Four-year Curriculum Research Articles

Academic performance of students in an accelerated medical pathway

ABSTRACT Accelerated medical school curricula, such as three-year programs, have gained attention in recent years but studies evaluating their impact are still scarce. This study examines the Fully Integrated Readiness for Service Training (FIRST) program, a three-year accelerated pathway, to assess its impact on students’ academic performance preparedness for residency. In this observational study, we compared the academic outcomes of FIRST program students to traditional four-year curriculum students from 2018 to 2023. We analyzed multiple metrics, including exam performance (United States Medical Licensing Examination Step scores, shelf exam scores, and pre-clinical course scores) and clinical performance scores during the application and individualization phases. Analysis of Variance was used to examine the effect of accelerated pathway program experience relative to traditional 4-year medical school curriculum on the learning outcomes. FIRST program students were on average 1.5 years younger upon graduation than their traditional peers. While FIRST program students scored slightly lower on Step 2 Clinical Knowledge (CK), they exhibited no significant differences in other exam scores or clinical performance relative to the traditional students. Notably, FIRST students achieved equivalent clinical performance ratings during critical clerkships and rotations. Our findings suggest that a three-year medical school curriculum can effectively prepare students for residency and produce graduates with comparable medical knowledge and clinical skills, offering potential benefits in terms of financial relief and personal well-being for medical students.

Design and Implementation of an Integrated Curriculum: A Case Study

The construction Management program at Purdue University has introduced a unique educational model for its undergraduate degree. This curriculum transformation has been the most complex initiative ever undertaken by the School of Construction Management Technology. It is believed that no other academic program has implemented the integration of this magnitude encompassing the entire four-year curriculum. This paper provides a “30,000-foot view” of the novel educational approach including brief discussions about: the motivation for starting the transformation; the concept of knowledge “decompartmentalization”; horizontal and vertical integration of the curriculum; foundational elements of the “new” learning environment; and some of the major challenges that have been encountered, ranging from organizational to pedagogical. The main goal is to facilitate the exchange of ideas aimed at advancing the quality of undergraduate education regardless of the field of study. It is recognized that the model in its current state may be too complicated for adoption as a “whole”, however, there are many aspects of the model that other institutions can study and potentially benefit from.

Twelve tips for using the Understanding by Design® curriculum planning framework

Background Health professions faculty engaged in curriculum planning or redesign can struggle with developing courses or programs that align desired learner outcomes, such as competencies to be applied in a clinical setting, with assessment and instruction. Aims Our medical school implemented the Understanding by Design (UbD) framework to achieve alignment of outcomes, assessments and teaching during the renewal of our four-year curriculum. This article shares our strategies and practices for implementing UbD with teams of faculty curriculum developers. Description The UbD framework is a ‘backward’ approach to curriculum development that begins by identifying learner outcomes, followed by the development of assessments that demonstrate achievement of competencies and concludes with the design of active learning experiences. UbD emphasizes the development of deep understandings that learners can transfer to novel contexts. Conclusions We found UbD to be a flexible, adaptable approach that aligns program and course-level outcomes with learner-centred instruction and principles of competency-based medical education and assessment.

Well-being at a Military Medical School and Implications for Military Retention

Physical and psychological well-being play a critical role in the academic and professional development of medical students and can alter the trajectory of a student's quality of personal and professional life. Military medical students, given their dual role as officer and student, experience unique stressors and issues that may play a role in their future intentions to continue military service, as well as practice medicine. As such, this study explores well-being across the 4 years of medical school at Uniformed Services University (USU) and how well-being relates to a student's likelihood to continue serving in the military and practicing medicine.In September 2019, 678 USU medical students were invited to complete a survey consisting of three sections-the Medical Student Well-being Index (MSWBI), a single-item burnout measure, and six questions regarding their likelihood of staying in the military and medical practice. Survey responses were analyzed using descriptive statistics, analysis of variance (ANOVA), and contingency table analysis. Additionally, thematic analysis was conducted on open-ended responses included as part of the likelihood questions.Our MSWBI and burnout scores suggest that the overall state of well-being among medical students at USU is comparable to other studies of the medical student population. ANOVA revealed class differences among the four cohorts, highlighted by improved well-being scores as students transitioned from clerkships to their fourth-year curriculum. Fewer clinical students (MS3s and MS4s), compared to pre-clerkship students, indicated a desire to stay in the military. In contrast, a higher percentage of clinical students seemed to "reconsider" their medical career choice compared to their pre-clerkship student counterparts. "Medicine-oriented" likelihood questions were associated with four unique MSWBI items, whereas "military-oriented" likelihood questions were associated with one unique MSWBI item.The present study found that the overall state of well-being in USU medical students is satisfactory, but opportunities for improvement exist. Medical student well-being seemed to have a stronger association with medicine-oriented likelihood items than with military-oriented likelihood items. To obtain and refine best practices for strengthening engagement and commitment, future research should examine if and how military and medical contexts converge and diverge throughout training. This may enhance the medical school and training experience and, ultimately, reinforce, or strengthen, the desire and commitment to practice and serve in military medicine.

