The Impact of a Modular Curriculum on Veterinary Students’ Quality of Life and Academic Knowledge: Proof of Concept ^†

Abstract

This study examined quality of life and deep learning among 109 veterinary medicine students across three cohorts (2021–2023) in an integrated modular curriculum in Portugal. Quality of life was measured three times per academic year using the WHOQOL-BREF, whereas deep learning was assessed twice yearly via assessment tests. The results revealed consistently low scores in the psychological domain of the quality-of-life assessment and a noticeable decline in both quality of life and assessment tests during the second year. These findings highlight the need to monitor student well-being and adapt teaching strategies to sustain motivation and academic success.

1. Introduction

The educational landscape has shifted from traditional lectures to active learning, fostering greater student engagement and academic success [1]. This transition attempts to reduce surface learning to promote deep learning, which focuses on understanding, critical thinking, and problem solving rather than mere memorisation [1]. Student motivation drives deep learning, which is impacted by both individual and institutional elements such as the learning environment and teaching strategies, including learning climate, course content, and curriculum design [2].

One innovative approach for curriculum design is a modular curriculum, where students study one subject at a time during the semester. It offers different formats such as sequential, integrative, or integrated approaches that combine theory with practice [3]. Understanding how various factors, such as students’ psychological well-being, impact academic performance is essential. Specifically, the well-being of veterinary medicine students is an increasing concern, with rising reports of high stress levels, poor well-being, and depression [4,5,6]. These outcomes are mostly attributed to the intense academic pressure and high expectations [6].

The Egas Moniz School of Health and Science launched its veterinary medicine programme in the 2021–2022 academic year and has designed it to achieve Day One Competencies after the six-year course. The veterinary course is set on an integrated modular programme, with a strong practical component. It is the first Portuguese institution to adopt this innovative curriculum in veterinary education, striking a balance between contact hours and students’ well-being. The latter is critical for maintaining motivation and learning quality. The purpose of this study was to understand how students navigate the course and manage academic demands alongside their personal well-being, as well as to assess their level of deep learning, with the aim of enhancing teaching practices and fostering a supportive learning environment.

2. Materials and Methods

Sample: A total of 109 veterinary medicine students enrolled between the 2021–2022 and 2023–2024 academic years participated in this study. The students were divided into cohorts, according to their entrance year for the course: 2021 cohort, 2022 cohort, and 2023 cohort.

Quality-of-life assessment: Student quality of life was assessed using the WHOQOL-BREF questionnaire at three time points in each academic year: September (start of school), January (end of 1st semester), and June (end of 2nd semester). The questionnaire has 26 items and evaluates four domains: physical, psychological, social relationships, and environmental. Each item was rated on a 5-point Likert scale. Domain scores were calculated according to the WHOQOL manual [7].

Study design for post-curricular evaluation: A twice-yearly evaluation was conducted at the beginning of each semester to evaluate the completed curricular units (CUs) per semester, to assess students’ deep learning. The test comprised multiple-choice, true/false, and open-response questions; was developed in collaboration with several lecturers from the Egas Moniz School of Health & Science involved in different CUs; and was conducted via an online platform.

Descriptive statistics: Means and standard deviations (SD) were calculated for post-test and quality-of-life questionnaires.

3. Results and Discussion

This study analysed well-being scores and academic assessments of veterinary medicine students across three cohorts. As data collection began in June, only this time point was available for the 2021–2022 cohort, with earlier data missing. Additionally, as the study is ongoing, June data are not yet available for the 4th, 3rd, and 2nd years of the 2021, 2022, and 2023 cohorts, respectively, and are therefore not included.

3.1. Well-Being

As shown in

Table 1. Well-being scores. Means and SD of WHOQOL-BREF scores for veterinary medicine students in the 2021, 2022, and 2023 cohorts. T indicates the total number of students enrolled and n the number of students who completed the questionnaire.

