Introduction: Backward design, an instructional model outlined by Wiggins and McTighe, emphasizes identifying key learning outcomes (LOs) that students must be able to perform after learning about a topic. It requires educators to first develop authentic assessments aligned with the key LOs, which form the basis of course content and activities. The majority of medical students across the United States encounter lecture-based learning in their first two years of basic sciences curriculum with little opportunity for hands-on training to build on necessary learning skills for future application in the clinic. Compared to traditional lecturing, a backward-designed session with planned activities may better develop medical students’ critical thinking and problem-solving skills. Our goal was to redesign a traditional first-year medical school lecture using the backward design model, and compare student perceptions and understanding of key concepts. Methods: We redesigned a traditional lecture on the topic, “Blood Glucose Control” from Fall 2022, using a backward design framework, and delivered it in Fall 2023. For redesign, we re-evaluated our LOs, and ensured that they aligned with the four assessment questions that we developed, which were used to build session content. We then compared student perceptions of learning and their performance on assessments between the two years. In both years, this topic was delivered asynchronously along with four assessment questions in the foundational course offered to 125 first-year medical students (M1s). Results: LOs were edited to include specific concepts that were tested on the four assessment questions. Upon mapping, we found that certain learning objectives were not adequately covered in the lecture, so we followed an iterative process to edit lecture content and created two activities, such as a clinical case branching scenario and a drag-and-drop activity. Of the 125 M1s, the four assessment questions in the years 2022 and 2023 were completed by a total of 50 and 60 students respectively. The average score for M1 students in Fall 2022 was 68.3562 (SEM=4.241577536) while those for students in Fall 2023 was 72.76966667 (SEM=3.655350463) ( p=0.617). Conclusion: Our results demonstrate an upward movement of the average score among students from Fall 2023 when a backward-design framework was used, compared to that of Fall 2022 students who received the traditional lecture. Although not statistically significant, the backward-design framework benefitted medical student performance when compared to traditional lecturing. Additionally, our research introduces innovative ways of incorporating interactive student activities in an asynchronous lecture that medical educators can implement into their own courses. Our future directions include comparing student perceptions between the two lecturing styles and correlating it with their performance. No funding sources to disclose. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.