Presented By: Alice Villalobos, Texas Tech University Health Sciences Center School of Medicine
Co-Authors: Ion Bobulescu, City University of New York School of Medicine
Cassandra Kruczek, Texas Tech University Health Sciences Center School of Medicine

Purpose 
Our institution transitioned from a legacy two-pass preclinical curriculum with categorical grading to a one-pass organ system-based format with pass/fail grading (>70%). We evaluated first-year medical student (MS1) performance and satisfaction in the Organ Systems-2: Renal and Respiratory (RNR) block that integrated content previously taught in both Year I and Year-II legacy blocks.

Methods 
The 8-week RNR block integrated physiology, pathophysiology, infectious diseases, and pharmacology of the renal system (Weeks 1-4) and respiratory system (Weeks 5-8). Instructional methods included didactic lectures, team-based activities, dry labs, case-based reviews, cognitive integration-clinical reasoning sessions, and simulations. Formative assessments included weekly quizzes and practice exams administered before each exam. Three faculty-designed exams assessed learning in the renal physiology, renal pathophysiology, and respiratory physiology units at the end of Weeks 2, 4 and 6; performance on exam questions was compared with equivalent questions from legacy exams. A customized comprehensive NBME exam assessed cumulative learning at the end of Week 8; mean item performance was compared to mean source item difficulty, as the legacy curriculum had no dedicated renal/respiratory NBME exam.

Results 
Student performance on faculty-designed exams was comparable to the legacy curriculum. Mean scores on renal and respiratory portions of the NBME exam closely aligned with source item difficulty (0.76 vs. of 0.78 and 0.77 vs. 0.78, respectively). Surveys and student focus groups indicated a 73% student satisfaction rate with RNR.

Conclusions
The first implementation of the integrated RNR block resulted in MS1 performance on the NBME exam comparable to source item difficulty, performance on faculty-designed exams matching the legacy curriculum, and high student satisfaction. More detailed analysis of exam performance is needed. Improvements in future iterations of RNR will include additional simulations and flipped-classroom sessions.