Background: Many, many studies, including three major reviews, that compare problem-based curricula to more traditional curricula, have been published in the last IO years. No study, however, has looked specifically at a closed-loop or reiterative problem-based approach. Purpose: A 3-year retrospective study was done to compare the academic performance of students in a reiterative problem-based learning (PBL) curriculum with that of their counterparts in the standard curriculum to ensure that the PBL students were nor disadvantaged. Methods: Three graduating classes' performance on a number of outcome measures, including the United States Medical Licensing Examination, clinical clerkship, and clinical practice examination performance, were compared. Results: Analyses indicate that students in the PBL curriculum performed at least as well as, and in some instances better than, their counterparts in the standard curriculum. Conclusion: Students in the PBL curriculum, a student-directed curriculum were nor disadvantaged. Of note is their strong clinical performance. Copyright 1998 by Lawrence Erlbaum Associates, Inc.