In the first study to show system-wide outcomes of such reform, at UTMB Health reported that failure rates of the Step 1 licensing exam dropped dramatically among some students while significantly increasing graduation rates.

Published in the December issue of Medical Education, the outcomes demonstrate a more effective way of educating a diverse corps of much-needed doctors and challenge previous studies of discrete curriculum revisions that have shown mixed success. The findings underscore the importance of a broad-based, systemic approach to reforming the education system at a time when the U.S. Department of Health and Human Services projects a shortage of 100,000 physicians by 2020, including minority physicians who currently account for only six percent of practicing doctors.

A comparison of the final three classes of students taught under UTMB's traditional curriculum (1995-1997; 517 students) with three classes that studied under the institution's "integrated medical curriculum" (2003-2005; 597 students) showed a nearly 70 percent decrease in the failure rate -- from 7.5 percent to 2.3 percent -- of the United States Medical Licensing Examination Step 1. Nationally, for all students, the failure rate for the exam in the periods studied was six to seven percent.

African Americans showed the greatest improvement, with the failure rate decreasing by 94 percent, from 25 percent to 1.6 percent. Hispanic students' failure rates dropped 56 percent, from 12.9 percent to 5.7 percent. Failure rates among women decreased 79 percent, from 9 percent to 1.9 percent, and gender differences in mean scores narrowed.

Four-year graduation rates, the norm at UTMB Health and the majority of medical schools, also increased from 81 percent under the traditional curriculum to 88.1 percent under the integrated medical curriculum. Five-year graduation rates grew from 89 percent to 94.8 percent.

"Over the last two decades, many medical schools have made various reforms but even well-implemented changes may not realize their full potential unless they are coordinated across the multiple, interdependent components of the medical education system," said the study's lead investigator, Dr. Steven Lieberman, vice dean for academic affairs and a professor of internal medicine. "Our hope is that education leaders recognize that fully aligning institutional values and priorities with sound educational approaches across the organization is key to successfully engineering change."

These findings build on a 2008 UTMB study published in Academic Medicine that showed all students who studied under the integrated curriculum 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 were approximately 10 points higher than those studying under the TC (210.8 vs. 201.1).

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