A Retrospective Observation of Medical Students Matching into Neurology Residencies Following a Change to Clerkship Curriculum (P11-2.004)

<h3>Objective:</h3> To retrospectively observe the proportion of the graduating medical school class pursuing residency training in neurology following a transition of the neurology clerkship to the third year of medical school. <h3>Background:</h3> Neurology is a rapidly growing field, resulting in adaptations in education over the years. In medical schools, there has been a trend to shift neurology clerkship rotations from fourth-year to third-year curriculums which has resulted in improved academic performance and higher enthusiasm for the field of neurology. <h3>Design/Methods:</h3> A retrospective observational study evaluating enrolled clerkship medical students at the Loyola University Chicago Stritch School of Medicine and the match rates into adult and child neurology specialties from 2001–2021. The students were divided into two groups involving those enrolled in clerkship when neurology was during the fourth-year curriculum (2001–2012) and students enrolled in clerkship when neurology was during the third-year curriculum (2013–2021). <h3>Results:</h3> Among the 3,093 students observed during 2001–2021, 59 students (1.9%) matched into adult neurology residencies and 15 students (0.48%) matched into child neurology residencies. There was a higher rate of students matching into both adult and child neurology specialties when neurology clerkship had transitioned to the third-year curriculum (37 students at 2.5% for adult; 11 students at 0.67% for child; <i>p</i> = 0.02) compared to the fourth-year curriculum (22 students at 1.4% for adult; 4 students at 0.28% for child; <i>p</i> = 0.11). <h3>Conclusions:</h3> There was a statistically significant observation of medical students matching into adult neurology residencies after the transition of neurology clerkship to the third-year curriculum. The match into child neurology was not statistically significant and likely due to an overall low events number. This data suggests earlier exposure to neurology can lead to a higher likelihood of students matching into neurology for residency training. <b>Disclosure:</b> Dr. Gill has nothing to disclose. Dr. Garg has nothing to disclose. Dr. Raedy has nothing to disclose. Dr. Pardieck has nothing to disclose.

A Design Sprint towards a Four-Year Curriculum in Transdisciplinary Studies

In this design case, we describe our design process that resulted in recommendations for a four-year undergraduatecurriculum in transdisciplinary studies. The case is centered on a fast-paced, two-week design “sprint” undertaken by thetwo authors, which involved consolidating and synthesizing program evaluation data and course designs from the threeprevious years of a novel undergraduate transdisciplinary degree program, creating design blueprints that outlinedprogram-level objectives, and identifying recommendations for future course-level design. In the process of completingthese hand-off materials for the incoming team of instructors, we had to work through substantial ambiguity, balancing the needs of identified learner personas, the capabilities of existing instructional team members, and the end goalof producing students that had a flexible, personal transdisciplinary identity. This case describes the design activitieswe used, the instances of failure that precipitated our design sprint, the instructional and institutional constraintswe faced, the blueprints for future instructional design we created on the course and program level, and the ultimatefailure of the degree program we sought to support.

Our First Experience Implementing “Clinical Embryology and Reproductive Medicine” as a Curriculum Course of the Study Program General Medicine at the Faculty of Medicine in Bratislava, Slovakia

