The Harvard Medical School Pathways curriculum: A comprehensive curricular evaluation

The Harvard Medical School Pathways curriculum represents a major reform effort. Our goals were to enhance reasoning and clinical skills and improve the learning environment and students’ approach to learning via use of collaborative, case-based pedagogy; early clinical exposure; and enhanced approaches to teaching and evaluating clinical skills. We evaluated the impact of Pathways on key outcomes related to these goals. In this prospective, mixed-methods study, we compared the last prior-curriculum cohort (2014 matriculation, <i>n</i> = 135) and first new-curriculum cohort (2015 matriculation, <i>n</i> = 135). Measures included Likert-type surveys, focus groups, and test scores to assess outcomes. Compared with prior-curriculum students, new-curriculum students reported higher mean preclerkship learning environment ratings (Educational Climate Inventory, 62.4 versus 51.9, <i>p</i> &lt; 0.0001) and greater satisfaction with the quality of their preclerkship education (88% versus 73%, <i>p</i> = 0.0007). Mean USMLE Step-1 and Step-2 scores did not differ between groups. At graduation, new-curriculum students rated their medical school experience higher in 6 of 7 domains, including ‘fostering a culture of curiosity and inquiry’ (4.3 versus 3.9, <i>p</i> = 0.006) and focus on ‘student-centered learning’ (3.9 versus 3.4, <i>p</i> = 0.002). The new curriculum outperformed or was equal to the prior one on most measures of learning environment and perceived quality of education, without a decline in medical knowledge or clinical skills. Robust longitudinal evaluation provided important feedback for ongoing curriculum improvement.