introducing integrated learning program in nervous system for first year undergraduates : experience...
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INTRODUCING INTEGRATED LEARNING PROGRAM IN NERVOUS SYSTEM FOR FIRST
YEAR UNDERGRADUATES : EXPERIENCE FROM INDIAN MEDICAL SCHOOL
SARMISHTHA GHOSH, HIMANSHU PANDYA,SK SINGH, RAKSHA BHAT, N.HARIDAS,
HH AGRAVATPRAMUKHSWAMI MEDICAL COLLEGE
KARAMSAD, GUJARAT 388325
INTRODUCTION• Dividing medicine into disciplines is an artificial
construct• The real world of medical practice is transdisciplinary
in a large part.• Learning facts become easier when they are learnt in
a relevant and meaningful way • GPEP report, GMC[UK] recommendations stress the
need for greater integration of subjects in medical curriculum
• Medical Council of India recommends both horizontal and vertical integration in undergraduate medical education
• Modular approach has also been recommended alongwith incorporation of problem based learning.
OBJECTIVES
Curriculum Committee and Basic Science faculty of the Pramukhswami Medical College designed an Integrated Learning Program for the Central Nervous System for the First year MBBS batch 2006-2007 students
• To develop and implement an integrated module on Central Nervous System in basic sciences
• To focus on integrated learning using multiple teaching learning modalities
• To demonstrate the feasibility and importance of an integrated learning program in preclinical phase of medical education in a college following traditional medical curriculum
METHODOLOGY
Series of meetings
Formal meeting with all faculty of basic Science
Departments
Identification of Learning Objectives
on CNS
Content delivery
1. Didactic Lectures
2. Interactive Lectures
3. Case Based Learning [CBL]
4. Group Seminars by students
5. Dissection/ Demonstration / Practical Laboratory exercises
6. Hospital Visits with patient contact
Histology, Embryology
DURATION OF THE MODULE - 6 WEEK
TOTAL NUMBER OF HOURS : 199
END OF MODULE INTEGRATED ASSESSMENT ON ANATOMY, PHYSIOLOGY & BIOCHEMISTRY
OF CNS IN A CASE VIGNETTE FORMAT
Evaluation of the program by a structured questionnaire
STUDENTS BASIC SCIENCE FACULTY
Distribution of hours to Anatomy, Physiology and Biochemistry in ILP[CNS]
Number of total hours =199
Anatomy50%Physiology
47%
Biochemistry3%
Proportion of various teaching learning methods incorporated into the Integrated Learning Program
on Central Nervous System [ILP-CNS]
Dissection28%
CBL8%
Prac/ Hosp visits9%
Demo[only]5%
Didactic Lec - Interaction
31%
Didactic Lec+Interacti
on12%Seminar
3%
Self study4%
RESPONSES OF THE STUDENTS
Overall Rating of Integrated Learning Program on Central Nervous System [ILP-CNS] with regard to understanding, appreciation and application of
basic knowledge of nervous system to health and disease; N=98
0
5
10
15
20
25
30
35
40
Understanding Appreciation Application
type of response
nu
mb
er o
f st
ud
ents
Poor
Satis
Good
Very Good
Excellent
NR
RATING OF INDIVIDUAL TEACHING/LEARNING METHODS BY THE STUDENTS
Poor
Satis
Good
Very Good
Excellent
No resp
Poor
Satis
Good
Very Good
Excellent
No resp
PoorSatis
Good
Very Good
Excellent
No resp
Poor
Satis
Good
Very Good
Excellent
No resp0
5
10
15
20
25
30
35
40
45
Poor Satis Good Very Good Excellent No respRating
Num
ber
of R
esponse
s
DL [-I] DL [+I] Seminar CBL
RATING OF INDIVIDUAL TEACHING/LEARNING METHODS BY THE STUDENTS
Poor
Satis Good
Very GoodExcellent
No resp
Poor
Satis
Good
Very Good
No respPoor
Satis
Good
Very Good
Excellent
No resp
Excellent
0
5
10
15
20
25
30
35
40
45
Rating
Num
ber of R
esponses
Demo[only]Practicals Hosp visits
RESPONSES OF THE BASIC SCIENCE FACULTY
Proportion of Faculty in Basic Sciences according to designation and departmentwise who
participated in the ILP-CNS; N=15
Prof27%
Addl Prof 13%
Assoc Prof13%
Assistant Prof27%
Lecturer/ Tutor20%
Anatomy40%
Physiology40%
Biochemistry20%
Likings and Dislikings of Basic Science faculty regarding different aspects of ILP-CNS
0
2
4
6
8
10
12
1 2 3 4
Items in questionnaire
Nu
mb
er o
f re
sp
on
se
s
Liked
Did not like
Uncertain
No Resp
1.Interdepartmental discussions amongst basic science faculty
2. Interdepartmental discussions amongst basic and clinical science faculty
3. Integrated assessment of Students of Phase I
4. Coordination & Group activity towards implementation of ILP
Level of Satisfaction amongst Faculty of Basic Sciences towards different aspects of Integrated
