Integrated teaching--our experience.S Joglekar, PS Bhuiyan, S Kishore
Dept of Physiology, Seth GS Medical College, Parel, Bombay, Maharashtra.
Keywords: Curriculum, Education, Medical, Human, India, Teaching, methods,
"Knowledge Learnt in Isolation is Rapidly Forgotten"
Here comes the importance of integration. The dictionary meaning is “to make entire". Integration is defined as organization of teaching matter to interrelate or unify subjects frequently taught in separate academic courses or departments.
Our own nervous system gives us a good example of integration and its effectiveness. There are approximately ten million afferent (input or sensory) neurons, fifty billions integrating neurons and only half million efferent (output or motor) neurons. This provides a ratio of about 20:1 between the aggregate input and output channels. Thus by integration vast amount of information can be presented to the students in a concise and comprehensive manner. Of course, a lot of effort is required to process and organise the information.
This is only possible if departmental (both intradepartmental and inter-departmental) barriers are completely broken down and the curriculum is revamped.
The present system of education follows a building block principle. In this, each subject has its own block of time, usually restricted to one part of the course [Figure - 1].
The early curriculum are expected to lay foundation for the other subjects which follow. It is left to the students to solve the jigsaw puzzle. Let us see an example. It you give the students individual ingredients of a cake - flour, egg and sugar to eat, even if you force them to swallow it, will they be able to digest it? On the other hand, it you mix the ingredients, blend it well and bake it - the students would love to eat it and definitely will have no problem to digest it.
Flaws with the present system are:
1. unnecessary repetition; 2. disjointed approach to teaching; 3. confusion in student's mind due to difference in opinion which in turn leads to 4. disunity and hence the subject as a whole is never grasped. This discourages students from learning and they get disinterested in applying the knowledge achieved into practice.
Integration aims at giving the students a holistic instead of a fragmented outlook on his studies. Thus the topics can be presented in a more meaningful way. This overcomes the separation in the students mind between form and function of the system concerned, its diseases, their diagnosis, therapy and social and preventive aspects.
Integration can be done in the following ways:
Horizontal integration: means two or more departments teaching concurrently merge their educational identities. Vertical integration: is an integration between disciplines traditionally taught in the different phases of curriculum [Figure - 2].
In practice, integrated courses often have elements of both horizontal and vertical integration. The concerned departments come together and the content of the curriculum is presented by the staff members acting under the control of “topic committees”. These committees devise the programme to which teachers from individual departments concerned contribute as directed.
A programme prepared jointly by a group of persons will be less liable to error than one prepared by a single person.
Systematic integration: Students study in sequence the system of the body as they are presented by the committees. Every aspect of each system is treated in its entirety before the next system is considered.
1. Reduces fragmentation of medical courses:
2. Prevents repetition and waste of time;
3. Students learn to apply their knowledge to clinical practice;
4. Promotes interdepartmental collaboration; and
5. Rationalization of teaching resources.
However there are difficulties encountered too viz.
1. lack of cooperation;
2. additional staff work in organising the course;
3. the more the links in the chain of communication the more likely it is that one will break and
4. it is useless to provide integrated course if the examination pattern is not integrated.
During May ‘94 vacation, Medical Education Technology cell carried out integrated Neuroanatomy and Neuro-physiology classes (horizontal integration). Central nervous system was selected, as this is the most dreaded system for the students. Attendance was on voluntary basis. All the major topics were covered in eight sessions of 2 ˝ hours duration each.
Each topic was discussed with respect to structure, function and its clinical correlation followed by practical demonstration. Feedback was obtained on the last day in the form of a questionnaire.
The opinions of 99% students were as follows:
1. This approach improved their understanding;
2. removed CNS phobia and
3. developed interest in the topic.
The students also suggested other areas where integration would help them.
Following the vacation, the second terminal examination was held as usual. To get an idea on students performance, comparison was made in marks (CNS component only) of the students who attended the sessions and those who did not.
Of the 178 students, 79 had attended the integrated classes while 99 did not. The questions based on CNS in anatomy and physiology carried 20 and 28 marks respectively. [Table - 1] shows the marks obtained by the students.
After analysing the data statistically (X2 test) it was observed that the marks obtained in the two subjects by the students who had undergone integrated teaching was significantly greater than those who did not (?2 value = 99.44, df = 3, p < 0.001)
Thus we emphasize from our own experience that considering the volume load to which the students are subjected to, integrated teaching would definitely save their time, energy and give them better insight into the subject. It would also benefit the teachers to broaden their horizon.
We would like to thank our Dean, Dr. P M Pai for always encouraging us and also Dr. Kendurkar and Dr. Lopa Mehta, departmental heads of Physiology and Anatomy respectively for their support.
[Figure - 1], [Figure - 2][Table - 1]