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Final integration and alignment

Based on the history and investigations, what is your provisional diagnosis for this child? Student: The provisional diagnosis is Thalassemia Major. Thalassemia is an inherited blood disorder caused by reduced or absent amounts of hemoglobin. The key features that point to Thalassemia Major in this case are: - Recurrent pallor and need for frequent blood transfusions since birth indicating severe anemia. - Hepatosplenomegaly which is commonly seen in Thalassemia Major due to extramedullary hematopoiesis. - Microcytic hypochromic anemia on blood smear examination. - Hemoglobin electrophoresis showing

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Alignment and Integration Dr. Prabhakar Patil Professor Department of Pharmacology Dr. Prasanna.N Assistant Professor Department of Pathology
Traditional curriculum in MBBS:- 1st Phase:- Anatomy , Physiology , Biochemistry 2nd Phase : Pathology , Pharmacology , Microbiology, Forensic Medicine 3 rd Phase Medicine, Surgery & Orthopedics , Gynecology and obstetrics, Pediatrics, Community Medicine, ENT, Ophthalmology Internship
Confused Doctor :- It was Myocardial Infarction. Everyone around me was acting very fast to save patients life. But I was totally in confusion. I started feeling the same pain and anxiety of the patient in front of me. Seniors started shouting at me. That made me more embarrassing. My eyes welled up with tears Then I started thinking Whatever I learnt . I was not able to apply it
Whether that was my fault? Or My teachers fault? No . Not at all. Then what was the reason for my failure in practical aspects? We got education in Silos model:- Model of Compartmentalized education
Things were not taught to us as whole disease The concepts though taught were fragmented
e.g. Myocardial Infarction 1) Anatomy :- Origin, course, branches of coronary arteries Anatomical basis of Ischemic heart disease 2) Physiology:- The functional anatomy of heart including chambers, sounds and pacemaker tissue and conducting system. Introduction to ECG:- Normal and abnormal patterns 3) Biochemistry:- Biochemical tests done in MI 4) Pathology :- Pathogenesis of MI 5) Pharmacology :- Classification ,Mechanism of action, PK/PD, doses and side effects of drugs used in MI 6) PSM :- Modifiable and non modifiable risk factors of MI 5) Internal Medicine:- Pathogenesis, causes, differential diagnosis, investigations and treatment.
How we can overcome this situation?
What are the advantages of Integrating? 1) Can avoid redundancy 2) Promote contextual learning 3) Promote meaningful and relevant learning 4) Student will be able to correlate between basic and clinical science 5) Things learned are better retained 6) It promotes faculty communication
How integration can be done? Try to cover the whole organ system(CVS/RS/Endocrine/CNS),or a particular disease (Anemia, Myocardial infarction ) within certain time period. This can be done by 1) Aligning the topics(Subjects of same phase) 2) Integrating them (Subjects of different phase) 3) Link the concepts in alignment and integration by using linker
1) Alignment of the organ systems/topics as much possible – (Temporal coordination) • It means that as much as possible organ systems/ topics in different subjects in the same phase that have similar threads will be grouped together in the timetable • Used for the majority of the curriculum (80% )allowing similar systems or topics in different subjects to be learnt separately but during the same time frame. • This is the principal method to be followed while creating the phase-wise timetable.
How alignment can done? 1)We can align organ systems 2) We can align Topics 3) We can align both
Examples of Alignment : 1) Organ system:- Cardiovascular system in anatomy, physiology and biochemistry can be scheduled simultaneously in the timetable (Organ system based Time table for CVS)
2) Topics:- Aligned timetable using Topics (Myocardial Infarction)
3) Organ systems plus topics Aligned timetable using organ system(CVS) and topic(MI)
2) Integrate the topics to the limited extent. :- Topics in different subjects in the same phase or different phases that have similar threads will be grouped together in the timetable Concepts in a topic / organ system that are similar, overlapping or redundant are merged into a single teaching session in which subject based demarcations are removed
Directions of integration: A) Horizontal : Two or more disciplines of any phase of MBBS curriculum (preclinical, para-clinical or clinical) • The purpose of horizontal integration (within a phase) is to remove redundancy and provide interconnectedness
B) Vertical : Two or more disciplines of two or more phases of MBBS curriculum. The purpose of vertical integration • In the earlier phases: It used is to emphasize on the applied aspect of the basic science • In the later phases: It is to used to give more information clinically oriented concepts
The progression of integration How integration takes place?
