Longitudinal evaluation of a major curricular reform in undergraduate medical education: a cohort study from Chile
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Date
2025
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Abstract
Medical education is undergoing significant transformations to better align with evolving healthcare needs. In 2015, the Pontificia Universidad Católica de Chile implemented a major curricular reform in its School of Medicine, shifting from a traditional 7-year program to an integrated, competency-based 6-year curriculum. This study aimed to assess the academic outcomes, clinical competencies, and differences in student well-being between both curricula. Methods:We conducted a prospective, longitudinal, comparative study of two cohorts: the last cohort under the traditional curriculum and the first cohort under the new curriculum. Three measurements were carried out along the study program: at the beginning, at the middle and at the last year of the program. Academic performance, professionalism, and clinical competencies were evaluated using standardized written tests, OSCEs and the National Medical Exam (EUNACOM). In addition, we compared the courses grades and attrition statistics along the studies. At these three points, students also answered a range of self-reporting instruments regarding distress, burnout, wellbeing, mindfulness, empathy and the educational environment. Results: Both cohorts achieved similar average grades and EUNACOM scores. The new curriculum cohort had a significantly lower course failure rate (7.6% vs 13%, p<0.01) and better outcomes in professionalism and communication. Final OSCE scores were slightly higher in Obstetrics/Gynecology and Family Medicine. Despite these improvements, both cohorts showed high and increasing levels of stress, burnout, and declining empathy, particularly in the final years. While the elevated levels of stress and anxiety observed among medical students are extensively documented in the literature, the COVID-19 pandemic may have exerted an additional influence on these outcomes. Conclusion: The new curriculum maintained academic performance while enhancing professionalism and reducing failure rates and training time. However, persistent mental health challenges underscore the need for stronger and more effective support systems. These findings reveal the value of competency-based education while highlighting the importance of holistic curricular evaluation.
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Keywords
Medical education, Curricular reform, Competence-based curriculum, Active methodologies, Professionalism, Well-being, Educational environment