Table of Contents  
Year : 2016  |  Volume : 9  |  Issue : 4  |  Page : 484-488  

Introduction of an integrated interactive lecture in the early blocks of 1st year medical students: A pilot study

1 Department of Anatomy, MAHSA University, PJ, Selangor 46200, Malaysia
2 Department of Family Medicine, MAHSA University, PJ, Selangor 46200, Malaysia
3 Department of Physiology, MAHSA University, PJ, Selangor 46200, Malaysia

Date of Web Publication12-Jul-2016

Correspondence Address:
Anudeep Singh
Block B, Ehsan Ria Condo, Jalan 11/2, Section 11, PJ, Selangor 46200
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-2870.186062

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Background: In an integrated curriculum, topics are integrated at the system block level from semester 2 onward. However, in the basic biomedical block, opportunities to integrate also exist which is often overlooked. Aim: A study was conducted to determine the possibility and acceptability of a new pedagogical approach to aid integration of form and function along with the improvement of understanding. Materials and Design: The study was prospective and questionnaire-based, conducted in an upcoming medical college in Malaysia with 1st year medical students. Materials and Methods: An integrated lecture on the autonomic nervous system was planned for the 1st year medical students in their biomedical science block of the first semester by the lecturers from anatomy and physiology and interactive lecture for 1 h and 30 min was delivered. After the session, responses were taken on a structured questionnaire with 10 questions on the Likert scale and a test was conducted to check their understandability. SPSS version 19.1 was used to analyze the results and data were reported based on descriptive statistics and scores were compared by t-test. Results: About 84.2% of the students wanted more lectures of this kind whereas 15.8% disagreed. About 80% stated that proper integration increased their understandability, whereas 83% preferred this modality in comparison to didactic lectures. Conclusions: This pedagogical approach with careful planning can be extended to involve clinical departments thus reaching vertical integration. Including more such integrated interactive sessions will prove to be significant and an effective tool for teaching and learning.

Keywords: Autonomic nervous system, didactic lecturing and holistic learning, horizontal integration, integrated interactive lecture

How to cite this article:
Singh A, Min AK, Ghosh S. Introduction of an integrated interactive lecture in the early blocks of 1st year medical students: A pilot study. Med J DY Patil Univ 2016;9:484-8

How to cite this URL:
Singh A, Min AK, Ghosh S. Introduction of an integrated interactive lecture in the early blocks of 1st year medical students: A pilot study. Med J DY Patil Univ [serial online] 2016 [cited 2024 Feb 24];9:484-8. Available from:

  Introduction Top

Integration is the organization of teaching matter to interrelate or unify subjects frequently taught in separate academic courses or departments.[1] Integrated teaching involves the teaching of various subjects in a co-ordinate fashion so that the boundaries of the subjects are abolished and the teaching is made system wise rather than subject wise.[2]

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 strategy.[3] This makes learning process more methodical and planned. The integration ladder is a useful tool for the medical teacher and can be used as an aid in developing, implementing, and evaluating the medical curriculum.[4]

Integration can be done in two ways:

  1. Horizontal integration – Two or more departments teaching concurrently merge their educational identities.
  2. Vertical integration — An integration between disciplines traditionally taught in the different phases of the curriculum.[5]

A third way is called spiral integration — defined as a curriculum involving “learning both sciences (basic and clinical) across both time and subject matter.”[6]

Three areas have been suggested by Brauer and Ferguson [7] in need of improvement and clarification for successful integration: Ensuring synchronous presentation of material, avoiding the tendency to diminish the importance of the basic sciences, and using unified definitions.

Despite a century of evolution of the fund of knowledge in basic and clinical sciences as well as advancements in teaching strategies, traditional curriculum format still persists in many medical schools around the world, yet viewed as an inadequate system to prepare future physicians for the 21st century medicine.[8],[9] Even though many medical schools follow integrated curriculum, these programs described as “integrated teaching programs” are often, in practice, programs which are “temporally coordinated.”[10] In these “parallel” or “concurrent” teaching programs, the time table is adjusted so that the related topics within the disciplines are scheduled on the same day or week; but still remain part of a subject-based teaching and students are left to themselves to uncover the relationships.[3]

Most of the times, there are duplication, time consumption, and overlapping of topics taught in the entire course. These can sometimes act as lacunae in the qualitative and quantitative advancement in medical education and also in the achievements of health care system. The above deficiencies can be overcome by implementing integrated lecture approach to teaching.[4],[5]

The curriculum in our medical school is of an integrated type, where the preclinical subjects are taught in an integrated manner in the system block fashion. Teaching is temporally aligned and primarily occurs by didactic lectures with small group tutorials and practical sessions. Students are formally exposed to a topic by individual subject experts based on well-drafted learning outcomes but at different time periods in the schedule. However, if the same topic is taught by relevant disciplines in an integrated manner, a better reception by the students can be expected.

