|Year : 2015 | Volume
| Issue : 4 | Page : 438-440
Integrated teaching: An effective tool for active learning
Department of Physiology, Faculty of Medicine, MAHSA University, Kuala Lumpur, Malaysia
|Date of Web Publication||14-Jul-2015|
Department of Physiology, Faculty of Medicine, MAHSA University, Kuala Lumpur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ghosh S. Integrated teaching: An effective tool for active learning. Med J DY Patil Univ 2015;8:438-40
Traditionally medical curriculum involved teaching of various disciplines in basic and clinical sciences separately with emphasis on basic sciences in the initial years and clinical sciences in the later years. Furthermore, while teaching the basic sciences, the disciplines are taught individually. In the later part of the 20 th century, medical educators proposed a combination of disciplines and their teaching in an integrated fashion, with varying degrees of integration. Harden conceptualized a 11-step ladder of integration, ranging from individual discipline based to interdisciplinary and transdisciplinary designs.  Most universities around the world use integrated medical curriculum, where there is frank horizontal integration and also vertical integration. Horizontal integration is done within the disciplines in the preclinical basic sciences whereas, vertical integration is defined when there is the integration of disciplines from preclinical and clinical phases.
The Medical Council of India in their Vision 2015 document, published in 2011, proposed the introduction of a restructured curriculum and training program with emphasis on early clinical exposure, integration of basic and clinical sciences, clinical competence and skills, and new teaching learning methodologies to ensure production of a new generation of medical graduates of global standards.  However, even to this date, not many medical colleges in India have been able to adopt an integrated curriculum and undertake integrated lectures to ensure the proper understanding of topics by the students. The rationale for integrated learning is that an information obtained in isolation is not easily retrieved from memory unless it is learned in context. Janssen-Noordman et al. commented that complex tasks when learned in an integrated manner, the transfer of information learned is more easily done in a real life day-to-day situation.  Educational research has proven that students who learn in an integrated approach perform better in the end of year examinations as compared to their teaching-hospital based peers.  Few medical colleges in India have attempted to introduce integrated teaching, both at the horizontal and the vertical levels, through the introduction of early clinical exposure and problem-based learning (PBL)/case based learning (CBL). ,
The current paper entitled "Introducing integrated teaching and comparison with traditional teaching in undergraduate medical curriculum: A pilot study" has shown a very good example of an integrated lecture on Tuberculosis, which is usually taken by only the Department of Community Medicine under a traditional teaching program. The authors have used multiple methods of teaching learning activities and compared two groups of students undergoing traditional teaching and integrated teaching, respectively with regards to their pretest and posttest scores. The results are very enterprising and can help other medical educators in the country to redesign their teaching strategies. The paper also highlights the involvement of clinical (general medicine, chest medicine, and pediatric medicine) and paraclinical departments (microbiology, pharmacology, and community medicine) in teaching of tuberculosis to 3 rd year medical students. Majority of students rated the new method to be very good and the posttest scores showed considerable improvement. Even though the study has few limitations, it throws considerable light on the benefits of integrated lecture and its feasibility in the Indian medical education arena.
In this era of exponential growth of information, medical curriculum has been overloaded with information, hence we need to move away from the "discipline-based, fragmented" way of teaching the students and adopt the integrated curriculum and integrated teaching with sincere efforts. Basic sciences taught in the didactic manner as is mostly done, also creates disinterest in the students in the very 1 st year and they are unable to understand the importance of the basic concepts as is required in their clinical years. Hence, it is required to understand that the teaching should be made as meaningful as possible. Integration probably leads to better retention of knowledge and the ability to apply basic science principles in the appropriate clinical context because it take care of repetition of topics by individual departments and also helps the students to relate basic concepts with clinical cases at the same time in the same time frame. However, proponents of the traditional curriculum advocate that without an in depth knowledge of basic sciences students will not be able to understand clinical sciences properly. A properly designed integrated program should include integrating threads for clinical applications in each class of pre- and para-clinical subjects. The way to do this is to start the class with a common case of the disease in that particular system, and the teacher should talk about the basic concepts and relate them to the case.  A systematic approach with a PBL or CBL serves well for integrated teaching.
Integration entails coordination and cooperation among teachers of various disciplines to teach important core topics as a combined activity. The purpose of integration is to increase the effectiveness and efficiency of the teaching-learning process. More medical schools should start using integrated teaching strategies and make an effort toward developing active learning modules to shift "rote learning" to "meaningful learning", so that they are able to understand and apply the concepts in the later clinical years.
"Information in isolation is inert and unhelpful" - Regehr and Norman. 
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