Domain/Cohort	2021 (T = 30)			2022 (T = 49)		2023 (T = 30)
	1st year	2nd year (n = 20)	3rd year (n = 26)	1st year (n = 46)	2nd year (n = 48)	1st year (n = 27)
	September
Physical	-	68.67 ± 11.96	71.97 ± 13.98	75.23 ± 11.07	68.11 ± 14.48	71.43 ± 11.38
Psychological	-	62.71 ± 14.46	69.07 ± 13.70	68.29 ± 13.48	63.81 ± 15.81	66.82 ± 14.03
Social Relations	-	72.92 ± 16.86	73.07 ± 16.67	76.27 ± 12.66	72.22 ± 13.35	68.21 ± 20.29
Environmental	-	72.81 ± 10.09	75.6 ± 14.89	76.63 ± 9.36	72.85 ± 12.38	71.88 ± 10.07
Domain/Cohort	January
	1st year	2nd year (n = 30)	3rd year (n = 26)	1st year (n = 50)	2nd year (n = 43)	1st year (n = 33)
Physical	-	70.35 ± 12.56	68.81 ± 15.47	73.64 ± 13.14	68.85 ± 14.96	70.24 ± 14.73
Psychological	-	66.38 ± 12.38	66.02 ± 13.93	68.1 ± 13.59	63.76 ± 18.71	63.13 ± 15.17
Social Relations	-	73.33 ± 17.42	75.00 ± 22.83	77.17 ± 12.69	71.12 ± 16.19	70.20 ± 20.23
Environmental	-	74.27 ± 12.02	74.4 ± 12.41	74.19 ± 11.94	73.77 ± 13.54	69.32 ± 11.32
Domain/Cohort	June
	1st year (n = 28)	2nd year (n = 26)	3rd year (n = 24)	1st year (n = 47)	2nd year (n = 50)	1st year (n = 25)
Physical	72.06 ± 13.43	71.43 ± 13.32	85.42 ± 14.89	69.45 ± 15.11	64.93 ± 17.54	72.43 ± 15.52
Psychological	68.15 ± 14.66	70.03 ± 14.09	68.93 ± 15.39	65.78 ± 15.99	61.67 ± 18.71	66.33 ± 16.13
Social Relations	77.97 ± 18.03	75 ± 13.54	77.08 ± 16.35	73.40 ± 17.08	71.67 ± 17.58	71.33 ± 21.79
Environmental	71.76 ± 13.78	73.52 ± 12.19	79.9 ± 12.83	75.46 ± 11.56	70.19 ± 15.48	72.25 ± 15.86

, among the 109 students enrolled, adherence rates to the WHOQOL-BREF were above 86% at all points, except for the 2021 cohort in the 2nd year (September), which had an adherence rate of 67%.

In Table 1, in September, at the beginning of the first semester, the lowest scores across all cohorts and years were observed in the psychological domain (PD), ranging from 62.71 to 69.07. In contrast, the highest scores were found in the environmental domain, ranging from 71.88 to 76.63. For the 2021 cohort, a slight increase in all domains was observed in both the second and third years. Conversely, the 2022 cohort showed a decline across all domains in both the first and second years.

In January, the lowest scores were again observed in the PD, ranging from 63.13 to 68.1. For the 2021 cohort, a slight decrease was noted in the physical domain during the second and third years. In contrast, the 2022 cohort continued to exhibit a decline across all domains in both the first and second years.

In June, a similar behaviour was observed, as the lowest scores were again observed in the PD, ranging from 61.67 to 70.03. For the 2021 cohort, a slight decrease followed by an increase was observed across the first, second, and third years in the physical and social relations domains. Similar behaviour to the previous time points was observed for the 2022 cohort.

Overall, the PD domain has the lowest score across the three time points. This domain measures negative feelings, cognitive functions such as concentration, and body appearance. The WHOQOL questionnaire has previously been used to assess the well-being of veterinary students. The scores in our study were higher than those reported in these studies, as the highest score they reported was 63.57 [4,8]. Furthermore, better academic performance was associated with greater quality of life in most domains [4].

3.2. Assessment Test

A surprise assessment test was administered each semester for the veterinary medicine students across the three cohorts. The adherence rate to the assessment test was always above 83%, except in the first semester of the third year of the 2021 cohort, which the adherence rate was 56%. The test was scored on a scale of 0–20, and the mean score for each CU and semester was calculated. These results are presented in Figure 1.

As shown in Figure 1, the assessment results revealed that some CUs consistently had negative mean scores. Notably, certain CUs present low scores across multiple cohorts. For example, Scientific Thinking (Sci Think) and Animal Body Function I (ABF I) had low average scores in the 1st year for both the 2022 and 2023 cohorts, while Animal Body Function IX (ABF IX) exhibits similar patterns in the 2nd year for the 2021 and 2022 cohorts. When comparing mean scores across semesters, a decline is evident in the second year. For the 2021 cohort, the average decreased from 13.52 (SD = 2.8) in the first semester to 11.09 (SD = 0.8), and from 13.25 (SD = 3.2) to 10.70 (SD = 3.3) in the second semester. A similar trend was observed in the 2022 cohort: from 15.06 (SD = 1.4) to 11.41 (SD = 3.1) in the first semester, and from 12.64 (SD = 1.7) to 10.84 (SD = 1.5) in the second semester. As the study progresses, we intend to have enough data to try and correlate the grades scored on the assessment tests with the well-being results, thus showcasing how the well-being of students can have an impact on their academic performance.

4. Conclusions

The quality of life varies across cohorts; however, it appears to decrease during the second year. This decline was similar regardless of the time point. Additionally, a decrease in the assessment results was also found in the second year; however, a correlation between these two scores is not yet possible, as the study is ongoing.

Since high stress and poor well-being have been reported among veterinary medicine students, it is important to continue measuring these conditions throughout the veterinary programme. If necessary, Egas Moniz should implement strategies to improve the learning environment and provide support to students to prevent and/or reduce stress. The results obtained in this pilot study support the need to continue with the study to improve the learning environment.