There is no separate course in the medical curriculum summarizing all aspects of human reproduction in most medical school curricula. At the same time, such a course would logically connect knowledge from clinical embryology and assisted reproduction, encompassing the issue of female and male infertility, mechanisms of birth defect formation, their prenatal diagnosis and subsequent specialized neonatal care. The aim of a wide team of university teachers comprising embryologists, gynecologists, neonatologists, endocrinologists, geneticists and others was to create and implement a new course entitled "Clinical Embryology and Reproductive Medicine" into the fourth-year curriculum of the study program General Medicine at the Faculty of Medicine, Comenius University in Bratislava. There has been a great interest in the course, as evidenced by the number of medical students enrolled. The lecture syllabuses have been divided into several thematic areas: 1) Clinical embryology including a laboratory part of assisted reproduction, 2) Cause and treatment options of female and male infertility, 3) A comprehensive view of the issue of birth defects, 4) The issue of preconception education, prenatal and childbirth training, family planning, 5) Reproductive immunology and endocrinology. Despite the complexity of human reproduction being a mainstay of gynecology and obstetrics, it is underemphasized in the medical school curricula worldwide. It is often reflected in shorter hospital / practical trainings during undergraduate studies and lower requirements at the final exam. Therefore, as students almost unanimously valued, this new course is extremely helpful in preparing for the final state exam.

“It’s All About the Trust And Building A Foundation:” Evaluation of a Longitudinal Medical Student Coaching Program

Problem Coaching is increasingly implemented in medical education to support learners’ growth, learning, and wellbeing. Data demonstrating the impact of longitudinal coaching programs are needed. Intervention We developed and evaluated a comprehensive longitudinal medical student coaching program designed to achieve three aims for students: fostering personal and professional development, advancing physician skills with a growth mindset, and promoting student wellbeing and belonging within an inclusive learning community. We also sought to advance coaches’ development as faculty through satisfying education roles with structured training. Students meet with coaches weekly for the first 17 months of medical school for patient care and health systems skills learning, and at least twice yearly throughout the remainder of medical school for individual progress and planning meetings and small-group discussions about professional identity. Using the developmental evaluation framework, we iteratively evaluated the program over the first five years of implementation with multiple quantitative and qualitative measures of students’ and coaches’ experiences related to the three aims. Context The University of California, San Francisco, School of Medicine, developed a longitudinal coaching program in 2016 for medical students alongside reform of the four-year curriculum. The coaching program addressed unmet student needs for a longitudinal, non-evaluative relationship with a coach to support their development, shape their approach to learning, and promote belonging and community. Impact In surveys and focus groups, students reported high satisfaction with coaching in measures of the three program aims. They appreciated coaches’ availability and guidance for the range of academic, personal, career, and other questions they had throughout medical school. Students endorsed the value of a longitudinal relationship and coaches’ ability to meet their changing needs over time. Students rated coaches’ teaching of foundational clinical skills highly. Students observed coaches learning some clinical skills with them – skills outside a coach’s daily practice. Students also raised some concerns about variability among coaches. Attention to wellbeing and belonging to a learning community were program highlights for students. Coaches benefited from relationships with students and other coaches and welcomed the professional development to equip them to support all student needs. Lessons Learned Students perceive that a comprehensive medical student coaching program can achieve aims to promote their development and provide support. Within a non-evaluative longitudinal coach relationship, students build skills in driving their own learning and improvement. Coaches experience a satisfying yet challenging role. Ongoing faculty development within a coach community and funding for the role seem essential for coaches to fulfill their responsibilities.

Incorporation of virtual enhancement in anatomy, physiology and clinical pathology instruction in medicine and veterinary medicine basic sciences

Classic anatomic dissection of humans and animals has been an essential element of the gold standard in medical and veterinary medical education for many decades, but in recent years has encountered previously unforeseen obstacles including the COVID‐19 pandemic and restrictions in laboratory and classroom participation. Included among the factors are a decreasing availability of cadaver donations to medical schools, combined with increasing costs of obtaining suitable cadavers. Specifically, class sizes and individual participation have waned over time, as has student interest in participating in the traditionally months‐long cadaveric dissection labs, and the attendant potential chronic exposure to the noxious embalming preservatives and their possible health risks from inadvertent over‐exposure. In addition, a decreasing trend in the prevalence of graduate education in gross anatomy, a primary source of new anatomy faculty. While physical cadavers have proven their spectacular function in providing anatomy content for medical and veterinary students for decades, their limitations of delivering adequate physiology and clinical pathology content under current requirements are more limited. To this end, we redeveloped our anatomy lab to include SPOC (Small Platform Online Course) and didactic lectures in anatomy, physiology, and clinical pathology, including targeted virtual instruction in small group settings both during cadaveric dissections and with the Anatomage®, and culminating with an abbreviated cadaveric dissection employing fresh, unembalmed cadavers over structured 2 day‐long dissections with small groups of now well‐prepared students with surgical microscopy and 3‐D fabrications. The additions to this lab have provided great benefits to veterinary anatomy instruction, which can now include up to two hundred different animal species and exposure to rare species not easily visualized in an academic laboratory setting. A pioneer in medical education, William Harvey was one of the most influential physicians of all time, and recognized the crucial role of cadaveric dissections in anatomy learning and their applications to clinical medicine, but the physiologic and pathologic implications were more limited in content and application than are needed in today’s instruction. The fields of medicine and veterinary medicine have now made extraordinary advances in content and detail, requiring inclusion of ever more content at the molecular, cellular, and organismal levels within the constraints of a traditional four‐year curriculum, and where the outcomes and expectations have also increased to meet the demands and vigor of current practice standards soon after graduation. The results of our incorporation of extensive virtual anatomy and physiology modules in our curriculum have demonstrated significant increases and improvements in student participation and in content retention upon entering later phases in their academic programs.

