Changes in pathology instruction and student performance on the United States Medical Licensing Examination Step 1, 1995-2000: a nationwide 6-year longitudinal study.

A multi-institutional collaborative longitudinal study was conducted to assess the effect of curricular change (overall curricular format and detailed pathology instruction) and school policy regarding the Step 1 requirement on the United States Medical Licensure Examination (USMLE) Step 1 Total and Step 1 Pathology scores over a period of 6 years (1995 to 2000). Detailed descriptions of instruction (overall curricular format and the format and number of hours of instruction in various areas of pathology) and the school policy of USMLE Step 1 requirement for classes entering in 1993 to 1998 were matched with Step 1 Total scores and Step 1 Pathology scores for 48,166 students from 73 schools who took the corresponding June 1995 to 2000 examination. Hierarchical linear modeling was used for analysis while controlling for students' MCAT-bpv (Medical College Admission Test, composite of biological and physical sciences and verbal reasoning) scores and undergraduate grade point average (GPA). Results indicated that the GPA and MCAT-bpv scores of students significantly impacted their Step 1 Total score and Step 1 Pathology score for each year. The mean MCAT-bpv scores of entering classes showed a steady increase from 1993 to 1998. About this same time, Step 1 Total scores were on the rise (especially for classes entering 1994 to 1996, after which they stabilized). During the same time period (1993 to 1998), there was a substantial move toward integrated instruction of Pathology. The mean Step 1 scores of schools with integrated instruction were slightly higher than those of schools with nonintegrated instruction, but the difference was not significant. Analyses of variance were run to examine the effect of change of curriculum on Step 1 Total and Step 1 Pathology scores. Our analysis does not appear to show a cause-and-effect relationship between changes in curriculum toward integrated instruction and the increasing Step 1 scores during the study period. The MCAT-bpv scores showed an upward pattern during the study period, and given that they are strong predictors of Step 1 scores, it appears that the rising MCAT-bpv scores are a major contributory factor to the upward trend in the scores during the study period. The only clearly significant result at the school level is that a requirement to pass Step 1 before moving on to clinical rotations is positively related to Step 1 Total and Step 1 Pathology scores.