The 11 steps on the integration ladder described by Professor Ronald M Harden Professor Ronald M Harden, Centre for Medical Education Dundee university ,UK
Methods of integration suggested MCI for new curriculum
Liver function in physiology and bilirubin metabolism in biochemistry can be planned jointly in one single session Mainly used for Horizontal Integration
Used for vertical integration Most of the part of Subjects are taught by using methods like temporal coordination (Covering large part of the syllabus) In the same time frame you add a session which brings together concepts common to each of the subjects
Mainly used for vertical integration The teacher identifies concepts and skills from other subjects and incorporate them while teaching his own subject
How exactly should we integrate? What are the steps involved? Step 1: Identify a list of topics or organ systems that will be accommodated in the timetable as aligned and integrated topics (AITo). E.g.:- Topics :- Anemia, Diabetes, Thyroid Diseases, Nutrition, Febrile Illness , Tuberculosis, Malaria, Diarrhea Ischemic Heart Disease ,Polycystic Ovarian Syndrome, Jaundice Organ system :- Cardiovascular System, Gastro-intestinal system, Endocrine system
Here we are taking example of Meningitis In which subjects Meningitis can be taught? Pathology(Phase 2) Microbiology (Phase 2) Internal Medicine(Phase 3)
Step 2: • Use the subject-wise competency document book developed by the MCI for noting down required competencies in each subject to teach that particular topic • Transfer the competences into a template • Arrange these competencies according to phase and subject
Step 3: For each competency, derive learning objectives. Subject Pathology Microbiology Internal Medicine Competencies 2 1 3 Objectives 5 3 7
Step 3: Derive learning sessions to teach these objective a.Put together a bunch of objectives that can be accomplished in the allotted time and require a similar method of instruction and create a learning session b.While creating a learning session Review the objectives / competencies in each phase for particular topic so that Redundancy can be reduced C. Put together a bunch of learning sessions for alignment and integration that covers a particular objectives from different subjects Subject Pathology Microbiology Internal Medicine Competencies 2 1 3 Objectives 5 3 7 Objectives those can aligned and integrated 3(2) 2(1) (2) Learning methods(Instruction ) Lecture ,Practical Small group discussion Case study
Objectives which can be aligned and integrated 3(2) 2(1) 5(2) Derive assessment methods for each objective. Subject Pathology Microbiology Internal Medicine Competencies 2 1 3 Objectives 5 3 7 Objectives those can aligned and integrated 3(2) 2(1) (2) Learning methods Lecture ,Practical Small group discussion Case study Assessment method Structured essay Viva Skill assessment Structured essay Viva Skill assessment Structured essay Viva Skill assessment
Step 4: Create a adding a linker to each AITo so that we can introduce it into time table A linker is a session that will be helpful in connecting the concepts(helps the student to Correlate) in different subjects while learning about a particular topic or organ system The linker is most commonly a case. Linker can be creatively written and used in each phase (often the same case) to allow students to correlate what they have learnt and apply into understanding disease process, diagnosis and care.
When you use the case discussion at different time points in integration students will be able to link concepts appropriately In addition, encourage the student to go for collaborative and self-directed learning
Step 5: Ensure that while making table adequate time should be given to AITos (Aligned and Integrated topics) ,Non aligned topics and assessment methods
Which things we must take into consideration according to GMR 2019 while doing integration:- • Integration should not to exceed 20% of the total curriculum • The integration session most preferred will be a case based discussion so that student will learn concepts as well as their connection with other subjects
• Prime importance should be given to achieve phase - based objectives • The integrative elements from lower phases are used only to provide adequate recall of applied concepts and understand their clinical application in higher phases • Objective writing and session planning must be done with teachers of all subjects involved in the aligned and integrated topic (AITo) and their inputs taken for the integrated session
• It must be emphasized that integration does not necessarily require multiple teachers(the concepts should be integrated. It is not necessary to integrate teachers) in each class. Experts from each phase and subject may be involved in the lesson planning but not it in its delivery unless necessary • Topics that cannot be aligned and integrated(Non- aligned topics) must be provided adequate time in the curriculum throughout the year
• Assessment will continue to be subject based. However, efforts must be made to ensure that phase appropriate correlates are tested to determine if the learner has internalized and integrated the concept and its application (This is nothing but integrated assessment)
Lets start …….
