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Characterization and comparison of osteopathic medical student performance in pathology and laboratory medicine: an analysis of competency in an integrated organ-systems curriculum

Journal: Journal of Osteopathic Medicine Date: 2025/12, 125(12):Pages: A664–666. doi: Subito , type of study: retrospective study

Full text    (https://www.degruyterbrill.com/document/doi/10.1515/jom-2025-2000/html)

Keywords:

clinical competence [223]
curriculum [289]
gastrointestinal tract [9]
genitourinary system [1]
laboratory medicine [1]
medical students [644]
osteopathic medicine [2016]
pathology [15]
retrospective study [312]
USA [1630]

Abstract:

Context: Pathology and laboratory medicine is a foundational component of well-informed clinical decision making. As such, student competency in disease recognition, consideration of underlying pathology, and appropriate laboratory testing are essential to the delivery of high-quality, osteopathic patient care. Although laboratory medicine is included in domain 2 and category 3.1 as described in the COMLEX-USA blueprint, the evolution of medical education from siloed basic science disciplines to integrated curricula presents challenges as to where best to incorporate foundational laboratory content. Objective: To characterize to what extent pathology and laboratory medicine is assessed in our organ system-based curriculum and evaluate student performance across three previously published competency domains. Methods: We analyzed three years of performance data related to pathology and laboratory medicine on multiple-choice examinations from genitourinary and gastrointestinal-hepatobiliary systems courses, the latter including a large representation of nutritional health. The rationale behind selected courses was three-fold. These courses include: (1) diagnostics, risk factor identification, management, and prognosis of highly prevalent chronic disease, (2) the physiological effects of chronic disease, and (3) an emphasis on opportunities for optimum laboratory stewardship diagnostic testing of chronic disease. Further, these courses encompass curricula taught in both years one and two for comparison. Questions were categorized into one of three content domains: (1) recognizing presented disease process (Pathology), (2) describing underlying pathophysiology (Pathophysiology), and (3) appropriate ordering and interpretation of laboratory results including anatomic pathology reports (Lab medicine). Anonymous student performance data was measured and extracted from Examplify: a secure and ubiquitous testing platform. Coding into one of the three categories was performed independently by course directors and another Medical Education department faculty member with significant clinical and academic experience in pathology and laboratory medicine. The faculty coded all exam questions administered for both courses which occurred during a three-year period. The reviewers discussed and compared the categorically assigned exam items. Differences in coding were resolved with consensus as the final criterion. Data was organized and analyzed using Excel (Microsoft) Results: We analyzed 957 exam questions across three osteopathic medical school classes found within two systems-based courses. Questions items assessing pathology and laboratory medicine items constituted 67% of the sample. Items relating to underlying disease pathophysiology were the most frequent domain in both years (24% and 29%). The performance distribution across domains and years is found in Figure 1. There was no significant difference in performance between content categories for any individual year. However, significant differences were found (Kruskal-Wallis χ2 = 6.79, df = 2, P-value = 0.03361) in ranks between Lab medicine and Pathology for all calendar years (Z = 2.57, P-value = 0.015). Conclusions: Our findings demonstrate that pathology and laboratory medicine continue to represent a significant part of our institution’s competency assessment in a system-based curriculum. Non-significant performance differences across domains within individual classes is direct evidence of relative student competency therein. Nevertheless, students performed significantly different across all years with regard to laboratory medicine and pathology content. Reasons for discrepancies between competencies may include over emphasis of specific topics within each domain, distribution of pathology and laboratory medicine content across lectures, assessment differences such as question styles or content framing, or inherent differences between medical school classes. Future research, including curriculum mapping or content auditing of lectures may better inform future approaches to assess content performance and potentially improve both content delivery and performance.


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