Systems-Based Curricula

Perhaps the most important attribute of a medical school is its curriculum. It’s interesting, then, that when I look back on my earlier series about how to choose the medical school that’s right for you, I didn’t touch on curriculum format. This is probably because it isn’t something that I considered when choosing where I wanted to go; I imagine that most people don’t. But I’ve come to realize how important it is as I’ve gone through this first year of my program. In this article, I’d like to talk about the two main curriculum formats utilized by the vast majority of medical schools (both allopathic and osteopathic) as well as how those formats are designed to align with the most important test you take in medical school, the USMLE Step 1. Eventually, I’ll progress to an entire article or series about Step 1, which medical students take at the end of their second year, but for now this will do. Let’s dive in.
If you’ve heard anything about medical school curricula, you’ve probably heard it in the context of “systems-based learning”. This is the new normal in terms of how medical schools teach their preclinical material. From what I’ve seen, most of those schools that don’t yet teach this way are planning to switch in the near future. A at this point I would expect that more schools deliver systems-based curricula than not. The idea behind this structure is to group together all of the aspects of a single body system into one class. Instead of small sections of microbiology, physiology, pathology, and pharmacology courses that concern the gastrointestinal tract, for example, a single GI course delivers all of the GI material from each of these courses. When patients present with GI symptoms, you don’t want to have to recall many disparate sources of knowledge - with this structure, everything is integrated. This is especially helpful for Step 1, wherein a large number of questions ask you to make a diagnosis or recommend a treatment given only signs and symptoms. This structure usually affords schools the opportunity to teach only one such class at a time, which reduces the likelihood of overlapping tests and would seem to decrease the number of tests required overall. You can see why medical schools might be pushed to make this change. Not to say that traditional curricula are any worse at preparing students for Step 1 or for practice, though - occasionally the opposite is true for reasons I’ll get to in a bit. Let’s talk about why curriculum is so important.
Just like the MCAT, the USMLE Step 1 is designed to standardize academic performance across everybody applying for something - in this case, for medical residency. It may seem strange that a test taken at the end of year two goes into an application submitted in year four, but the test is designed to assess preclinical knowledge gained in years one and two. Another test (you guessed it - Step 2!) tests clinical skills during year four. Because it is standardized, residency programs look at the score before looking at other items like grades or extracurriculars. In my earlier series about choosing schools, I talked about school “prestige” and discussed why I thought it was less important than most other aspects (like price and location). A great way to strip away all of the rankings and just look at how successful a schools’ students are is to find their classes’ performance on Step 1. All of the schools that I’ve come across have made this data available to applicants and students. If you were to compare those schools that already use a systems-based curriculum to those who use a traditional curriculum, I’m not sure that you would see much difference. Both curriculum structures get the job done! Differences between schools probably reflect the school’s competitiveness and the quality of their curriculum more than they do their curriculum structure. My point here is that systems-based curricula seem to me to be more comfortable for students as far as workload, a good traditional curriculum will probably result in a similar Step 1 score. A special case that you should pay attention to, though, is a school that has recently switched to a systems-based curriculum. This is an incredibly complex, multi-year undertaking that likely to result in some reduction of quality for a couple of years after the switch. I applied to one such school; their Step 1 score average had dropped significantly since switching their curriculum. In this case, all else being equal, it might be better to choose a school with a strong traditional curriculum.
No matter what type of curricula the schools you’re interested in deliver, you can be successful anywhere. Even if a school has a lower Step 1 average than you want to achieve, as a motivated student you can perform well on the exam and beat that average. The main reason that I wrote this article isn’t to let curriculum structures strongly influence your decision, but to let you know what people are talking about when they discuss them. Most people are only interested in a couple of schools, anyway! If you have any questions about this topic or any other that I’ve written about, send me an email at And if you’re heading to Dallas in June for HOSA’s 2018 International Leadership Conference, I’ll be delivering a workshop about getting into medical school with Dr. David Berman. I hope to see you there!