Influence of curriculum type on student performance in the United States Medical Licensing Examination Step 1 and Step 2 exams: problem-based learning vs. lecture-based curriculum

INTRODUCTION: The results of the United States Medical Licensing Examination Step 1 and 2 examinations are reported for students enrolled in a problem-based and traditional lecture-based curricula over a seven-year period at a single institution. There were no statistically significant differences in mean scores on either examination over the seven year period as a whole. There were statistically significant main effects noted by cohort year and curricular track for both the Step 1 and 2 examinations. These results support the general, long-term effectiveness of problem-based learning with respect to basic and clinical science knowledge acquisition. CONTEXT: This paper reports the United States Medical Licensing Examination Step 1 and Step 2 results for students enrolled in a problem-based and traditional lecture-based learning curricula over the seven-year period (1992-98) in order to evaluate the adequacy of each curriculum in supporting students learning of the basic and clinical sciences. METHODS: Six hundred and eighty-nine students who took the United States Medical Licensing Examination Step 1 and 540 students who took Step 2 for the first time over the seven-year period were included in the analyses. T-test analyses were utilized to compare students' Step 1 and Step 2 performance by curriculum groups. RESULTS: United States Medical Licensing Examination Step 1 scores over the seven-year period were 214 for Traditional Curriculum students and 208 for Parallel Curriculum students (t-value = 1.32, P=0.21). Mean Step 2 scores over the seven-year period were 208 for Traditional Curriculum students and 206 for Parallel Curriculum students (t-value=1.08, P=0.30). Statistically significant main effects were noted by cohort year and curricular track for both the Step 1 and Step 2 examinations. CONCLUSION: The totality of experience in both groups, although differing by curricular type, may be similar enough that the comparable scores are what should be expected. These results should be reassuring to curricular planners and faculty that problem-based learning can provide students with the knowledge needed for the subsequent phases of their medical education.