam were approximately 10 points higher than those studying under the traditional model (210.8 vs. 201.1).

Further studying only students with low MCAT scores, the researchers found that failure rates decreased by 67 percent. The greatest improvement was seen among African American students, with an 81 percent decrease in the failure rate.

Once enrolled, UTMB also takes preemptive measures to provide academic support, peer tutoring, mentoring, USMLE preparation and professional academic counseling. Students at high risk for academic difficulty are identified early, sometimes even before matriculation, for additional preparation and early support.

According to Lieberman, the studies suggest wider adoption of such approaches may significantly impact academic achievement and increase the number of minority doctors. "This is important because we know that physicians from underserved areas often return to the same communities to serve."

In the Vanguard of Finding and Nurturing Talent
UTMB's most prescient move was instituting novel undergraduate pipeline programs to identify high-potential candidates from underserved populations and bring them onto campus for intensive training and early exposure to medical school.

Six pipeline programs, housed in Office of Special Programs, identify premedical students from Texas and across the U.S. and ensure that students have the skills and credentials to be candidates at UTMB or other medical schools. Many are offered pre-acceptance at UTMB. For example, the Medical Careers Diversity and the Medical School Familiarization Programs provide disadvantaged premed students clinical and research experiences and career and academic counseling.

Through the Early Medical School Admissions (EMSAP) and the Joint Admissions Medical Programs, a state-funded initiative created after UTMB's EMSAP, dozens of underrepresented minority students receive assistance in completing admission applications, and coaching for medical school interviews, which results in early acceptance offers.

"Theses comprehensive curriculum changes and pipeline programs provide a nurturing and collegial environment that help students not just learn, but learn well," according to Garland Anderson, M.D., Executive Vice President and Provost, Dean of the School of Medicine.

"It is UTMB's hope that the outcomes proven by these studies will spur more medical schools to adopt a comprehensive integrated curriculum model with the confidence and knowledge that it can produce results with benefits for our entire health care system," Anderson said.