title: Comprehensive changes in the learning environment: subsequent step 1 scores of academically at-risk students.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0133, USA. slieberm@utmb.edu
authors.forename: Steven A
authors.initials: SA
authors.lastname: Lieberman
authors.forename: Ann W
authors.initials: AW
authors.lastname: Frye
authors.forename: Lauree
authors.initials: L
authors.lastname: Thomas
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Rabek
authors.forename: Garland D
authors.initials: GD
authors.lastname: Anderson
mesh_terms: D000328:Adult; D002983:Clinical Competence; D015331:Cohort Studies; D003099:College Admission Test; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000458:organization & administration*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008007:Licensure, Medical; D008297:Male; D008913:Minority Groups / Q000706:statistics & numerical data*; D015397:Program Evaluation