Thirty-six (24.3%) of 148 s-year students from ATSU and 29 (19.3%) of 150 s-year students from EVMS responded to the survey. Of those, 9 men, 21 women, and 1 nonbinary person were from ATSU, and 11 men and 18 women were from EVMS (Table 1). Age and education characteristics were similar for both groups of students.

Outside resources recommended by classmates or other medical students (27/36, 75.0% ATSU students; 18/27, 66.6% EVMS students) were used most often by both groups (Table 2). However, EVMS students were equally as likely to use resources recommended by academic support staff (18/27, 66.6%). Differences were found between the two groups for outside resources recommended by students at other medical schools (p = 0.01) and academic support staff (p = 0.02) (Fig. 1).

Student reported use outside resources by recommendation. All values are percentage endorsements within each category. p < 0.05

For most students from both schools, the purpose for using outside resources was to prepare for licensing exams (35/36, 97.3% ATSU students; 27/27, 100% EVMS students), prepare for course exams (24/36, 66.6% ATSU students; 27/27, 100% EVMS students), seek efficient means of comprehending concepts (31/36, 86.1% ATSU students; 27/27, 100% EVMS students), and seek effective learning resources (29/36, 80.6% ATSU students; 25/27, 92.6% EVMS students) (Table 3). Differences were found between the two groups for using outside resources to prepare for licensing exams, prepare for course exams, seek efficient means of comprehending concepts, access practice questions, and have opportunities for practice (all p < 0.02) (Fig. 2).

Student reported purpose for using outside resources. All values are percentage endorsements within each category. p < 0.05

For frequency of use of instructor-produced resources, students from both schools most often used instructor slides (21/31, 67.7% ATSU students; 15/27, 55.5% EVMS students) (Table 4). Differences were found between the two groups for using instructor-produced resources of live lecture recordings, transcripts, and instructor-led review sessions (all p < 0.02) (Fig. 3).

Students reported frequency use of instructor-provided resources. All values are percentage endorsements within each category. p < 0.05

For frequency of use of outside resources, students from both schools most often used board review resources (29/31, 93.5% ATSU students; 25/26, 96.2% EVMS students) and practice questions provided in board review question banks (24/31, 77.4% ATSU students; 23/26, 88.4% EVMS students) (Table 5). Students from EVMS used these two resources more frequently than students from ATSU (both p = 0.01). Students from EVMS used Apps (8/27, 29.6%) less frequently than ATSU students (18/30, 60.0%, p = 0.01) (Fig. 4).

Student reported frequency of use board review resources and applications. All values are percentage endorsements within each category. p < 0.05

For frequency of use of student-generated resources, most students from both schools used online content generated by other students (17/31, 54.9% ATSU students; 18/26, 69.2% EVMS students) (Table 6). The ATSU students most frequently used self-generated study resources (20/30, 66.7%) and used this resource more often than EVMS students (10/27, 37.0%, p = 0.047) (Fig. 5).

Student reported frequency of use of self and peer-generated resources. All values are percentage endorsements within each category. p < 0.05

For frequency of use by discipline, most students from both schools used outside resources to study pathology (17/31, 54.8% ATSU students; 26/27, 96.3% EVMS students), pathophysiology (18/31, 58.1% ATSU students; 27/27, 100% EVMS students), physiology (18/31, 58.1% ATSU students; 25/27, 92.6% EVMS students), and pharmacology (22/31, 71.0% ATSU students; 20/27, 74.1% EVMS students) (Table 7). Differences were found between the two groups for these four disciplines (all p < 0.046). For ATSU students, outside resources were most frequently used to study pharmacology and clinical sciences (21/31, 67.7%). For EVMS students, outside resources were most frequently used to study pathophysiology and pathology. Differences were also found between the two groups for the disciplines of biochemistry, genetics/molecular biology, and osteopathic principles and practice (all p < 0.02).

Fourteen students from ATSU and EVMS (21.5%) replied to the two open-ended survey questions. Five themes were identified: (1) distrust of current curriculum, (2) augmentation of instructor-created content, (3) preparation for clinical responsibilities, (4) creation of a framework for current and future learning, and (5) efficiency (Table 8). The themes of augmentation of instructor-created content, preparation for clinical responsibilities, and creation of a framework for current and future learning correspond to the quantitative analysis.