Medical student exam performance and perceptions of a COVID-19 pandemic-appropriate pre-clerkship medical physiology and pathophysiology curriculum

Abstract

Background: Medical schools were compelled to abruptly transition pre-clerkship curricula to remote learning formats due to the emergence of the Coronavirus Disease 2019 (COVID-19) pandemic. We evaluated student perceptions of remote learning, exam performance, and utilization of third-party learning resources to assess the implementation of a newly developed pandemic-appropriate physiology curriculum.

Methods: This was an observational study based on a survey conducted in the Spring of 2021 at the University of California, Irvine, School of Medicine (UCISOM). This study aimed to assess first (MS1) and second year (MS2) medical students' perceptions of satisfaction, support, academic performance, and connectedness before and during the COVID-19 pandemic. The MS1 class began medical school during the first year of the COVID-19 pandemic, whereas the MS2 class did so prior to the start of the pandemic. A survey instrument was developed and validated to identify the impact remote learning had on student self-perceptions of the Medical Physiology and Pathophysiology course. Surveys were distributed to all students and responses were collected on a voluntary basis. Exam scores on a customized National Board of Medical Examiners (NBME) physiology shelf exam were also compared to objectively identify how the remote curriculum during the pandemic impacted academic performance.

Results: Of 204 students enrolled, 74 responses were analyzed, with 42 MS1 (40% of MS1s) and 32 MS2 (31% of MS2s) responses. Overall, MS1s and MS2s were satisfied with the curriculum they received (95 and 97% respectively) and the school's support of their concerns (86 and 100% respectively). Notably, only 50% of MS1s felt connected to their peers, compared to 94% of MS2s. Lecture attendance and self-perception of their academic performance were similar between both classes. Interestingly, the intra-pandemic class's NBME exam average in 2020 (60.2% ± 8.9, n = 104) was significantly higher than the pre-pandemic class average in 2019 (56.8% ± 11.3, n = 100). Both classes primarily used course materials over third-party learning resources. An additional set of survey questions distributed only to the MS1 class found that the majority of MS1s reported minimal barriers with regards to accessibility, including internet connectivity, study-conducive environments, and balancing family commitments. Overall, pre-clerkship medical students had positive perceptions of the newly developed pandemic-appropriate physiology curriculum.

Conclusions: Changes to the pre-clerkship physiology curriculum during the COVID-19 pandemic were met with overall satisfaction from the students and an increase in NBME scores. More attention to student connectedness is needed to improve how remote learning can be best optimized into future curricula development.

Keywords: COVID-19; Physiology; Pre-clerkship; Remote learning; Undergraduate medical education; Virtual curriculum.

Fig. 1

MS1 and MS2 students’ survey responses on student satisfaction. I am satisfied with the: Q1) quality of the pre-clerkship education that I have been receiving; Q2) physiology education I received in the PHYSIO 543AB: Medical Physiology and Pathophysiology course. The PHYSIO 543AB: Medical Physiology and Pathophysiology course: Q3) prepared me for the USMLE Step 1 exam in a way that was appropriate for the first semester of the MS1 curriculum; Q4) prepared me for clinical rotations in a way that was appropriate for the first semester of the MS1 curriculum

Fig. 2

MS1 and MS2 students’ survey responses on connectedness. I felt: Q5) connected to my peers; Q6) that I had a good support system with my peers; Q7) that there were adequate opportunities for me to meet my peers; Q8) connected to faculty

Fig. 3

MS1 and MS2 students’ survey responses on School of Medicine support. I felt that: Q9) there were systems set in place for our class to express their thoughts and concerns; Q10) our class’s opinions were listened to. Q11) I feel supported by my school. Q12) I am aware of the mental health and wellness resources provided by our school

Fig. 4

MS1 and MS2 students’ survey responses on academics. Q13) I find it difficult to concentrate on my studies. Q14) I feel like I have been performing optimally in my classes. Q15) I felt that watching lecturers (either live or recordings) was necessary for passing block exams. Q16) I tried my hardest on the physiology NBME

Fig. 5

MS1 and MS2 students’ survey responses on study resources. I utilized: Q17) Third-party resources for learning; Q18) Third-party resources as my primary source of information; Q19) Third-party resources for practice questions; Q20) Software for communication regarding course content (i.e. Slack, Facebook, GroupMe)

Fig. 6

MS1 and MS2 students’ survey responses to Q21 regarding third-party learning study resources that they used, with sources utilized placed in ranking order. 6 students did not use any third-party sources for studying

Fig. 7

MS1 and MS2 students’ survey responses to Q22: Self-reported percent of lectures attended live. MS1 students attended didactic lectures in a synchronous format using Zoom software, and MS2 students attended live in the classroom, before the COVID-19 pandemic

Fig. 8

Customized Physiology NBME scores of pre-pandemic students in 2019 and intra-pandemic students in 2020. ** = p-value = 0.019. Whiskers represent min and max. n = 100 for MS2 class, n = 104 for MS1 class

Fig. 9

MS1 students’ survey responses on challenges with remote learning. Q23) The devices (iPad, computer, tablet, etc.) I used for remote education were adequate for learning the material. Q24) Living with family/roommates did not overly distract me from my remote education. Q25) Adjusting to the online format of remote education did not detract from my education. Q26) I had a quiet, comfortable place to attend class and to study. Q27) I was able to obtain a reliable internet connection in my home without financial difficulty. Q28) I felt that the remote learning experience was interactive. Q29) I was able to ask questions during my remote lectures if needed. Q30) Online instruction courses were flexible with my schedule