Background:
Recently, the University of Pikeville transformed its pre-clinical curriculum from a traditional, discipline-based model to an integrated, system-based, two-pass hybrid design. Prior to this reform, pharmacology was delivered as two stand-alone second-year courses, primarily through didactic lectures. The curriculum redesign reduced pharmacology contact hours and redistributed content across organ systems.

Objective:
This study evaluates whether pharmacology contact hours can be reduced within an integrated systems-based curriculum while maintaining national licensing examination performance and strengthening clinical application.

Methods:
Pharmacology content was systematically mapped across the revised curriculum to eliminate redundancies and clarify disciplinary roles. Faculty developed explicit guidelines: pharmacology focused on mechanisms of action, adverse effects, drug interactions, and core clinical uses, while internal medicine emphasized diagnosis, guidelines, and drugs of choice. Previously underrepresented topics (e.g., immunopharmacology and pharmacotherapy in pregnancy and lactation) were incorporated. A longitudinal case-based course reinforced pharmacologic principles across both pre-clinical years, and a second-year Therapeutics of Infectious Diseases series was introduced to strengthen antimicrobial application in clinical contexts. Student outcomes were assessed using NBOME Level 1 pharmacology performance reports, comparing cohorts before and after curricular transformation.

Results:
Following curricular reform, pharmacology contact hours were successfully reduced from 124 to 90 hours (a 27% reduction) without deterioration in national benchmark performance. Pre-transformation pharmacology scores were comparable to national means (national mean 549.07, SD 155.21 vs. school mean 502.25, SD 140.76). Post-transformation performance remained at national average levels, indicating the preservation of pharmacology competency despite a 27% reduction in instructional time.

Conclusions:
Strategic content mapping and longitudinal integration allow for a meaningful reduction in pharmacology contact hours while maintaining national examination performance. Embedding pharmacology within a two-pass, hybrid systems curriculum promotes efficiency and strengthens clinical application. Continued longitudinal assessment will further evaluate retention and clinical impact.