Cross-sectional comparison of spiral versus block integrated curriculums in preparing medical students to diagnose and manage concussions

BACKGROUND: An integrated curriculum is designed to be repetitive yet progressive and the concept has rapidly established itself within medical education. National organizations have recommended a shift to a spiral curriculum design, which uses both vertical and horizontal integration. This study examined differences between the recently implemented integrated spiral (class of 2019) and conventional block (classes of 2016–2018) MD curricula at the University of British Columbia (UBC) with respect to knowledge of concussion. METHODS: Cross-sectional online survey (FluidSurveys: Fluidware, Ottawa, ON), distributed via email to UBC medical students during the 2015–2016 academic year. Questions focused on demographic data, knowledge of concussion definition, and management considerations. Differences in responses across the two groups were assessed using chi-square tests. Ordinal Likert-scale data were analyzed using Mann-Whitney U-Tests. Statistical significance was determined a priori at p < 0.05. RESULTS: One hundred forty eight medical students (57% female) responded with 78 students in the spiral curriculum and 70 students the block curriculum. Important differences between responses from spiral versus block curricula students included: formal exposure to concussion-related educational material (10.8 h spiral vs. 3.95 h block), understanding concussions can occur without direct head impacts (90% spiral vs. 70% block, X(2)(1,148) = 9.41, p = 0.002) and identifying long-term consequences (dementia: 90% spiral vs. 66% block, X(2)(1,148) = 12.57, p < 0.0001; second impact syndrome: 80% spiral vs. 57% block, X(2)(1,148) = 8.60, p = 0.003; Parkinsonism: 47% spiral vs. 17% block, X(2)(1,148) = 14.87, p < 0.001). Block students identified the need for a full neurological exam (X(2)(1,148) = 17.63, p < 0.001) and had greater clinical exposure to acute concussion (47% block vs. 14% spiral, X(2)(1,148) = 19.27, p < 0.001) and post-concussion syndrome (37% block vs. 19% spiral, X(2)(1,148) = 5.91, p = 0.015). CONCLUSIONS: The findings from this preliminary study suggest the spiral curriculum design, which emphasizes and revisits clinical competencies, promotes a strong understanding and retention of knowledge in highly prevalent clinical conditions such as concussion.