Faculty Continuity and Anatomy Practical Exams as the Real Behavioral Levers: What a Passing Threshold in a Curricular Thread Revealed About Student Engagement in an Integrated Curriculum
This study found that implementing a passing threshold for an Anatomy and Embryology curricular thread failed to improve student engagement or performance, revealing instead that standalone thread-specific assessments and effective pedagogy are the primary drivers of learning in an integrated curriculum.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In medical schools across the United States, the way future doctors are taught has shifted dramatically over the last two decades. Instead of learning subjects like anatomy, physiology, and pathology as separate, isolated classes, students now study them woven together into integrated blocks centered on body systems or real-life patient cases. The goal is to help students see how the basic science connects to clinical practice from day one. However, this approach carries a hidden risk: when foundational topics are scattered thinly across many different lessons, they can become easy to overlook. Students, who naturally focus their energy on what they believe will be tested most heavily, may inadvertently skip over these scattered threads of knowledge. This is particularly true for anatomy and embryology, the study of body structures and early development, which have seen their dedicated teaching time shrink as curricula have become more integrated. If students do not engage deeply with these topics, they may arrive at their clinical rotations and licensing exams with dangerous gaps in their understanding.
Researchers at the Geisel School of Medicine at Dartmouth set out to solve this specific problem. They wondered if setting a strict minimum passing score for the anatomy and embryology portion of their curriculum would force students to pay closer attention to these vital subjects. In the summer of 2024, the school introduced a new rule for one graduating class: to move on to their clinical training, students had to achieve an average score of at least 70 percent on all anatomy and embryology questions throughout their pre-clerkship years. The researchers compared this group to the previous year's class, who had taken the same courses but faced no such specific requirement. They wanted to see if this policy acted as a lever, pulling student effort toward these difficult topics, or if students would simply find a way to meet the bar without changing their habits.
The results of this experiment were surprising. The policy did not succeed in changing how students studied or in raising their overall performance. When the researchers looked at the test scores, the class with the new rule actually performed slightly worse on average than the class without it, and a larger number of students in the new group fell below the 70 percent threshold. While the difference was not large enough to be statistically definitive, the trend suggested that the rule did not improve learning. More importantly, when the researchers interviewed students from both groups, they found that the students in the new group did not alter their study strategies because of the rule. Most students were not even aware that the requirement was new; they assumed it had always been there. Those who knew about it generally felt it was a fair safety net, but it did not make them study harder or differently.
The study revealed that the real drivers of student engagement were not distant policy rules, but immediate, tangible events. Students reported that they only dedicated significant time to studying anatomy when a practical laboratory exam was approaching. These hands-on tests, where students had to identify structures on real human cadavers, were separate from the standard written exams and felt like distinct, high-stakes challenges. The presence of these practical exams, rather than the abstract passing threshold, was what motivated students to learn the material. Furthermore, the researchers found that the consistency of the teaching staff mattered more than the grading system. When the same instructors taught the anatomy and embryology sessions year after year, using a predictable and effective style, students felt the material was coherent and worth mastering. In contrast, when instructors rotated frequently or sessions felt like one-off lectures, students viewed the content as disjointed and were more likely to deprioritize it.
The researchers also discovered a paradox in how the curriculum was labeled. When content was explicitly marked as a separate "thread" or a distinct module, students tended to mentally separate it from the main course material, making it easier to ignore. However, when anatomy was taught as a foundational part of every organ system block, students viewed it as essential core knowledge. The study suggests that simply adding a passing grade requirement to a scattered curriculum is not enough to fix learning gaps. Instead, schools may need to focus on the design of their assessments, ensuring that practical exams and consistent teaching styles provide the immediate motivation students need to engage with complex, foundational science. The policy itself was not the solution; the way the material was taught and tested was.
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