The Effect of Histology Examination Format on Medical Student Preparation and Performance: Stand-Alone Versus Integrated Examinations

Most medical schools have transitioned from discipline-based to integrated curricula. Although the adoption of integrated examinations usually accompanies this change, stand-alone practical examinations are often retained for disciplines such as gross anatomy and histology. Due to a variety of internal and external factors, faculty at the University of Cincinnati College of Medicine recently began to phase out stand-alone histology practical examinations in favor of an integrated approach to testing. The purpose of this study was to evaluate this change by (1) comparing examination performance on histology questions administered as part of stand-alone versus integrated examinations and (2) ascertaining whether students alter their approach to learning histology content based on the examination format. Data from two courses over a period ranging from 2018 to 2022 were used to evaluate these questions. Results indicated histology question performance initially dropped after being included on integrated examinations. Stratification of students by class rank revealed this change had a greater impact on lower-performing students. Longitudinal data showed that performance 2 years after the change yielded scores similar to previous standards. Despite the initial performance drop, survey results indicate students overwhelmingly prefer when histology is included on integrated examinations. Additionally, students described alterations in study approaches that align with what is known to promote better long-term retention. The results presented in this study have important implications for those at other institutions who are considering making similar changes in assessment strategies.