Effect of COVID-19 Curriculum Changes on Medical Student Exam Performance: A Case Series

Background: The COVID-19 pandemic caused medical schools to convert to an online format, necessitating a swift change in medical education delivery. New teaching methods were adapted, with some schools having greater success than others. Kirk Kerkorian School of Medicine (KSOM) employed a small-group interactive learning style that consists of eight or fewer medical students and one faculty mentor engaging in group problem-based learning (PBL) twice weekly. This style had clear signs of struggle with a significant decrease in exam performance. Rocky Vista University College of Osteopathic Medicine (RVUCOM) employed a large-group didactic lecture style that consisted of one faculty mentor lecturing hundreds of medical students in a pre-recorded setting five times weekly. This style had greater success with its curriculum adaptation leading to minimal effect on their exam performance. This study aims to investigate whether the type of medical school curriculum (small-group interactive vs. large-group didactic) impacts student exam performance during online learning transitions forced by the COVID-19 pandemic. Methodology: KSOM and RVUCOM students were grouped into above-expectations and below-expectations categories based on each institution's standardized exam performance metrics. Independently sampled t-tests were performed to compare groups. KSOM was classified as a small-group interactive curriculum through its heavy reliance on student-led PBL, whereas RVUCOM was classified as a large-group didactic curriculum through its extensive proctor-led slideshow lectures. Results: KSOM's transition to online PBL resulted in fewer students scoring above the national average on the National Board of Medical Examiners (NBME) exams compared to previous cohorts (55% vs. 77%, respectively; N = 47 and 78; P < 0.01). RVUCOM's transition to online large-group lectures yielded no significant differences between students who performed above expectations and students who performed below expectations between their cohorts (63% vs. 65%, respectively; N = 305 and 300; P > 0.05). Conclusions: KSOM's COVID-19 cohort performed significantly worse than RVUCOM's COVID-19 cohort during their medical school organ-system exams. We believe that the small-group learning at KSOM is less resilient for online curricula compared to the large-group didactics seen at RVUCOM. Understanding which didactic methods can transition to online learning more effectively than others is vital in guiding effective curriculum adjustments as online delivery becomes more prominent.