Design and implementation of a core EPA-based acting internship curriculum

Purpose The Association of American Medical Colleges published Core Entrustable Professional Activities (Core EPAs), expected independent clinical skills for first-day interns. We sought to determine whether a required acting internship (AI) in the fourth-year curriculum could be used for summative assessment of students’ mastery of Core EPAs to a predefined level that would readily generalize across disciplines and campuses. Methods The University of North Dakota School of Medicine and Health Sciences MD Program created a standardized, required Core EPA-based AI curriculum for multiple specialties at multiple geographic sites providing a final entrustability assessment for 10 EPAs in a single course. Results The course was successfully designed and launched for all students in a single class. During the AI, students functioned at the level of an acting intern, rated the courses as superior, and performed at satisfactory exit-level competence for 10 Core EPAs. Conclusions A standardized, EPA-based AI curriculum can provide an opportunity for exit level EPA assessment in the medical curriculum. This model functions well within multiple specialties and at diverse community-based, volunteer faculty teaching sites.

Editor’s Introduction

Editor’s Introduction

72 Medical Student Attitudes Towards Point-of-Care Ultrasound in Undergraduate Medical Education

Point-of-care ultrasound (PoCUS) is a bedside imaging modality that provides the operator with instant clinical patient information. PoCUS is a low-cost, radiation-free, portable diagnostic tool that is utilized in many specialities The aim of the study was to assess undergraduate medical students’ attitudes towards PoCUS through the implementation of a rudimentary proctored PoCUS workshop.Third-year medical students at the Royal College of Surgeons in Ireland participated in a 1-hour PoCUS workshop as part of their fundamental clinical skills training. Medical students attended the in-person workshop repeated over 8 weeks. Students were exposed to three ultrasound stations. The first was a CAE Vimedix ultrasound simulator utilizing augmented reality colourization and 3D modelling. The second station was learning and performing an extended FAST scan with a focus on bright mode image acquisition and free fluid recognition. The third station was the practical placement of peripheral/central IV-line insertion helping students to identify vasculature while also manipulating the ultrasound transducer as a procedural adjunct. Students were asked to complete a post-workshop survey to investigate their attitudes towards ultrasound teaching in undergraduate medical education. The survey consisted of 10 questions to assess attendee’s prior ultrasound knowledge, to provide constructive feedback regarding the workshop and how ultrasound can be incorporated into future undergraduate medical education.A total of 121 students completed the post-workshop survey. Of those who completed the survey, 94.2% of students had never used an ultrasound machine before and 100% had never performed PoCUS previously. Collectively, participants strongly agreed 100% that PoCUS should be incorporated into the undergraduate medical student curriculum at RCSI. In particular, 89.3% and 45.5% of students indicated that POTUS should be included in the third- and fourth-year medicine curriculum, respectively. 85.1% of students indicated that PoCUS education would be most valuable to supplement clinical placement followed by anatomy (62.8%), pathology (59.9%) and physiology (23.1%). 86.8% of the students were interested in learning more about PoCUS through an online format.PoCUS appears to be an additional valuable learning resource for undergraduate medical students. Of the students surveyed, it is apparent that there is strong support in favour of early ultrasound integration into the future medical school curriculum.

