The Impact of Heterogeneous Grouping and Reciprocal Peer Teaching on Anatomy Medical Education Outcomes

Goals of the 2019 University of New Mexico (UNM) School of Medicine curriculum revision include reducing the students repeating Phase I for academic reasons to less than 5% and those delaying Step I to less than 10%. To address these goals and improve student performance on the National Boards of Medical Examiners (NBME) final exam in Clinical Morphology (CM), the foundational anatomy course taken by first year UNM medical students, we introduced two interventions: competence‐based heterogeneous (CBH) student group formation and reciprocal peer teaching (RPT). These interventions applied independently have been shown to elevate outcomes for the lowest performing students without negatively impacting higher performing students (Donovan et al., 2018 & Pizzimenti et al., 2016). CM is designed around classroom and lab‐based active learning sessions completed in small groups that were historically formed by random assignment. Students in the cohort projected to complete undergraduate medical education in 2025 (MS2025) were administered a pre‐quiz to stratify them into quartiles, after which CBH groups of six to eight students were formed. Students participated in all classroom‐based CM active learning sessions within their CBH group. CBH groups were divided into two (physically adjacent) dissection groups for lab sessions. After completing weekly lab dissections, students participated in RPT sessions in which the divided CBH group alternately taught each other. Students were provided training, checklists, and facilitation questions to guide teaching sessions. As all students dissected and taught each week, our study addressed some of the limitations of other research that found students perform better on exams only for content for which they dissected and taught (Manyama et al., 2016). MS2025 student performance on assessments was compared with the previous two cohorts (MS2023 and MS2024). Assessments included weekly low‐stakes quizzes and an NBME final exam. Initial results indicate that MS2025 students performed significantly better (mean = 84.6%) than MS2023 (mean = 82.2%) and MS2024 (mean = 80.9%) students on the standardized NBME final exam. Additionally, this significant difference was amplified when comparing NBME scores from the lowest quartile of each cohort; however, no difference was observed when comparing the scores from the highest quartile of each cohort. There were no differences among cohort scores on weekly quizzes collectively and across quartiles. Because both interventions were applied to all subjects, it is not clear to what degree results can be attributed to RPT or CBH groupings; however, with both interventions, student NBME exam scores improved. Overall, each of these interventions requires a minimal investment of time and resources, and can be replicated in future iterations of this course. If shown to be consistently effective, they may further contribute to best practices in anatomy education with reasonable expectations to improve lower quartile student performance.