The purpose of this study was to compare instruction effectiveness between a regional approach and a systems approach in teaching the musculoskeletal system to sophomore-level anatomy and physiology students. Exam grades from two consecutive fall semesters were compared. Laboratory materials for the second and third exams were presented using a systems approach first, followed by using a regional approach. This order was used with students (n=139) in the first year of the study. In the second year of the study, the order of presentation was reversed for students (n=144) so that the regional approach was used first, followed by a systems approach. There was no significant difference in the test scores for the first exam between the years, suggesting that there was no difference in overall student ability between years. The overall class average on the third exam was significantly higher (p<0.05), both within year and between years, when the material was presented in a regional approach first. However, correlation analysis did not suggest an increase in individual student performance. Results suggest that spaced repetition and testing of the course material may enhance learning.