INTEGRATION

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REFERENCES

INTEGRATION: There is a fusion of knowledge from different subjects. This

interconnectedness and interrelationship among the subjects are usually linked around
organ-systems of the human body".. (or themes of clinical presentation).

CONCLUSIONS OF ATWA HS, GOUDA EM (2014):

1. Integrating a curriculum is a complex process (Consisting of many interconnecting
parts or elements)
2. Differentially understood by students and faculty involved in:
a. Developing curriculum
b. Teaching
c. Administration
3. Refer to integration related to
a. Instructional method
b. Content
c. Synthesis of knowledge
4. It can occur at different rates.
5. Some subjects are integrated more easily than others.
6. An integrated curriculum holds much promise for raising students, who can apply
their medical school-acquired knowledge to their work and personal development.

APPROACHES TO INTEGRATION
1. The integration may occur within a single subject or across the subjects.
2. The integration may occur across the subject
a. across subjects of the same academic year (horizontal integration)
b. across subjects of the different academic years (vertical integration)
3. The integration may be done by
a. placing topics in the timetable appropriately.
b. Using methods of teaching that promote integration. PBL, CBL, TML
c. Introducing short-duration courses that promote integration, E.g., PTC,
BLS, etc.

METHODOLOGIES OF INTEGRATION
The two most common continuums of methodologies for integration are:
1. Fogarty methodologies for integration consist of ten levels, grouped under three
forms:
a. Form One: Within a Single Discipline
b. Form Two: Across the Disciplines
Curriculum And Evaluation

c. Form Three: Within and Across Learners

2. Harden's methodologies for integration consist of 11 Steps

HARDEN – LEVELS OF INTEGRATION

Harden, in his paper "Harden RM (2000) The integration ladder: a tool for curriculum
planning and evaluation. Med Educ 34: 551-557," writes about his levels of integration

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1. LEVEL 1, ISOLATION
a. Teaching is subject-based, with each subject remaining responsible for its
teaching programme.
b. Each department looks from the perspective of its subject only.
C. Teacher & Students attend a lecture on anatomy and then move on to a lecture
in physiology, with neither lecturer aware of what was covered in the other
lecture.

2. LEVEL 2, AWARENESS
a. Teaching is subject-based, with each subject remaining responsible for its
teaching programme.
b. Each department looks from the perspective of its subject only. However, the
teacher in one subject is made aware of what is covered in other subjects
in the curriculum through appropriate documentation, avoiding unnecessary
duplication where appropriate.

3. LEVEL 3, HARMONIZATION
a. Teaching is subject-based, with each subject remaining responsible for its
teaching programme.
b. However, Teachers of different subjects consult each other face to face.
c. The consultation process between teachers takes place through the;
i. Informal discussions
ii. Formal meetings.
d. The process of consultation is overseen by staff with the responsibility for the
overall curriculum

4. LEVEL 4, NESTING
a. Teaching is subject-based, with each subject remaining responsible for its
teaching programme. Teachers of different subjects consult each other and
communicate.
b. The teacher teaches, within its subject, the content relating to other
subjects.

5. LEVEL 5, TEMPORAL COORDINATION

a. Teaching is subject-based, with each subject remaining responsible for its
teaching programme.
b. However, the timing of teaching topics within a subject is done in consultation
with other disciplines. Therefore, the timetable is adjusted so that topics
within the subjects or disciplines that are related are scheduled at the same
time.

6. LEVEL 6, SHARING
Curriculum And Evaluation

a. Two disciplines plan and jointly implement a teaching programme. The

shared planning and teaching occur in two disciplines where overlapping
concepts or ideas emerge as organizing elements.
b. Unlike temporal co-ordination which may be a step towards a more fully
integrated overall programme, shared programs are often seen as ends in
themselves

7. LEVEL 7, CORRELATION
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a. Teaching is subject-based.
b. Each subject remains responsible for its teaching program
c. Within this framework, an integrated teaching session or course is
introduced in addition to subject-based teaching. This session brings
together areas of interest common to each of the subjects. Examples include the
Integrated Clinicopathological conference, PBL, etc.

8. LEVEL 8, COMPLEMENTARY
a. Teaching is subject-based & integrated.
b. The integrated sessions now represent a major feature of the curriculum.
c. The focus for the teaching may be a theme or topic to which the disciplines can
contribute
d. Examinations need to re lect the emphasis on both integration and subjects or
disciplines.

