In my work as an instructional designer at a medical school, I have often heard a couple of observations made by faculty and staff about the learning goals of our students. First, that many of our students are keenly focused on final grades and overall scores within their cohort, especially while progressing through pre-clerkship. Second, that this focus on grades is often at the expense of deeper engagement with, and understanding of, the foundational biomedical science (FBS) and systems courses covered during this period.

In light of Bloom's taxonomy, these students are essentially focusing on their ability to remember FBS or systems information, but are often ill-equipped to apply this knowledge to new scenarios (Krathwohl, 2002). Passing level 1/step 1 medical board exams and progressing to clerkship/clinical experience is not a guarantee of strategic thinking (Webb, 2005) and many are hard-pressed to apply their rote memorization to actual patients and the scenarios they present with.