Student's Perception About Integrated Teaching In An Undergraduate Medical CurriculumCorrespondence Address :
Kalpana Kumari M.K
Flat 710, C-Block, Sterling Residency, Dollars Colony,
Bangalore 560094, Karnataka, India
Email : Kalpank@Gmail.Com
The: objective of this study was to analyze the results of a survey on students regarding the integration of their institutionâs health science curriculum.
Methods: One hundred and twenty five (125) students of the 5th term of the undergraduate medical course were given a questionnaire on the integration sessions. The questionnaire with a five point Likert scale, with a minimum of one and a maximum of five rating, was administered in October 2009. The data from the questionnaire was compiled and analyzed by using the SPSS version 16.
Results: One hundred and twenty two students out of the one hundred and twenty five answered the questionnaire 122/125 (97.6%). The reliability of the scale was 0.50 (Cronbachs alpha -0.5). 91.8% students agreed that integrated teaching helped in the appreciation and application of the basic science knowledge to health and disease. 82% agreed that integrated teaching improved the performance in clinics and university examinations. The responses were equally distributed in favour of traditional teaching (36%) and integrated teaching (30.3%), while 33.6% responses were of indecisisive. 51.7% of the students preferred the horizontal to vertical integrated teaching. Many positive aspects were listed by the students, such as âintegrated teaching improves the understanding of the topicsâ and a few negative remarks such as âlengthyâ were mentioned. The students suggested mind mapping, concept maps and small group discussions to improve the interaction.
Conclusion: The students recognized that integrating the medical subjects was useful and of interest to them, and that they should be continued.
Integrated teaching, vertical integration, horizontal integrations
There is a famous saying that, âKnowledge that is learnt in isolation is rapidly forgottenâ. The dictionary meaning of integration is âto make entireâ. Integration is defined as the organization of teaching matter to interrelate or unify the subjects which are frequently taught in separate academic courses or departments(1).
The medical colleges in India have been following a traditional curriculum which was characterized by a discipline wise model âwith a high degree of compartmentalization into the subject of basic sciences and the para clinical and the clinical branchesâ. Several areas of redundancy, repetition and overlapping, along with the observation of a gap between the qualitative and quantitative advancement in medical education and achievements in the field of health care prompted the Medical Council of India to adopt a need based curriculum for undergraduate medical education in India. Regulation on undergraduate medical education, 1997â recommends a teaching approach which is characterized by maximal efforts to encourage integrated teaching between the traditional subject areas by using a problem based learning approach and to de-emphasize the compartmentalization of the disciplines, so as to achieve both the horizontal and vertical integration in the different phases(2).
Integrated teaching was introduced in the M.S.Ramaiah Medical College, Bangalore, in year 2004-2005. The aim of this study was to analyze the perception of the students. The students were queried regarding their attitudes towards integration, in order to expose the barriers to integration and to identify a potential new mechanism for facilitating the implementation of the integrated curricula.
Framing a time table- A curriculum committee was formed by the heads of the paraclinical departments, namely pathology, microbiology, forensic medicine and pharmacology. A series of meetings were held, wherein particular topics of interest as per the curriculum were selected, such as tuberculosis, rheumatic heart disease and myocardial infarction. The departmental heads then assigned the topic to their faculty for preparation. The staff who were assigned from various departments for a particular topic, had a meeting and formulated the learning objectives and various teaching learning methodologies to ensure an active participation from the students and also to improve their analytical and clinical reasoning skills. The teaching learning methods which were incorporated were case simulated interactive lectures. This approach which was employed was large group lectures with a patient problem which was accompanied by questions. This ensured an active participation from the students and improved their reasoning ability.
Student feedback âAfter the completion of the module, the feedback was collected on the last day by using a questionnaire. The questions were framed, keeping in mind the utility of the integration, the understanding, appreciation and the application of the para clinical knowledge to the health and disease questionnaire. It consistsed of a five point Likert scale and open ended questions about the positive and negative aspects and the studentâs suggestions to improve the integrated teaching. It was administered in October 2009.
