Comprehensive changes in the learning environment: subsequent step 1 scores of academically at-risk students.

BACKGROUND: During the past 10 years at our institution, a number of changes have been instituted in the learning environment, including instructional techniques, assessment methods, academic support, and explicit board preparation. METHOD: The authors studied the Step 1 performance of students with MCAT scores of 20 to 25 in our former and current curricula. Effect sizes were calculated for score improvement using adjusted means from ANCOVA with covariates of MCAT and age. RESULTS: The overall effect size was 0.48, with larger effects seen for underrepresented minority students overall (d = 0.64) and African American students especially (d = 0.77), representing medium to large effects. Overall failure rates decreased by two thirds. CONCLUSIONS: Comprehensive changes in the learning environment were followed by substantial improvement in Step 1 performance among academically at-risk students.