Autonomic nervous system (ANS) is one of the most confusing and misunderstood topics among the 1st year medical students. The structure and function of ANS are taught in the first block of the 1st year and is often done through didactic lectures taught separately. At the end of the block, it has been observed that the students fail to link the structure and function to eventually understand the role of ANS in the maintenance of health.

Hence, the present study was planned to introduce an integrated interactive lecture of anatomy and physiology and determine its acceptability among the students together with the improvement of their understandability of the topic. The aim of the study was to plan an intervention whereby the teaching of ANS will be done by lecturers from both the disciplines followed by a feedback from the students and a test to find out their understandability of the topic.

  Materials and Methods Top

The design of the study was prospective and questionnaire-based. An integrated interactive lecture on ANS was planned for the 1st year medical students in their biomedical science block of the first semester. The lecturers from anatomy and physiology planned the lecture based on the learning outcomes already drafted by senior subject experts while framing the curriculum. The lecture was prepared for a large group on a power point presentation and topics were arranged in a meaningful manner where a short day-to-day event was used to start the lecture by physiology lecturer. This invited interaction from the students that eventually led to the introduction of the topic, an overview of ANS, and its role in health and disease. Following this, the anatomy lecturer delivered the talk on the anatomical explanations of the origin and distribution of sympathetic and parasympathetic nerves and brief account of the sympathetic chain and formation of plexuses. After the anatomy talk, physiology lecturer talked about the function of ANS, neurotransmission, and its regulation by various agents and higher control of ANS, with interim interactive sessions calling for student participation in the large group class. The whole lecture was completed within 90 min. The lecture slides of the two lecturers were incorporated as one presentation, and both the lecturers were allotted about 35 min each with a 5 min break in between for the students to recapitulate. At the end of the class, an interactive question–answer session of about 15 min was conducted.

This was followed by student's perception which was assessed using a structured questionnaire with 10 items [Table 1]. The questionnaire items were related to the students' understanding of the content of the lecture, better integration of subjects, leading to motivation and the overall experience of the session. The responses were obtained with a 5-point Likert scale (each item was rated as 5 - strongly agree, 4 - agree, 3 - neither agree nor disagree, 2- disagree, and 1- strongly disagree). The questionnaire also had open-ended questions, calling for points of liking or not liking the session. The results were analyzed by SPSS version 19.1 (IBM). One hundred and thirty-three students' responses were primarily divided into two groups based on question 10 in the questionnaire. Students who want more integrated interactive lectures were kept in Group A and the students who did not want more integrated interactive lectures were kept in Group B. Questionnaire validity was checked by experts in medical education research of the institution.
Table 1: The student feedback questionnaire

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  Results Top

One hundred and seventy students attended the lecture and 133 students responded through the questionnaire. [Figure 1] shows the overall students' responses to questions 1-9 in the questionnaire. More than 90% students found the lecture to be interesting, understandable, and made them learn how to integrate the two subjects. A high percentage of students voted positively for all of the questions.
Figure 1: Overall percentage response by students to the questions 1-9 in the questionnaire

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To find out the reason for students not liking the modality, we divided the responses to question 10 in the questionnaire into two groups. Group A consisted of students who want more integrated interactive lectures while the Group B consisted of students who did not want more integrated interactive lectures. [Figure 2] shows that 84.2% students were in Group A whereas 15.8% were in Group B. The students' responses to rest of the questions in the questionnaire were interpreted according to the quality of lecture (questions 1-3), better integration of topics/subjects and motivation (questions 4-6), and overall experience (questions 7-9).
Figure 2: Percentage distribution of student's response for question 10 in the questionnaire regarding integrated lectures (ILEC)

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[Figure 3] shows the percentage response of agreeable factors by the students of both Groups A and B to each of the questions 1-9 in the questionnaire. It shows that only 14.3% students in Group B prefer this modality over didactic teaching whereas only 28.6% found the slides in the lecture to be well integrated. Students in Group B are also skeptical that integration will help 38.1% and 42.9% felt agreeable to questions 7 and 9. The students in Group A are highly agreeable to all the factors.
Figure 3: Percentage distribution of factors agreed for ILEC by both groups

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Few of the following free comments were received from the students:

  1. It is easier to connect ideas and what we learn.
  2. I was able to relate structure to function. It was easier to comprehend the topic.
  3. It provided a holistic understanding of the topic.
  4. Switching of lecturers keeps the lecture interesting.
  5. Simple but comprehensive.
  6. Too much information in less time.
  7. There must be more organization between subtopics.