9. LEVEL 9, 10 & 11
a. The subject boundaries are lost, and subjects do not remain responsible
for teaching their subjects.
b. Level 9, Multi-disciplinary: brings together a number of subjects in a single
course with themes
c. Level 10, Inter-disciplinary: there is a further shift of emphasis to themes as a
learning focus.
d. Level 11, Trans-disciplinary: the boundary of subjects does not exist.

EXAMPLES OF TIMETABLES
1. Time Table Level 1 To 4
8am-9am 9am- 10am-11am 11am 11:30am 1pm-2pm
10am - -1:00pm
11:30

Histology Lab Physiology Biochemistry Anatomy Physiology

MON Cell Cardiac Functions of Upper limb Practical
cycle proteins
BREAK

Bio- Biochemistry
Anatomy Physiology
Anatomy Practical
TUES Classi ication of chemistry Heart and
Carbohy- circulation Upper limb Preparation of
joints
drates solution
Curriculum And Evaluation

Physiology
Physiology
Blood pressure Anatomy Biochemistry Anatomy
WED Cell Practical
and its Proteins Upper limb
division RBC count
regulation

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Level 5 Temporal Coordination

Days/ 8am-9am 9am- 10-11 am 11am- 11:30am- 1pm-2pm
Time 10am 11:30 1:00pm

Biochemistry Anatomy Physiology

Monday

Anatomy Physiology
Functions Biochemical Dissection Practical
Cell
of cell composition Hall Upper Use of the
membrane
membrane of the cell limb microscope

Bio-
chemistry Physiology Anatomy Biochemistry
Active Dissection Practical

BREAK
Tuesday

Anatomy Cell
membranes transport Hall Different Introduction
Cell
and their across Muscles of to laboratory
Organelles
chemical the cell the upper technique
composition membrane limb

Physiology Anatomy
Wednesday

Passive Anatomy Dissection Histology

transport Cell Biochemistry
Hall Bones Lab Cell
across cell Nucleus ATP
of upper as a whole
membrane limb

Level – 7, Correlation
Days/ 8am- 9am 9am- 10am 10am-11am 11am- 11:30am- 1pm-2pm
Time 11:30 1:00pm

Physiology
Anatomy Physiology Biochemistry
Monday

PBL Practical
Cell Functions Biochemical SESSION 1 Use of the
membrane of cell composition (Cell Factory) microscope
membrane of the cell
BREAK

Anatomy Bio-
Biochemistry Dissection chemistry
Physiology
Curriculum And Evaluation

Anatomy Cell
Tuesday

Active Hall Practical

Cell membranes
transport Different Introduction
membrane and their
across cell Muscles of to
chemical upper limb laboratory
membrane
composition technique

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Physiology
Wednesday

PBL Histology
Passive Anatomy Biochemistry BREAK SESSION 2
transport Lab Cell
Cell Nucleus ATP (Cell Factory) as a whole
across cell
membrane

Level – 9, Complimentary. (Theme palpitation)

Days/Time 8am-10am 10am-11am 11am- 11:30am- 1pm-2pm
11:30 1:00pm
MON CBL Physiology PBL CPC
Granny having Tutorial SESSION 1 Angina
palpitation -I Blood low (Irfan's
congestive
BREAK heart)

TEUS CBL CBL Anatomy Integrated

Granny having Biochemistry Dissection Exam
palpitation -II Obese patient Hall
Pericardium

WED CBL Anatomy PBL

Granny having Heart Blood SESSION 2
palpitation -III supply (Irfan's
congestive
heart)

HARDENS' CONCLUSION
"………The `integration ladder' is a useful tool for the medical teacher or educator and
can help in a number of situations. Teachers may agree about the value of integration,
but may differ in their views as to the optimum balance between integrated and
subject-based teaching. The demonstration of the range of options helps to avoid a
polarization in the debate. The `integration ladder,' by setting out the menu of choices,
encourages teachers to explore the options available and discuss the extent or form of
integration most appropriate in the curriculum. Such informed decision making is
preferable to a debate, usually sterile, about whether the curriculum should be
integrated or not…..."
"………. The most appropriate step on the integration ladder for a school will depend on
many factors, including the existing curriculum, the experience and views of the
Curriculum And Evaluation

teachers, the organizational structure of the medical school (resources), and the
overall aims of the curriculum. The move from a traditional subject-based to an
integrated curriculum may involve major changes. Alternatively, one can start with
something small and manageable such as a few integrated themes using a correlated
teaching approach…..."
‘………In addition to its use in curriculum planning, the integration ladder may also be
used as a tool to assist curriculum evaluation and to evaluate the level of integration in a
curriculum."
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