Dental Curriculum's Continuing Improvement in the North American and Gulf Cooperation Council (GCC) Education Systems

Background: Dynamic oral health care needs, alongside a diverse demographic of patients, presents a challenge to dental clinicians as they strive to resolve the ever-increasing demand for quality oral care service. Claims have arisen that the most appropriate way of speeding up the slow change in adopting innovations within the dental practice is by updating dentists' knowledge and skills through improving the undergraduate students' curriculum. Objective: This review compares the dental curriculum's continuing improvement processes between the North American and Gulf Cooperation Council (GCC) countries. Methods: The process of analysis consisted of identifying, examining, and interpreting patterns and themes within textual data, and then determining how each of these help answer the research questions. Results: Efforts to implement the dental curriculum's continuous improvement processes in the North American and GCC countries are evident, but the significant barriers for the dental curriculum's continuing improvement among the North American countries include the consequences of a compressed four-year curriculum, reliance on professional regulations, insufficient focus on patient perceptions, and the lack of a more theoretically robust approach to self-reflection. Conversely, amongst the GCC countries, the available literature states that the most significant factors hindering the dental curriculum's continuing improvement include deficient leadership attributes and low research productivity. Conclusion: The North American and GCC regions will benefit from the new dental curriculum and result in producing more competent dental practitioners, with improved leadership and patient-centered care. However, it has been observed that the dental curriculum’s continuous improvement processes are adopted slowly, particularly among the GCC countries.

Students’ views and experiences of the training and use of phonetic transcription in speech and language therapy – the Irish perspective

ABSTRACT Phonetic transcription is an essential skill for a practising speech and language therapist (SLT) required during the assessment, diagnosis and management of clients with speech difficulties. It is vital that appropriate training is received by student SLTs to ensure that they carry out phonetic transcription accurately and reliably once out in the workplace. This study investigates the views and experiences of final year SLT students regarding the training in phonetic transcription they received in university, with the aim to identify what poses difficulties for them and what could be done to enhance their learning. Responses from 40 participants representing one cohort of SLT students, graduates of a particular year, were collected using an online questionnaire. The majority of the respondents consider phonetic transcription an important professional skill and plan on maintaining it after graduating. Learning phonetic transcription was easy/quite easy for 57% of the respondents; however, the confidence in transcription skills was rather low: 70% of them reported not being confident and fully equipped to enter the workforce with their transcription skills. The main difficulties were associated with narrow (impressionistic) transcription and transcription of disordered speech. 58% of the respondents found the teaching environment suitable; however, a recurring theme is the need for small-group tutorials during which the lecturers could provide feedback to individual students more efficiently. Participants’ responses suggest that more clinically relevant transcription practice of disordered speech, the opportunity to refresh and apply phonetic transcription skills throughout the four-year curriculum and smaller group teaching would benefit their learning and enhance their confidence using transcription on placements and in the workforce.

Rutgers Robert Wood Johnson Medical School.

Rutgers Robert Wood Johnson Medical School.

Medical University of South Carolina College of Medicine.

Medical University of South Carolina College of Medicine.

A Survey of Psychiatry Course Offerings for Fourth-Year Medical Students.

Fourth-year course offerings seem to vary widely among psychiatry departments with some offering a wide selection while others offer little or unspecified opportunity. The purpose of this study was to learn the distribution and diversity of fourth-year medical school psychiatry courses and identify unique course offerings that may inspire other departments. The authors compiled a list of US allopathic medical schools accredited by the Liaison Committee on Medical Education (LCME) using the LCME website. They accessed each school's website catalog and recorded all psychiatry electives available to fourth-year students listed in the catalog or the Visiting Student Application Service® (VSAS®) database. The authors calculated median published course offerings per department and categorized each course according to learning opportunity. The authors identified 142 fully accredited allopathic medical schools of which n = 126 listed fourth-year medical student courses on their website or through VSAS. The median number of fourth-year psychiatry course offerings per school was 6 (range, 1-22). The most frequently offered courses were inpatient psychiatry (n = 105 schools), child and adolescent psychiatry (n = 95), and consultation psychiatry (n = 84). The authors also identified unique enrichment courses in media, women's health, ethics, research, and cultural psychiatry. The fourth-year curriculum varies widely among institutions. Hypotheses to be tested are if prioritizing robust fourth-year rotations include improved resident readiness, improved retention of home students into the training program, improved recruitment of visiting students, increased faculty scholarly activity and career development, and improved recruitment into the subspecialties.

