Presented By: Verena Van Fleet, Northwestern Health Sciences University
Co-Authors: Mariluz Henshaw, Touro College of Osteopathic Medicine
Raquel Ritchie, Michigan State University College of Osteopathic Medicine

Purpose 
Complex and extensive processes, such as the human metabolism and its regulation, are introduced to students in smaller chunks. We developed a module (""Three Diets"") to foster the integration of these smaller chunks. Here, we present the details of the module and the flexibility with which it was implemented at three institutions with different curricula. 

Methods 
The module, consisting of three short cases (a high carbohydrate meal, a high protein diet, and a ketogenic diet) and concise resources to support the review of biochemical pathways, was delivered in different ways at three institutions. At Northwestern Health Sciences University (NWHSU), it was part of an assigned group project that challenged students to connect all the major metabolic pathways. At Touro College of Osteopathic Medicine (TouroCOM-NY), it was delivered as an interactive discussion session with the three cases given as prework. At Michigan State University, College of Osteopathic Medicine (MSUCOM), the module was the basis for a board review session employing clicker questions. At NWHSU and TouroCOM-NY, student performance on summative exam questions regarding metabolism and regulation was compared for student cohorts before and after the implementation of the new module. At MSUCOM, performance on clicker questions was analyzed. 

Results 
At NWHSU, there was a favorable odds ratio for improved performance on summative questions for students who used the module. At TouroCOM-NY, there was no significant difference in exam score performance between cohorts. In the board review application at MSUCOM the students' clicker responses revealed that they were performing better on questions related to the high carbohydrate than the ketogenic diet.

Conclusion 
At NWHSU, the module was shown to improve students' performance on summative exam questions, while at TouroCOM-NY, no significant differences were observed. Feedback from students was positive as the case scenarios given were relatable and allowed them to learn peer-to-peer.