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Medical Biochemistry Without Rote Memorization: Multi-Institution Implementation and Student Perceptions of a Nationally Standardized Metabolic Map for Learning and Assessment


Despite the growing number of patients worldwide with metabolism-related chronic diseases, medical biochemistry education is commonly perceived as focusing on recall of facts irrelevant for patient care. The authors suggest that this focus on rote memorization of pathways creates excessive cognitive load that may interfere with learners’ development of an integrated understanding of metabolic regulation and dysregulation. This cognitive load can be minimized by providing appropriate references during learning and assessment. Biochemistry educators collaborated to develop a medically relevant pathways of human metabolism map (MetMap) that is now being used at many medical schools as a nationally standardized resource during learning and assessments. To assess impact, students from three medical schools were surveyed about its benefits and disadvantages. Responses were obtained from 481 students (84%) and were examined using thematic analysis. Five main themes emerged as perceived benefits of using the MetMap: (1) aids visual and mental organization, (2) promotes deep learning and applied understanding, (3) decreases emphasis on memorization, (4) reduces anxiety on exams, and (5) aids recall. Perceived disadvantages were (1) fear of underpreparation for licensing exams, (2) overwhelming nature of the map, and (3) reduced motivation for and time spent studying. Results affirm that students’ perceive use of the MetMap promotes focus on broader metabolic concepts and deep versus surface learning, supporting a shift in cognitive load toward desired goals. Although the long-term impact on learning needs to be further studied, the use of the MetMap represents a step toward open-reference exams that reflect “real-world” practice.

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The authors thank Steven Haist, MD, and Christy Bracken-Vasquez, MBA, at the National Board of Medical Examiners for hosting multiple meetings and discussions about the MetMap and licensing exams; Holly Nishimura, MPH, for help reviewing the literature; Arianne Teherani, PhD, Bridget O’Brien, PhD, and Judith Bowen, MD, FACP, for feedback about the conceptual framework and data analysis; and Justin Sewell, MD, MPH, and Patricia O’Sullivan, EdD, for critical review of the manuscript.


Research assistant supported by the UCSF Academy of Medical Educators Chair for Excellence in Foundational Teaching.

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Correspondence to Douglas B. Spicer.

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This study was determined to be exempt from full review by the institutional review boards of all three institutions.

Conflict of Interest

JEL, TMC, and TBF serve on the USMLE Metabolic Map Task Force. JEL and TBF have served on USMLE Item-Writing Committees and on USMLE Step 1 Interdisciplinary Review Committees.

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Spicer, D.B., Thompson, K.H., Tong, M.S. et al. Medical Biochemistry Without Rote Memorization: Multi-Institution Implementation and Student Perceptions of a Nationally Standardized Metabolic Map for Learning and Assessment. Med.Sci.Educ. 29, 87–92 (2019).

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