A test consisting questions on ANS was taken, and the results of the same were recorded. A comparison of grades achieved by students in 2014 (ILEC) as compared to 2013 (didactic lectures) is shown in [Figure 4]. Number of students in 2014 scoring pass marks was more than that of in 2013 whereas the number of failures decreased.
Figure 4: Grade comparison of performance in autonomic nervous system test between batches 2013 and 2014

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  Discussion Top

Integrated teaching aims at giving the undergraduate students a holistic outlook on their studies.[3],[4] For an efficient integrated teaching program, it is important to plan for the theme of topic, sequencing of topics, and contents of each topic. To accomplish this, teachers participating in the integrated teaching program have to organize, plan, discuss with interdepartmental members, and do a preassembly workup. These preassembly activities require time and dedication on the part of teachers and subject experts to achieve good results.[11]

This study shows that integrated lecture is possible even in the earlier blocks and is effective for better understanding of topic and improvement in learning by integration of subjects.[3],[11],[12] The overall impact of the session was positive as most of the students like the integrated interactive lecture. They were satisfied with the overall experience and prefer integrated lectures as compared to didactic lectures. Most of the students found the lecture to be interesting and easy to understand as has been suggested by other studies.[3],[4],[11],[12] Students also responded positively that the lecture made them learn how to integrate and felt motivated. The results of the test showed improvement in performance when compared with a similar test conducted in the year 2013. A decrease in the number of students scoring <50% is indicative of the fact that students were able to score. However, this pedagogical intervention needs to be conducted on a regular basis to prove its efficacy.

The current study also showed that few students did not want more of such integrated lectures. This is mostly attributed to the reason that they found the lecture slides were not well organized which led to their being skeptical. This can be looked up further by the lecturers and improving the learning objectives by better planning, discussions with involved department members, and more preassembly workup. A concern was also raised regarding the time that a lot of information is bombarded onto them in a short period of time. This, we believe, is due to the fact that it was the 1st time they were exposed to such an integrated approach. As we go along implementing more such sessions, the students will get into the habit of it and will be able to appreciate the benefits of integrated lectures. Overall, the response from the 1st year medical students was encouraging. Inclusion of more such integrated interactive sessions within the existing integrated curriculum from beginning of semester one, with the involvement of faculty and planning with other departments, will prove to be a significantly effective tool for learning. This pedagogical approach, with careful planning, can be extended to involve clinical departments, thus reaching vertical integration.


We are thankful to the head of the Department of Anatomy, the dean, faculty of medicine, and the management of MAHSA University.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Harden RM, Sowden S, Dunn WR. Some educational strategies in curriculum development: The SPICES model. ASME medical education booklet number 18. Med Educ 1984;18:284-97.  Back to cited text no. 1
Bapat SK. Modern trends in medical education: A critical appraisal. Kathmandu Univ Med J (KUMJ) 2009;7:330-3.  Back to cited text no. 2
Malik AS, Malik RH. Twelve tips for developing integrated curriculum. Med Teach 2011;33:99-104.  Back to cited text no. 3
Lohitashwa R, Narendra SS, Mufti M. Evaluation of impact of integrated teaching over didactic lecture on student learning. J Educ Res Med Teach 2014;2:14-6.  Back to cited text no. 4
Raman VL, Solomon Raju K. Study on effectiveness of integrated lecture module versus didactic lecture module in learning skills. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) 2015;14:14-6.  Back to cited text no. 5
Bandiera G, Boucher A, Neville A, Kuper A, Hodges B. Integration and timing of basic and clinical sciences education. Med Teach 2013;35:381-7.  Back to cited text no. 6
Brauer DG, Ferguson KJ. The integrated curriculum in medical education: AMEE guide no. 96. Med Teach 2015;37:312-22.  Back to cited text no. 7
Cooke M, Irby DM, Sullivan W, Ludmerer KM. American medical education 100 years after the Flexner report. N Engl J Med 2006;355:1339-44.  Back to cited text no. 8
Irby DM, Cooke M, O'Brien BC. Calls for reform of medical education by the Carnegie Foundation for the Advancement of Teaching: 1910 and 2010. Acad Med 2010; 85:220-7.  Back to cited text no. 9
Harden RM. The integration ladder: A tool for curriculum planning and evaluation. Med Educ 2000;34:551-7.  Back to cited text no. 10
Dandannavar VS. Effect of integrated teaching versus conventional lecturing on MBBS phase I students. Recent Res Sci Technol 2010;2:40-8.  Back to cited text no. 11
Spencer AL, Brosenitsch T, Levine AS, Kanter SL. Back to the basic sciences: An innovative approach to teaching senior medical students how best to integrate basic science and clinical medicine. Acad Med 2008;83:662-9.  Back to cited text no. 12


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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