Integrated Teaching of Health Professional Education

 

Mr. Muniyandi. S

Associate Professor & HOD, Kasturba Nursing College, Sevagram, Wardha 442102

 

ABSTRACT:

Integration of curriculum is meant to make the teaching/learning activities meaningful; however, the interpretation of ‘integration’ varies in different institutions and among individuals. Integrated curriculum is also referred to as interdisciplinary teaching, thematic teaching and synergistic teaching. An integrated medical curriculum helps graduates to put together the learned facts so as to get the whole picture and adopt a holistic approach while treating a patient or planning a health care strategy¹. Many Health care institutions find it hard to change their existing curriculum or develop a new integrated curriculum mainly because of lack of will, infrastructure and understanding the process of change. Main aim of integration is relating to staff development, establishing working groups, organizing the teaching/learning materials under themes and developing some innovative teaching/learning and assessment strategies, are the techniques that a teaching institution can use to change the existing curriculum to an integrated one or develop a new curriculum¹. So Knowing about the different levels of integration and steps for developing an integrated curriculum can make it easier to integrate an existing curriculum or develop a new one².

 

 

INTRODUCTION:

Health professional educationists all over the world recognize that integration in Health professional education is one of the major educational reforms required. The world Summit on Health professional Education (1993) identified “the disjunction between Health professional and their practice as one of the major problems”¹.

 

Integration promotes, Deep learning, Meaningful learning, Recall of knowledge, Retention of knowledge, Application of knowledge, Interdisciplinary working. “To make entire”.

 

 

 

 

Integration has been accepted as an important educational strategy in medical education Integration is defined as “Organization of teaching matter to unify subjects which are often taught in separate academic courses or departments².” -Harden et al 1986

 

 

Figure: 1 Makes a whole

Piece-meal learning: e.g. Tuberculosis

 

Figure: 2 Piece-meal learning

 

Makes a whole:

Purpose of integration:

To increase the effectiveness of the learning process Because it creates links between segregated pieces of learning. You know that adults learn by linking their previous / other knowledge to the present learning and integration just enhance that process.

 

Directions of integration:

·         Horizontal: Two or more disciplines of any phase of curriculum (pre-clinical, para-clinical or clinical)

·         Vertical: Two or more disciplines of two or more phases of curriculum.

 

 

 

Examples:

·         Horizontal: Combined teaching-learning of renal structure and function by Anatomy and Physiology

·         Vertical: Combined teaching-learning of renal failure by pathology and medicine departments to final yr students

·         Spiral: Combined teaching-learning of renal failure by the departments of Physiology, Pathology, Medicine and surgery since first year

 

Levels of integrated teaching:

·         Isolation

·         Awareness

·         Harmonization

·         Nesting

·         Temporal co-ordination

·         Sharing

·         Correlation

·         Complementary

·         Multi-disciplinary

·         Inter-disciplinary

·         Trans-disciplinary

 

 

Figure 3 isolation to Authentic T-L In 11 steps

 

Levels of integrated teaching

 

Table 1: levels of integrated teaching

 

Table 02: Symbolic presentation of levels of integrated teaching

Level	Symbolic Presentation	Characteristics	Mode
Isolation   (fragmentation)		Teaching without consideration of other disciplines	Mainly Lectures
Awareness		Teacher in one discipline is made aware of what is covered in other disciplines in the curriculum	Sharing of schedule, hand outs
Harmonisation   (Connection)		Consult each other and communicate about their courses	Discussions Formal meetings (college council
Nesting   (Infusion )		Targets within a discipline-based course, skills related to other disciplines	e.g. Clinical importance
Temporal coordination Parallel teaching		Related topics in various disciplines are scheduled at the same time	Time table is adjusted
Sharing   (Joint teaching)		Two disciplines (complimentary) plan and jointly implement a teaching programme	Symposium
Correlation   (Democratic Programme)		A small integrated teaching session or course in an otherwise discipline-based teaching, with no other changes in curriculum	Discussion, Written assignment by students
Complementary Programme   (Mixed programme)		Both Integrated teaching  and discipline-based teaching with curricular changes, including assessment	All methods of teaching and learning
Levels	Symbolic presentation	Characteristic	Mode
Multi-disciplinary   (contributory)		·          Brings together large number of subject areas with problems, topics or issues as the focus. Disciplines still preserve identity	Problem/ theme based modules
Inter-disciplinary   (monolithic)		·          Use of two or more academic disciplines simultaneously ·          Disciplines are not identified as such in the timetable.	Contents of subjects combined into a new course with a new menu
Trans-disciplinary   (fusion)		·          The disciplines loose their identity completely and become part of the real world of patient care ·	Problem based curriculum

 

Trans-disciplinary approach:

A set of more than 100 clinical problems or tasks provides the framework for integrating their experiences.

