To evaluate the implementation of flipped-classroom design for a preclinical neurology curriculum incorporating an online textbook and in-class application questions, with outcomes measured by course NBME examinations (midterm and final) and the annual NBME Comprehensive Basic Science Exam (CBSE) tool for Step 1 preparation.

During pre-clinical years, medical students seek to master neuroscience for USMLE Step 1 and clinical application.  In recent years, evolving needs and expectations of learners, institutional policy, lack of standardization, and prioritization of content mastery for Step 1 has led to low lecture attendance and participation, and utilization of external resources rather than faculty-developed course materials.

NBME scores for 2022 and 2023 were compared to scores after revised curricular design for 2024 and 2025 utilizing the two-sample t-test.  CBSE subscores for neurological and special senses content for 2022 and 2023 were compared to scores for 2024, as the 2025 examination has not yet been completed.

Implementation of a standardized Scholar Rx bricks-based curriculum led by core faculty with homogenous enrichment experiences (e.g., case-based learning) improved student performance on both course NBME and CBSE scores.

Pre-redesign NBME examination scores completed in 2022 and 2023 averaged 78.40% +10.18%, and 2024 and 2025 NBME examination scores averaged 84.23% + 5.60% (p < 0.001).  CBSE scores for 2022 and 2023 averaged 53.99 + 13.71 (national average 76.50 + 12.03), and 60 + 14 for 2024 (national average 72 + 8) (p < 0.001).

Students also indicated increased course satisfaction based on Likert scale ratings on the course evaluation.  Additionally, faculty expressed higher levels of satisfaction and noted increased number of students participating in class.

Pre-clinical neurology course curriculum redesign based on a flipped classroom model and an interactive online textbook successfully improved engagement and examination performance.