Overall response rate was 97.6% (122/125). The Cronbachâs alpha was 0.50. SPSS II for windows was used for the analysis of the data results. The average student ratings across the items varied between 2.9 to 4.27. (Table/Fig 1) 54.1% (66/122) of the students agreed and 37.7% (45/122) students strongly agreed that it helps in the appreciation and application of the basic science knowledge to health and disease.
49/122 (40.2%) agreed and 50/122 (41.8%) agreed that it improves the performance in the clinics and the university examinations. The responses were equally distributed in favour of traditional teaching 43/122 (36%) and integrated teaching 37/122(30.3%), while 41/122(33.6%) responses were of indecision (Table/Fig 2). The students felt that the topics which were discussed during the integrated sessions were relevant and that the discussions were satisfactory. When asked about their opinion on whether there was adequate interaction between the students and the faculty during the integrated seminars, 77.9% (95/122) of the students agreed that there was an interraction.
The students felt that a positive aspect of integrated teaching was that it enhanced the studentâs understanding of the diseases and helped them to correlate the para clinical and the clinical subjects. (Table/Fig 3)
The negative aspects which were stated, were that the sessions were lengthy and time consuming and that this cut down the time for the self study.(Table/Fig 4)
The alternate methods of teaching which were suggested by the students included group discussions, seminars and concept maps for better learning. (Table/Fig 5)
The students suggested that integrated teaching should be conducted more often, by including more topics. The students were enthusiastic about the idea of extending the integrated teaching to all the important topics. (Table/Fig 6)
Medical education is changing rapidly, with more than half of the American schools being engaged in curricular reforms. Many of these modifications focus on implementing horizontal or vertical curricular integration. Horizontal integration blends either the related basic science disciplines in order to enhance the studentâs understanding of the body systems, or the related clinical science disciplines through interdisciplinary clerkships(3).
In the present study, integrated teaching was perceived to be useful by a majority of the students with regards to an improvement in the appreciation and application of basic science knowledge. A similar finding was noted by Vyas et al. (4) Our students felt that their exposure to a case based discussion improved their performance in the clinics and university exams. Other studies have documented this observation(4).
In general, the students used positive statements to respond to open ended questions which solicited their opinions and suggestions about integrated teaching. The studentâs suggestions on mind mapping and concept maps and that more integrated teaching classes to be the taken regularly, will be incorporated in the subsequent integrated teaching sessions. These findings were noted in a study by Musal etal(5).
For an integrated curriculum to succeed, these different perspectives from students as well as the faculty should be given a voice, asmedical schools envision, plan and embark upon a redesign of their undergraduate education curricula(6).
In a similar study which was done by Grkovic (7), the author has highlighted the efforts which were made to expose the medical students to the real research environment and the academic way of thinking, in order to create health professionals with an ongoing interest in medical research.
Vidic et al (8) have suggested that it is imperative for the success of the new curriculum, however, that certain criteria should be satisfied: To 1. Reorganize the basic science departments to determine the course ownership.2. Establish a reward system for the teaching faculty.3.Establish course objectives.
In a study which was done by Soudarssannae and Sahai (9) the integrated teaching of epidemiology and the incorporation of the presentation and discussion of the actual studies which were conducted in the local population with the involvement of the clinical departments, was a novel attempt in the lecture discussions of the subject. This method was well appreciated by their students.
Schmidt (10) reported that in his experience, integration was most successful when it occurred naturally as a part of the teaching and learning process, rather than that of the mandated course structure.
Kingsley et al (11) stated that curricular integration was one method for improving the teaching and learning of the complicated andinterrelated concepts, thus providing an opportunity to incorporate the research training and objectives into traditionally separate didactic courses.
This study showed that it was possible to adopt integrated teaching under a conventional curriculum in spite of all the challenges. Thus, we can emphasize that considering the volume load which the students are subjected to, integrated teaching can definitely save their time and energy, and give them better insight into the subject. Our collective experience convinced us that designing an integrated curriculum was well worth the considerable efforts which were involved and that it would support the integration of the content into the minds of the learners. Implementing a well integrated curriculum requires strong leadership and overcoming departmental barriers.
Our experiences showed that it was difficult to formulate modules for integrated teaching and that the process required a thorough planning by faculty who were committed, who were genuinely interested in conducting these sessions. The faculty should be successful in creating sufficient interest among the students, so as to ensure maximum student participation.
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