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

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 alternative 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 smallgroup meetings. Students then work independently on learning issues that are defined by the group before coming back together to discuss their studies.