How nursing students\u2019 placement preferences and perceptions of community care develop in a more \u2018community-oriented\u2019 curriculum: a longitudinal cohort study

BackgroundExtramuralisation in healthcare has influenced medical and nursing curricula internationally with the incorporation of themes related to primary/ community care. Despite this, students do not easily change their career preferences. The hospital is still favourite, leading to labour market shortages in extramural care. This study investigates how baccalaureate nursing students’ perceptions of community care and placement preferences develop over time in a more ‘community-care-oriented’ curriculum, to gain insights on which curriculum elements potentially influence career choices.MethodsA nursing student cohort of a University of Applied Sciences in the Netherlands (n = 273) underwent a new four-year curriculum containing extended elements of community care. The primary outcome was assessed with the Scale on Community Care Perceptions (SCOPE). Data were collected each year of study. Descriptive statistics were used to investigate students’ placement preferences and perceptions, and linear mixed model techniques (LMMs) for measuring how students’ perceptions develop over time. Patterns of placement preferences at individual level were visualised.ResultsStudents’ perceptions of community care, as measured with SCOPE, show a slight decrease between year 1 and 4, while items mutually differ substantially. In contrast, the preference of community care for a placement increases from 2.6% in year 1 tot 8.2% in year 4. The hospital is favourite in year 1 (79.8%), and remains most popular. At individual level, students often change placement preferences, although a preference for the hospital is more consistent. The LMMs indicates that, at the four time-points, the estimated marginal means of students’ perceptions fluctuate between 6 and 7 (range 1–10). A placement in community care did not positively influence students’ perceptions, and an intensive 1 week theoretical programme was only temporarily influential.ConclusionsAlthough interest for placement in community care increased substantially, it was not clear which curriculum elements stimulated this, nor did the curriculum positively influence students’ perceptions. As most students do not look forward to the high responsibility of the field, other curricula with educational tracks for more mature students/ nurses with a vocational training may be an alternative contribution to solving the labour market problems in community care.

A global health capstone: an innovative educational approach in a competency-based curriculum for medical students

BackgroundGlobal health educational programs for medical and public health professionals have grown substantially in recent years. The University of Illinois Chicago College of Medicine (UICOM) began a global medicine (GMED) program for selected students in 2012 and has since graduated four classes. As part of the four-year curriculum, students complete a longitudinal global health capstone project. This paper describes the global health capstone project as an innovative educational tool within a competency-based curriculum.MethodsThe authors define and describe the longitudinal global health capstone including specific requirements, student deliverables, and examples of how the global health capstone may be used as part of a larger curriculum to teach the competency domains identified by the Consortium of Universities for Global Health. The authors also reviewed the final capstone projects for 35 graduates to describe characteristics of capstone projects completed.ResultsThe global health capstone was developed as one educational tool within a broader global health curriculum for medical students. Of the 35 capstones, 26 projects involved original research (74%), and 25 involved international travel (71%). Nine projects led to a conference abstract/presentation (26%) while five led to a publication (14%). Twenty-one projects (60%) had subject matter-focused faculty mentorship.ConclusionsA longitudinal global health capstone is a feasible tool to teach targeted global health competencies and can provide meaningful opportunities for research and career mentorship. Further refinement of the capstone process is needed to strengthen mentorship, and additional assessment methods are needed.

Patterns of Stress, Coping and Health-Related Quality of Life in Doctor of Pharmacy Students

Objective. To examine perceived stress, coping strategies, and health-related quality of life in Doctor of Pharmacy students across the first three years (pre-clinical portion) of the curriculum. Methods. Three instruments, the Perceived Stress Scale, Brief COPE, and Short Form-36, were administered to students three times a year over a five-year period. Median annual scores were compared using Skillings-Mack tests and correlations were assessed using Spearman correlation. Results. One hundred forty-five students (approximately 46% of the school's enrollment) participated. A significant increase in scores on the PSS, increase in students' maladaptive coping behaviors, and worsening mental health-related quality of life were detected in students across the first three years of the pre-clinical curriculum. The PSS scores of first- and second-year pharmacy students had a moderate to large positive correlation with maladaptive coping behaviors (rho = 0.43 and 0.58, respectively) and PSS scores exhibited a large negative correlation with maladaptive coping behaviors in all three years of the pre-clinical curriculum (rho ranged from -0.69 to -0.78). Conclusion. Increasing levels of stress, increasing use of maladaptive coping strategies, and declining mental health-related quality of life among pharmacy students across the first three years of the four-year curriculum were very similar to findings in the cohort of pharmacy students observed in the preceding five years.