Purpose
The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (ZSOM), as many undergraduate medical curricula, employs a spiral design, repeating the same topics in new context to reinforce learning. It is difficult to measure the actual overlap within any schools curriculum. It is important to identify the spiraling within the curriculum, to achieve the desired curricular design. We have developed a methodology to quantitatively calculate spiraling and tie this to a graphical representation to make it easy to interpret.

Methods
All Learning Objectives (LOs) for preclerkship courses were first converted to Medical Subject Heading (MeSH) terms. The MeSH terms tree structure was used to relate LOs from one course to another, to calculate the distance of one LO to another. We designed a program to compare course to course based on the MeSH term distance. This distance was then graphed to make a circle-plot which allows us to identify the overlap that one course will have with all course within the preclerkship curriculum.

Results
We found the method extremely useful to identify the level but also to graphically demonstrate degree of spiral between courses. Furthermore, it is very flexible and can be used to look at one courses components, multiple courses, an entire year or all courses.

Conclusion
This method can be used to monitor where there is overlap, to maximize student learning. Moreover, the figures produced can be used to explain the level and importance of spiraling to prospective faculty, students, or visiting faculty. In addition, this method is easily adaptable to any curriculum that utilizes LOs in their curriculum to demonstrate the level of spiral. One potential caveat to the methodology produced is that it only identifies overlap if the LOs are written with detail to the content.