Learning Program ILP-CNS,N=14
0
2
4
6
8
10
12
14
Framing ofTimetable
Delivery ofContent
Assessmentof Students
Evaluation ofProgram
Items for which satisfaction was evaluated
Nu
mb
er o
f re
spo
nse
s
Great extent
Some extent
Not at all
No Resp
Recommendation by Basic Science Faculty for introduction of Integrated Learning Program in Phase I
of Undergraduate Medical Course
0
1
2
3
4
5
6
7
8
9
1
Nu
mb
er
of
Re
sp
on
se
s Strongly
To someextent
Not at all
Noresponse
Recommendations
Opinions of Basic Science Faculty regarding various aspects of Integrated Learning Program; N=14
0
1
2
3
4
5
6
7
8
9
1 2 3 4
Items in Questionnaire
Num
ber of R
esponses
Strongly Agree
Agree
Strongly Disagree
Disagree
Uncertain
1. ILP has improved the understanding & application of basic science knowledge of first year students in health & disease
2. ILP will help the students perform better in University exam [Oct 2007]
3.ILP will help students to perform better in later days of their clinical exposure
4. The concept of ILP is interesting
Opinions of basic Science Faculty regarding ILP - II
0
1
2
3
4
5
6
7
8
5 6 7 8
Items in Questionnaire
Responses
Strongly AgreeAgreeStrongly DisagreeDisagreeUncertain
5. ILP has helped me develop positive attitude towards medical education
6. I developed better interpersonal skills in terms of listening, giving, discussing, receiving criticism
7. ILP requires too much of time and is not worth all the effort
8. ILP helped me develop the ability to accept and work with faculty of different nature and subject background
ILP- better performance in University Phase I exam.
Yes43%
No21%
Uncertain36% Yes
36%
No60%
Uncertain4%
FACULTY OPINION STUDENT OPINION
ILP - better performance in later days of clinical exposure
Yes78%
No16%
Uncertain6%
No0%
Uncertain14%
Yes86%
FACULTY OPINION STUDENT OPINION
Conclusions• It is possible to introduce Integrated Learning Program
in Phase I of a conventional medical curriculum• A lot of cooperation and coordination between
departments is required to make such a program a success.
• Majority of students rated the program as good to very good with reference to appreciation, understanding and application of basic science knowledge in health and disease
• Different teaching learning methods were rated differently by the students.
• Lectures with interaction, group seminars, hospital visits with patient contact as well as hands on practicals were more appreciated as compared to other methods.
• Faculty expressed overall satisfaction towards ILP[CNS] though they showed concern over the implementation of ILP approach for all systems in basic sciences
• The interaction amongst the basic science faculty and between basic and clinical science faculty resulted in cooperation and collaboration which is reflective of attitudinal change in faculty
• Considerable success in the implementation of this program for the first time in our Institution laid the foundation of adopting ILP in other systems in Phase I as well as for Phase II and Phase III.
References• Smith SR, Toward an Integrated Medical Curriculum. Medicine and Health
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• General Medical Council Tomorrow's doctors:Recommendations on Undergraduate medical education. London : General Medical Council 1993.
• Medical Council of India. Salient features of Regulations on Graduate Medical Education, 1997 Available at :http://www.mciindia.org/know/rules/rules_mbbs.htm, accessed Oct 08, 2007
• Pring R. Curriculum integration, p 265-72. In : Hooper, R ed. The Curriculum : Context Design and Developemnt Education. Edinburgh : Oliver & Boyd, 1970
• Shimura, T, Takumi A, Shimizu K,Miyashita S,Adachi K,Teramoto A,Implementation of Integrated Medical Curriculum in Japanese Medical Schools, J Nippo Med Sch 2004; 71:11-16,
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Acknowledgement
• Mr. Sandeep Desai, CEO, HM Patel Center for Medical Care & Education, Karamsad for initiating and driving the process
• All faculty members of the departments of Anatomy , Physiology & Biochemistry who took special interest in planning and implementation of timetable and then gave a feedback at the end of the program
• The students of batch 2006-2007 who participated in the program enthusiatically in spite of hurdles and gave a constructive feedback at the end of the program