Comparison of Three Parallel, Basic Science Pathways in the Same Medical College

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Since 1970, the Ohio State University College of Medicine and Public Health has offered medical students a choice between two basic science pathways, lecture discussion (LD) and independent study (IS). Since 1991 the college has offered entering students a choice among three pathways, LD, IS and problem-based learning (PBL). Most of the literature on implementing alterantive basic science curricula has focused on the comparison of USMLE Step 1 test scores between different curricular methods. The purpose of this study was to investigate outcome measures (other than USMLE test scores) such as student activities and achievement in clinical education, and affective measures of student and faculty satisfaction. Additionally, we sought to assess the effect of pathway choice on admission, and to determine the factors influential in determining student pathway choice. Ours is the only medical school in the country where entering students have a choice of three preclinical pathways, making it fertile ground for comparison of the effects of different curricula. Learning objectives, content material, and structure (organ-based organization) are very similar across all three pathways. The three also share faculty, staff, and administrative oversight. What differs across pathways are the teaching and learning methods. In 1997–98 the college formed a task force to study the benefits and overall desirability of maintaining the three preclinical pathways. Specifically, the task force was charged to look at all three pathways in terms of their educational importance, student and faculty preferences, and participant satisfaction. Until recently, the traditional LD was the most commonly chosen pathway among the 210 matriculating students each year. The primary mode of teaching in this pathway is large-group lecture supplemented with small-group discussions and labs. The IS pathway, established in 1970 as the first alternative to the LD, offers students the flexibility to learn on their own through the use of highly structured reading materials, computer-based materials, and diagnostic practice examinations. The PBL pathway, established in 1991, emphasizes student-centered, self-directed learning. Unlike IS students, PBL students are introduced to basic science concepts through the analysis and discussion of clinical cases during small-group meetings. Students then work independently on learning issues that are defined by the group before coming back together to discuss their studies. Literature Review Like any educational innovation, both IS and PBL programs have had to prove their effectiveness as alternatives to the traditional lecture-based teaching. Lecture-based teaching has existed primarily for its efficiency, not necessarily for its effectiveness. As medical schools struggled to develop alternatives to lectures, investigations comparing alternatives to traditional lecture curricula such as IS and PBL were reported in the literature. Such investigations have generally found little or no difference in examination scores or clinical performances when comparing lecture-based courses with alternatives. Way et al. compared alternative curricular approaches in one college and confirmed that no difference in average USMLE Step 1 scores existed across alternative basic science pathways when controlling for pre-matriculation differences.1 The literature on IS in the health professions reveals the following: There is little or no significant difference in learner performances as measured by examinations and patient care compared with traditional lecture-based curricula.2,3,4,5,6,7,8,9,10,11 IS offers both faculty and students more flexibility and portability in learning when compared with lecture-based learning.2,3,8 IS promotes lifelong, independent learning, self-pacing, and self-responsibility in learning.2,11 Students who participate in IS tend to pursue more research and full-time faculty positions than students in lecture programs.2 After start-up costs are accounted for, IS costs the same as or less than traditional lecture-based courses.2,3,7 The literature on PBL in the health professions reveals the following: There is little or no significant difference in learner performances as measured by examinations or patient care compared with traditional lecture-based curricula.12,16,17 Differences that have been reported generally indicate the same or less factual knowledge but better clinical performance and patient management for PBL students.13,14,15,19 Both faculty and students find PBL more enjoyable and prefer PBL to “traditional” lecture courses.12,13,14,16,18,19 PBL students tend to use “backward” reasoning (working from clinical information back to theory) when solving clinical problems, whereas traditional students reason “forward” (from theory to clinical practice).13,15,21 PBL students have a greater tendency to use evidence-based medicine practices (more journals and literature searches) than “traditional” students.14,15 Method This article reports part of a larger, more comprehensive institutional research project conducted by a task force of clinical and basic science faculty supported by consultants from the College of Medicine's Office of Academic Services (OAS) for Medical Education. Both qualitative and quantitative data were gathered for this report using a variety of methods: document analysis, survey methods, and interviews with key educational staff members. Annual reports dating back to 1991 from each of the three pathways were reviewed and summarized by task force members. Surveys for both students and faculty were developed, pilot tested, and summarized by task force members with help from OAS consultants. Surveys were administered in spring quarter of 1997 to all students. First- and second-year students were surveyed in their respective class locations, as a group; third- and fourth-year students received paper copies in their college mailboxes. Return rates were much lower for clinical-year students due to clinical assignments and time of the survey. Faculty surveys were distributed through internal mail services to faculty with 50–100% academic appointments. Likert-type survey items were analyzed using descriptive statistics: frequencies, percentages, cross-tabulations, means, and standard deviations. For reporting purposes “very satisfied” and “satisfied” were combined into “satisfied,” and “very unsatisfied” and “unsatisfied” were combined into “unsatisfied.” Documents, interview notes, and other qualitative data were analyzed using domain analysis of key words and phrases.20 Results Academic Outcomes. No difference across pathways was observed for graduation rates or grades on clinical rotations, but more IS students were in Alpha Omega Alpha (24% IS, 17% LD, 14% PBL) and higher percentages of both IS and PBL students received more departmental awards than did LD students. Student Survey. The student survey was designed to learn how students choose their pathways and assess their satisfaction with their choices. The students were also asked to comment on their impressions of all three pathways. Of the 839 student surveys distributed, 467 usable responses were returned (55.6%). The return rate was biased toward the basic science classes (year one = 92%, year two = 76%, year three = 43%, and year four = 11%). Return rates by basic science pathway for each class surveyed resembled the proportion of students enrolled across pathways (LD = 69%, PBL = 17%, and IS = 12%). Because so few fourth-year students returned the survey, their data were not used. Having a choice of pathways was a significant factor in the students' decisions to come to the college: 56% of the respondents agreed that choice of basic science pathway influenced their decisions to attend the school. Based on the students' responses, the factors that contributed to a student's choice of pathway were learning style, experience with nontraditional learning methods, personal

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