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BACKGROUND. This study evaluated the effect of a radically redesigned curriculum at Harvard Medical School on preclinical students' knowledge, skills, personal characteristics, approaches to learning, and educational experiences. METHOD. Multiple measures were used to collect data from 121 students from the entering classes of 1989 and 1990 who had been randomly assigned to the New Pathway or traditional curricula; all had applied to be in the new curriculum. RESULTS. The New Pathway students reported that they learned in a more reflective manner and memorized less than their control counterparts in the traditional curriculum during the preclinical years. The New Pathway group preferred active learning and demonstrated greater psychosocial knowledge, better relational skills, and more humanistic attitudes. They felt more challenged, had closer relationships with faculty, and were somewhat more anxious than those in the traditional program. There was no difference in problem-solving skills or biomedical knowledge base. CONCLUSION. Students in the new curriculum learned differently, acquired distinctive knowledge, skills, and attitudes, and underwent a more satisfying and challenging preclinical medical school experience without loss of biomedical competence. These findings should encourage other schools to consider such a curriculum.