Integration Strategy in Medical Education

1. Integration Strategy in Medical Education Dr.F.Hosseini

2. Integrate means: • To form or blend into a whole, UNITE Webster’s Dictionary

3. Integration in education: • Integration is defined as organization of teaching matter to interrelate or unify subjects frequently taught in separate academic courses or departments.

4. Why integration? • The present system of education follows a building block principle. In this, each subject has its own block of time, usually restricted to one part of the course . The early curriculum are expected to lay foundation for the other subjects which follow. It is left to the students to solve the jigsaw puzzle.

5. Why integration? Flaws with the present system are: • 1. unnecessary repetition • 2. disjointed approach to teaching • 3. disunity and hence the subject as a whole is never grasped. • 4. confusion in student's mind due to difference in opinion which in turn leads to

6. Why integration? • Integration aims at giving the students a holistic instead of a fragmented outlook on his studies.

7. Why integration? • The integrative process must occur within the minds of our students, but the curriculum should be structured to promote that goal.

8. Integration in education: • The need for greater integration of subjects in the medical curriculum has featured predominantly in reports on medical education ,including the GPEP report, Education Medical Students, the report of the ACME-TRI project and Tomorrow's Doctors.

9. Integration in education: Harden • Integration has been accepted as an important educational strategy in medical education .

10. Integration in education:Harden • The question to be asked of teachers and curriculum designers isnot whether they are for or against integration, but rather whereonthecontinuum between the two extremes should they place their teaching.

11. Integration in education: Harden • Integration is represented as a continuumwith full integration at one end, discipline-based teaching at the other, and with intermediate steps between the two extremes.

12. WFME Standard2.6 CURRICULUM STRUCTURE,COMPOSITION AND DURATION • Quality development: • Basic sciences and clinical sciences should be integrated in the curriculum. • Integration of disciplines would include both horizontal (concurrent) and vertical (sequential) integration of curricularcomponents.

13. Awareness Isolation Harmonization Nesting Sharing Temporal coordination Correlation Complementary Interdisciplinary Trans-disciplinary Multidisciplinary TheIntegrationLadder HARDEN 1999

14. TheIntegrationLadder • In the first four steps on the ladder, the emphasis is on the subjects or disciplines. • Moving up the ladder, the following six steps emphasize integration across several disciplines. • In the final step, the student takes more responsibility for the integration and is given the tools to do so.

15. curriculum Vision Mission, Goals, and Objectives Program Resources Management Students Teachers

16. 1-Integration in curriculum

17. 1-Integration in curriculum Integration through objectives

18. Integration through objectives Community needs assessment Role definition Task analysis Clinical Obj. Clinical educational needs assessment Basic Obj. Basic educational needs assessment

19. 1-Integration in curriculum Integration through Content -Content Orgonisation

20. Integration through Content - ContentOrgonisation • A. Integration through correlation of subjects • B. Integration through common issues

21. Integration through Content- Content Orgonisation A-Integration through correlation of subjects

22. Intra-courseintegration • Within each subject area, course content is connected topic to topic, concept to concept, and relates ideas explicitly.

23. Synchronized (Sequenced) Integration An Asynchronized Curriculum Anatomy Histology Embryology Physiology    1 2 3 4    Time 1 2 3 4  1 2 3 4 1 2 3 4 1 2 3 4  1 2 3 4 1 2 3 4 1 2 3 4 Kidney Heart NervousSystem Lung

24. Synchronized (Sequenced) Integration A Synchronized Curriculum Anatomy Histology Embryology Physiology         Time 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 Kidney Heart NervousSystem Lung

25. Horizontal integration • Integration of the basic sciences for example: • an organ system approach or • Integration of the clinical sciences for example: • interdisciplinary clerkships

26. Heart Lung Kidney Nervous System   1 2 3 4 1 2 3 4   1 2 3 4 1 2 3 4   1 2 3 4 1 2 3 4   1 2 3 4 1 2 3 4 HorizontalIntegration In BasicScience  Anatomy  Histology Organ System Approach  Embryology  Physiology

27. Medical schools in north America which have pre-clinical curricula and organized by organ system units. • Wright State • Oregon • Cornell • Sherbrooke • Toronto • Ottawa • Calgary • Northwestern • SIUSOM • University of Pennsylvania • University of Maryland, • Mayo Clinic, • Ohio (Toledo), • Texas (Galveston), • Connecticut, • Case Western, • University of Southern California

28. Vertical integration • Vertical integration refers to the interweaving of clinical skills and knowledge into the basic science years and, in turn, reinforcing and continuing to teach basic science concepts as they apply during the clinical years.

29. Vertical integration • Vertical integration through distribution of courses • Vertical integration through diffusion of content • Displacement and merging • Early exposure

30. Conventionalcurriculum Basic Science Clinical Science

31. Vertical distribution of courses

32. Anatomy Histology Embryology Physiology     Heart 1 2 3 4 1 2 3 4 Lung 1 2 3 4 1 2 3 4 Kidney displacementandmerging Nervous System         1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 Physiologyand Internal Medicine AnatomyandSurgery vertical integration of basic and clinical science

33. Early Exposure • A vast majority of schools expose students to real patients in clinical settings in the first two years, the courses having such names as • doctoring skills • clinical applications of basic science • patient-doctor • physician and society • clinical skills

34. Early Exposure • A vast majority of schools expose students to real patients in clinical settings in the first two years, the courses having such names as • doctoring skills • clinical applications of basic science • patient-doctor • physician and society • clinical skills

35. Integration through Content- Content Orgonisation B-Integration through common issues

36. Shared integration • Shared planning and teaching take place in two disciplines in which overlapping concepts or ideas emerge as organizing elements.

37. Nested integration • Within each subject, the teacher targets multiple items: • a social skill • a thinking skill • a content-specific item Diarrhea Diagnostic reasoning Cultural poverty

38. Threaded model of curriculum integration Skill Skill Curricular Area Curricular Area Curricular Area • Thinking skills, social skills, study skills, and/or the Essential Skills “thread” through all learning. This model of curriculum integration focuses on a meta-curriculum that overlays subject content matter.

39.  NetworkedIntegration • Learner filters all learning through the expert's eye and makes internal connections that lead by external networks of experts in related fields.   

40. Webbed integration • A fertile theme is webbed to curriculum contents and disciplines; subjects use the theme to sift out appropriate concepts, topics, and ideas. Case Problem Theme • Problembasedlearning • Casebasedlearning

41. Immersed model of curriculum integration Inquiry Exploration Issues Knowledge Skills Problems Concerns Investigation

42. 1-Integration in curriculum Integration through methods

43. Integration through method • Every method for integrated content specially PBL method

44. 1-Integration in curriculum Integration through Student assessments

45. conventional model of evaluation :an exam after each course                              

46. Vertical integration in assessment or asingleexamatthe endofbasicscience courses  

47. Vertical integration in assessment verticalintegration bydelayingbasic scienceexam  

48. Vertical integration in assessment untilclinicalcourses alreadybegan  

49. 2-Integration through faculty interactions

50. 4-Integration through faculty interactions • BasicsciencecontentisthoughtbyaPhDteacherinuniversityclassroom   • ClinicalsciencecontentisthoughtbyaMDteacherinhospital