 

Students look at each of the tasks from the perspective of the different attachments.

 

e.g. Abdominal pain: Students have an acute surgical perspective in their surgical posting, and different perspectives in the medical posting, in the OBGY posting and in their community posting in general practice.

 

A printed or electronic study guide is a key element in helping the student with the challenge of integrating these different experiences.

 

Why Harden’s ladder is a useful tool?

·       When Teachers agree on the value of integration, but differ on optimum balance between integrated and subject-based teaching.

·       By setting out the menu of choices, encourages teachers to explore the integration options available and to discuss the extent or form of integration most appropriate for a particular common theme³.

 

Methods of Integrated teaching we are using now:

1.     Early clinical exposure

2.     Revisiting basic sciences in clinical years

3.     Case-based learning (CBL)

4.     Interactive symposium

 

Problem- based learning?

Advantages³

·       Takes patient as a whole and not compartmentalized into disciplines

·       Avoid unnecessary repetition and waste of time. Rationalization of learning resources

·       Clinical acumen is sharpened due to merging of multiple concepts

·       Promotes interdepartmental collaboration and team work

·       Brings neglected areas in the learning loop- EBM, student research, team work

·       Practical way to use unconventional T-L methods- IT platforms

 

Problems of Integrated teaching:

·       Trained facilitators are difficult to find

·       Time consuming and resource intensive (Extra burden on faculty, resources and teaching schedule)

·       How to assess the learning?

·       Lack of adequate weightage in assessment makes it irrelevant from students’ point of view.

·       Too many modules may result in complex schedules that few may able to keep up with.

·       There is integration of theme, on the cost of fragmented learning of subjects and fragmentation of assessment⁴.

 

Types of Integrated Learning Modules:

1.       Topic based modules: UTI, DM, Tuberculosis, Hypertension,

2.       Problem based modules: acute abdomen, headache, shock,

3.       Task based modules: first aid, cardiopulmonary resuscitation, postoperative care

 

Integrated Learning Module:

·         Theme

·         List of participating departments

·         Learning objectives

·         Teaching-learning methods

·         Time – table

·         List of learning resources

·         Evaluation plan

 

Steps of integrated learning Module Development⁴:

1.     Choose the topic, problem or task (from ‘must know’ area).

2.     Core group formation- subject experts from basic and clinical areas, educationist, administrator

3.     Develop goal and learning objectives- according to the target student group

4.     Choose appropriate and feasible T-L methods

5.      Plan assessment methods

6.     Identify learning resources and T-L media

7.     Plan time table and decide time frame

8.     Trial implementation/ mock drill

9.     Develop resources, train faculty if needed

10. Implement the module

11. 360 degree Feedback

12. Evaluate the program for improvement in next cycle

 

2. Education- service approach: CMC Vellore

·       Gap analysis- nurse educators were no longer involved directly in the patient care.

·       Not responsible for the quality of patient care setting used for student learning.

·       Vice versa the practicing nurses had very little opportunity to share their practical knowledge with students 

·       Is this gap producing less learning?

·       Nurse educators are given dual responsibility: as faculty in the College and nurse managers in the wards

·       The faculty is accountable for student education to the Dean College of nursing and for patient care to the Nursing superintendent⁵

 

CONCLUSION:

Integrated teaching should be tried as an important strategy to fill the gap between learning of basic and clinical sciences; integrated teaching should be tried as an important strategy to fill the gap between learning of basic and clinical sciences; however is a complex concept and needs slow development.

 

REFERENCES:

1.      The integration ladder: a tool for curriculum planning and evaluation Professor Ronald M Harden, Centre for Medical Education, Tay Park House, 484 Perth Road, Dundee DD2 1LR, UK Ó Blackwell Science Ltd MEDICAL EDUCATION 2000;34:551±557

2.      Twelve tipstwelve tips for developing an integrated curriculum alam sher malik & rukhsana hussain malik universiti teknologi mara, Malaysia 2011; 33: 99–104

3.      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608281

4.      insights.sagepub.com/integrated-medical-curriculum-advantages-and-disadvantages-ar

5.      www.ijpsr.info/docs/IJPSR-10-01-01-04.pdf

 

 

Received on 05.04.2019          Modified on 14.05.2019

Accepted on 24.06.2019     © A&V Publications all right reserved