First, do no harm: impact of the transition to an integrated curriculum on medical knowledge acquisition of the transitional cohort

Figures & data

Table 1. Legacy M3 clerkships and forward phase 2 integrated blocks

	Clerkship	Duration	NBME Subject Exam
Legacy 2016–2017	Primary Care ^a (M3)	8 weeks	Adult Ambulatory Medicine
	Internal Medicine (M3)	8 weeks	Medicine
	Neuroscience (M3 or M4)	4 weeks	Neurology
	Obstetrics and Gynecology (M3)	6 weeks	Obstetrics and Gynecology
	Pediatrics (M3)	6 weeks	Pediatrics
	Psychiatry (M3)	4 weeks	Psychiatry
	Surgery (M3)	8 weeks	Surgery
	Anesthesiology (M3 or M4)	2 weeks	n/a
ForWard 2018	Acute Care Internal Medicine (8 weeks) Neurology (2 weeks) Psychiatry (2 weeks)	12 weeks	Medicine Neurology ^b
	Chronic and Preventive Care Primary Care ^a (8 weeks) Neurology (2 weeks) Psychiatry (2 weeks)	12 weeks	Psychiatry ^b Adult Ambulatory Medicine
	Care Across the Life Cycle Pediatrics (4–6 weeks) Obstetrics and Gynecology (4–6 weeks) Geriatrics (2 weeks)	12 weeks	Obstetrics and Gynecology Pediatrics
	Surgical and Procedural Care Surgery (10 weeks) Anesthesiology (2 weeks)	12 weeks	Surgery

^aThe Primary Care experiences include Family Medicine, General Internal Medicine, and occasionally General Pediatrics.

^bAll students must complete either the standardized didactic curriculum or 4 weeks of clinical experience in Psychiatry and Neurology before taking the related exam.

Figure 1. The University of Wisconsin School of Medicine and Public Health Legacy and ForWard curricula

Figure 2. The University of Wisconsin School of Medicine and Public Health ForWard curriculum, detailed

Table 2. Demographics of legacy & forward cohorts

	Legacy n = 183	ForWard n = 162	p value
Age (mean [SD])	26.9 (3.2)	25.6 (2.4)	< 0.001
Female (n [%])	91 (50%)	80 (49%)	0.95
Race/ethnicity (n [%])			0.07
Non-Hispanic White	130 (71%)	98 (60%)
Non-Hispanic Black	6 (3%)	17 (10%)
Hispanic	5 (3%)	7 (4%)
Asian	28 (15%)	23 (14%)
Native American	3 (2%)	2 (1%)
Other	11 (6%)	15 (9%)
Extended preclinical enrollment	26 (14%)	5 (3%)	< 0.001

Abbreviations: SD indicates standard deviation.

Table 3. NBME subject exam scores; adjusted means (95% confidence intervals)

	Legacy		ForWard
	n = 183		n = 162
	Mean ^a	95% CI	Mean ^a	95% CI	Difference (95% CI)
Adult Ambulatory Medicine	75.8	74.4–77.2	75.4	73.8–77.1	−0.35 (−1.9–1.2)
Medicine	75.5	73.8–77.3	74.9	72.7–77.0	−0.65 (−2.6–1.3)
Neurology	77.1	75.3–78.9	77.7	75.7–79.6	0.52 (−1.31–2.36)
OB/GYN	79.4	77.9–80.9	78.7	76.9–80.4	−0.75 (−2.33–0.84)
Pediatrics	76.2	74.6–77.8	75.7	73.9–77.6	−0.48 (−2.17–1.21)
Psychiatry	75.9	74.5–77.3	75.5	73.8–77.1	−0.44 (−1.97–1.10)
Surgery	75.5	74.0–77.1	75.4	73.7–77.1	−0.13 (−1.67–1.40)

Abbreviations: CI indicates confidence interval.

^aThe analysis was adjusted by age, gender, extended status, and location (Madison vs. all other locations).