gms | German Medical Science

Research in Medical Education – Chances and Challenges International Conference

20.05. - 22.05.2009, Heidelberg

Update on integrated block testing in the basic science years

Meeting Abstract

  • corresponding author presenting/speaker David L. Wiegman - University of Louisville School of Medicine, Louisville, Kentucky, United States
  • Uldis N. Streips - University of Louisville School of Medicine, Louisville, Kentucky, United States
  • Ruth B. Greenberg - University of Louisville School of Medicine, Louisville, Kentucky, United States

Research in Medical Education - Chances and Challenges 2009. Heidelberg, 20.-22.05.2009. DŁsseldorf: German Medical Science GMS Publishing House; 2009. Doc09rmeI3

doi: 10.3205/09rme51, urn:nbn:de:0183-09rme514

Published: May 5, 2009

© 2009 Wiegman et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Questions: Is block testing well received by students? Does block testing improve USMLE scores?

Introduction: At most medical schools in the USA, students master basic science concepts in disciple-based courses spread over the first two years. Individual discipline tests are given every few weeks. Students tend to cram for one test and fall behind in the other disciplines. This leads to reliance on short-term memory and little integration or long term understanding. The USMLE Step 1 is then administered at the end of two years and tests the students’ integrated understanding and long term memory of the disciplines.

Methods: Six years ago we introduced integrated block testing in the 2nd year [1]. The year is divided into 6 six-week blocks. Students attend classes for the first five weeks of each block and then have a study week that ends with a six-hour comprehensive examination over all courses. Questions are provided by each discipline and the Block Exam Committee coordinates the overall construction of the block exam. The Committee reviews each question, redrafts questions, and creates integrated questions when topics are covered by two or more courses.

Results: Student scores for the individual disciplines/courses have been tracked and are basically unchanged. USMLE scores and passing rates have improved. For the 5 years before the block exams students scored 6 points below the national average (209 v 215) and passed at 4% below the national average (88 v 92). For the first 5 years of the block exams they were at the national average for both score (218) and passing rate (93%) and on occasion have exceeded the national average. Student evaluations have been very positive. For example, in response to the statement “The block exam system facilitates integrated learning” the student evaluation was 4.2 (with 1 being strongly disagree and 5 being strongly agree). For the statement “The block exam system will help me prepare for the Step 1 Board exam” the score was 4.4.

Recent modification: Our first two years contain a longitudinal 2-year Introduction to Clinical Medicine (ICM) course. To better enable our students to integrate the disciplines we have modified the block system so that the first week is ICM and then the next four weeks are the individual disciplines. This change has been well received by the students and has not affected their local discipline scores, but it is too early to know what effect it might have on USMLE scores. We have recently expanded block testing to include the 2nd semester of the 1st year.

Conclusions: The integrated block testing approach appears to be achieving our goals. Further analysis of any effect on Step 2 and 3 ULSME scores will be done. Plans to implement block testing for the 1st semester of the 1st year and to create additional integrated questions are underway.


Streips UN, Virella G, Greenberg RB, Blue A. Analysis of the Effects of Block Testing in the Medical Preclinical Curriculum. JIAMSE. 2006;16(1):10-18.