Integration in

Medical Education

AMAL AL-OTAIBICP, MME

OBJECTIVESDefine “curriculum”,Identify different types of curricula,Identify the content structures of a

curriculum, List different educational strategies.Define integration.Identify types of integrationIdentify rationale for integrated learningIdentify the advantages & disadvantages.

What is a curriculum?

?

What is a curriculum? •The curriculum is the content or objectives

for which school hold students accountable.•The curriculum is the set of instructional

strategies teachers plan to use.

•These conceptual differences are based on distinction between a curriculum as expected end of education (Intended learning outcomes), and a curriculum as the expected means of education (Instructional plans).

What is a curriculum?•A curriculum is about what should happen

in a teaching program – about the intension of the teachers and about the way they make this happen.

•The curriculum in fact is What the student learns How the student learns (strategy/s &

Learning/teaching tools) How the student assessed The learning environment Learning outcomes

Types of Curriculum:

1- The official curriculum: (The written curriculum):

“It is documented according to a common theme and to successive grade levels with curriculum guide, course outlines, and list of objectives.”

The purpose is to giveTeachers a basis of planning for lessons and

assessing studentsAdministrators a basis for supervising teachers

and holding them accountable for their practices and results.

2-The Operational Curriculum•What is actually taught by the teachers

and how it is communicated.

•This includes what the teacher teaches in the class and the learning outcome for the students.

3- Hidden Curriculum•Includes the norms and values of the

surrounding society.•It is not part of the either the official or

operational curricula.•It has a deeper and durable impact on

students.

4- The Null Curriculum

•Subject matters that is not taught at all although they appear to be important.

•E.g. Student’s Psychology, Parenting (how to teach and care for student).

5- Extra Curriculum

•All planned experiences outside the school subject.

•It contrasts with the official curriculum by its responsiveness to students.

•E.g. Sports, social programs, competition programs

Different curricular models•Outcome-Based Education- What

sort of doctor is needed? What the doctor able to do

Doing the right thing How the doctor approaches his

practiceDoing the thing right

The doctor as a professionalThe right person is doing it

Different curricular models•Problem-Based Learning•Task-Based Learning

▫A range of tasks undertaken by a doctor are identified. E.g. Management of a patient with abdominal pain which is used as the focus for learning.

•An Integrated system-based approach.•Community-Based Education

Basic curricular structures

•The discrete curriculum,

•The linear curriculum,

•The pyramidal structure, AND

•The spiral curriculum.

Basic curricular structures

•The discrete curriculum The self-sufficient programs: unrelated or

independent contents

A DCB

The linear curriculum •Each concept or skill of the content

need the mastery of the previous concept or skill.

•Called Mastery Learning Strategies (Bloom,1871)

▫Linear Configuration

A DB C

The pyramidal structure •Multiple unrelated concepts or skills for

learning subsequent concepts or skills.A

CB

D E F G

The spiral curriculum •Organization of concepts and skills•There is interactive revisiting of topics

throughout the block•Topics are revisited at numerous levels of

difficulty•New learning is strongly related to

previous learning.•The competence of students increases

with each visit to a topic.

Educational strategies •Six educational strategies have been

identified in relation to curriculum in medical schools by Prof Harden.

•Each strategy can be represented as a spectrum or continuum:

Student-centered/teacher-centered Problem-based/information-gathering Integrated/discipline-based Community-based/hospital-based Elective/uniform Systematic/opportunistic

Educational strategies •Six educational strategies have been

identified in relation to curriculum in medical schools by Prof Harden.

•Each strategy can be represented as a spectrum or continuum:

Student-centered/teacher-centered Problem-based/information-gathering Integrated/discipline-based Community-based/hospital-based Elective/uniform Systematic/opportunistic

SPICES Model of Educational Strategies• Student centered

▫ “What the student learn rather than what is taught"• Teacher centered

• Problem-based

• Information-oriented

• Integrated or Inter-professional Integration throughout the

curriculum

• Subject or Discipline-based

• Community-based Less emphasis on hospital-

based programs

• Hospital-based

SPICES Model of Educational Strategies • Elective-driven

According to student needslearning & teaching adjusted to

the needs of students

• Uniform

• Systematic • Opportunistic

Think, Pair & Share:

What is Integration??

Abraham Flexner Recommendations: •Under Flexner’s influence, medical

curricula around the world came to be structured into:

•Preclinical medicine: learned in lecture theatres, teaching laboratories, dissecting rooms, and libraries

•Clinical medicine: learned in wards and operating theatres of university tertiary hospitals

•In the late twentieth century, national bodies began to respond to the wind of change to meet patients’ needs to be achieved through curriculum integration.

•Disciplines should integrate their contributions into a thematic, probably systems-based curriculum

•Integration was one of the key criteria for assessing the degree of innovation in a medical curriculum in the SPICES curriculum model (Harden, 1984).

Old CurriculumBasic Sciences:

• Anatomy• Physiology• Pathology/Immunology/Microbiology….• Biochemistry• Pharmacology

Clinical:• Medicine, surgery, Ob/Gyn, Peadiatrics,• ENT/Oph….

Learn like doctor & think like doctor

…because human beings are complexorganisms whose discrete systems arelinked intricately and elaborately withinthe body and modified profoundly byexternal influences, we need to teach inways that reflect this complexity and thatstimulate students to synthesize information across disciplines.

Dienctag

Learn like doctor & think like doctor

A sick patient does not represent a biochemistryproblem, an anatomy problem, a geneticsproblem, or an immunology problem; rather,each person is the product of myriad molecular,cellular, genetic, environmental, and socialinfluences that interact in complex ways to determine health and disease.

Dienctag

What is Integration??

Integration: a definition

“ The teaching of different subject areas in a thematic manner, so that the different disciplines are not emphasized”

Internal dictionary of Adult & CME

Integration: a definition

“ The organization of teaching of matter to interrelate or unify subjects frequently taught in separate academic courses or departments”

Harden

CurriculumIntegration

The rationale• Curriculum organization denotes a

systematic arrangement of curriculum elements,

• It will results in a more relevant, meaningful, and student centered curriculum,

• Integration makes the learning contexts close in which the information is to be retrieved.

Think, Pair & Share: Advantages& Disadvantages??

Advantages1. Matching curriculum aims.

2. Achieving higher level of objectives.

3. Avoiding information overload.4. Making learning interesting & effectives5. Motivating students.

Disadvantages

1. Loosing subject identity.

2. Requiring interdepartmental planning.

3. Resources shortage.

Clinical

Basic

Science

Horizontal Integration

Vertical integration

Types of Integration

Summary

Summary

Learning take place better if it is contextual.

Overcrowding information could be solved by integration.

Integration is the necessity & not the luxury.

This is the relatively new trend which has been applied in med education every where.

I wish you a very successful and enjoyable time in your course

All the best