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  1. Integration in Medical Education AMAL AL-OTAIBI CP, MME

  2. OBJECTIVES • Define “curriculum”, • Identify different types of curricula, • Identify the content structures of a curriculum, • List different educational strategies. • Define integration. • Identify types of integration • Identify rationale for integrated learning • Identify the advantages & disadvantages.

  3. What is a curriculum??

  4. 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).

  5. 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

  6. 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 give • Teachers a basis of planning for lessons and assessing students • Administrators a basis for supervising teachers and holding them accountable for their practices and results.

  7. 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.

  8. 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.

  9. 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).

  10. 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

  11. 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 practice • Doing the thing right • The doctor as a professional • The right person is doing it

  12. 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

  13. Basic curricular structures • The discrete curriculum, • The linear curriculum, • The pyramidal structure, AND • The spiral curriculum.

  14. Basic curricular structures • The discrete curriculum • The self-sufficient programs: unrelated or independent contents A B C D

  15. 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 B C D

  16. The pyramidal structure • Multiple unrelated concepts or skills for learning subsequent concepts or skills. A B C D E F G

  17. 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.

  18. 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

  19. 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

  20. Hospital-based SPICES Model of Educational Strategies • Teacher centered • Student centered • “What the student learn rather than what is taught" • 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

  21. Hospital-based SPICES Model of Educational Strategies • Elective-driven • According to student needs • learning & teaching adjusted to the needs of students • Uniform • Systematic • Opportunistic

  22. Think, Pair & Share: What is Integration??

  23. 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

  24. 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.

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

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

  27. Old Curriculum • Basic Sciences: • Anatomy • Physiology • Pathology/Immunology/Microbiology…. • Biochemistry • Pharmacology • Clinical: • Medicine, surgery, Ob/Gyn, Peadiatrics, • ENT/Oph….

  28. Learn like doctor & think like doctor …because human beings are complex organisms whose discrete systems are linked intricately and elaborately within the body and modified profoundly by external influences, we need to teach in ways that reflect this complexity and that stimulate students to synthesize information across disciplines. Dienctag

  29. Learn like doctor & think like doctor A sick patient does not represent a biochemistry problem, an anatomy problem, a genetics problem, or an immunology problem; rather, each person is the product of myriad molecular, cellular, genetic, environmental, and social influences that interact in complex ways to determine health and disease. Dienctag

  30. What is Integration??

  31. 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

  32. Integration: a definition “ The organization of teaching of matter to interrelate or unify subjects frequently taught in separate academic courses or departments” Harden

  33. Curriculum Integration

  34. 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.

  35. Think, Pair & Share: Advantages& Disadvantages??

  36. Advantages 1. Matching curriculum aims. 2. Achieving higher level of objectives. 3. Avoiding information overload. 4. Making learning interesting & effectives 5. Motivating students.

  37. Disadvantages 1. Loosing subject identity. 2. Requiring interdepartmental planning. 3. Resources shortage.

  38. Types of Integration Clinical Basic Science Vertical integration Horizontal Integration

  39. Summary

  40. 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.

  41. I wish you a very successful and enjoyable time in your course All the best