Step 2 ALIGN IT same Phase ( 2 ) – and sequence it (Pathology and Microbiology ) No. Competencies Pathology PA 13.1 Describe haematopoiesis and extra medullary haematopoiesis PA 13.3 Define and classify and anemia PA 13.4 Enumerate and describe the investigations of anemia PA 13.5 Identify and describe the peripheral blood picture in anemia PA 14.1 Describe iron metabolism PA 14.2 Decribe the etiology investigations and differential diagnosis of microcytic hypochromic anemia PA 14.3 Identify and describe the the peripheral and smear in hypochromic anmeia PA 15.1 Describe the metabolism of Vitamin B12 and the etiology and pathogeneisis of B12 deficiency PA 15.2 Describe the laboratory investigations of macrocytic anemia PA 15.3 Identify and describe the peripheral blood picture of macrocytic anemia PA 15.4 Enumerate the differences and describe the etiology and distinguishing features of megaloblastic and non megaloblastic anemia Microbiology MI 4 List the common microbial agents causing anaemia. Describe the morphology, mode of infection and discuss the pathogenesis, clinical course, diagnosis and prevention of the common microbial agents causing Anaemia. Pharmacology PH 1.35 Description of drugs used in haematological disorders and discuss mechanism/s of action, types, doses, side effects, indications and contraindications, like 1. Drugs used in anemias2. Colony Stimulating factors PA 16.1 Define and classify hemolytic anemia PA 16.2 Describe the pathogeneis and clinical features and hematologic indices of hemolytic anemia PA 16.3 Describe the pathogenesis features, hematologic indices and peripheral blood picture of sickle cell anemia and thallasemia PA 16.4 Describe the etiology pathogenesis, hematologic indices and peripheral blood picture of Acquired hemolytic anemia PA16.5 Describe the peripheral blood picture in different hemolytic anaemias. PA 17.1 Enumerate the etiology, pathogenesis and findings in aplastic anemia PA17.2 Enumerate the indications and describe the findings in bone marrow aspiration and biopsy
Creating Learning Session – Step 3
TS
Creating Integrated sessions (Single session ) Correlation NestingSharing
Step 3 b Bunch objectives and create learning sessions Subject 1 Subject 2 Obj Anemia Phase 1 Obj Obj Obj Obj Obj Obj Obj Obj Obj Obj Obj Obj Obj Obj Phase 2 Obj Obj Obj Obj Subject 4 Subject 5 Subject 6 Obj Obj Obj Phase 3 Obj Obj Obj Obj Subject 7 Subject 8 Integration - Correlation Choose objectives from a different phase can be used to link the concepts in various sessions Correlation LinkerCase PA 14.I DESCRIBE THE IRON METABOLISM PA 14.2 DISCUSS THE AETIOLOGY, INVESTIGATIONS AND DIFFERENTIAL DIAGNOSIS OF HYPOCHROMIC MICROCYTIC ANAEMIA A) Discuss absorption , transport , storage, functions and degradation of iron B) Discuss etio-pathogenesis , clinical features, diagnosis of iron deficiency anaemia PY 2.5 DESCRIBE RBC FORMATION (ERYTHROPOIESIS) AND FUNCTIONS • Describe the formation and regulation of erythropoiesis PE 13.1 DISCUSS RDA , DIETARY SOURCES AND ROLE OF IRON IN HEALTH AND DISEASE A) Discuss the RDA and dietary sources of iron B) Discuss role of iron in Health and disease A child with iron deficiency Anaemia Principle Integration CORRELATION
• Step 4 c : The objective writing and session planning should be done by teachers of all subjects in the AIT - Anemia • Step 4 d : The concept and not necessarily teachers should be integrated
. Anemia Session s Anemia Session Anemia Anemia Anemia IAnemia Anemia Step 5 b ANEMIA By reviewing objective / competencies across phases redundant ones and those with a common thread can be identified for Vertical integration Aligned and integrated Anemia sessions Anemia Session s Anemia Anemia Anemia IAnemia Anemia Anaemi a Anemia Anemia IAnemia Anemia Phase 1 Phase 2 Phase 3
. Anemia Session s Anemia Session Anemia Anemia Anemia IAnemia Anemia Step 5 b ANEMIA Consider Adding a Linker ( Aligned and Integrated ) Aligned and integrated Anemia sessions Vertically Common thread Linker is usually a case Anemia Session s Anemia Anemia Anemia IAnemia Anemia Anaemi a Anemia Anemia IAnemia Anemia Phase 1 Phase 2 Phase 3
Look at the vertically aligned document of “ Anaemia” What are the common problems that the IMG will have to solve, as a first contact physician in the community with respect to the disease (Anemia) ? Anemia in children , Pregnant women , elderly , Poly trauma To what degree of complexity can they solve the problem ? Recognition , evaluation , management and referral Create cases 1. An infant with repeated blood transfusion , anemia and jaundice 2. A pregnant women with iron deficiency anemia 3. An elderly alcoholic with GI bleed 4. A patient with POLY TRAUMA and acute blood loss , pre Operative , Post operative management Cases should address objectives from the various phases from “ Anemia” topic How to create linker ? What cases to link ?
Creating Formative assessment sessions
Knowledge Domain Skill Domain Assessments Written, Viva Assessments Skill Assessment T P
When ever we complete a topic or session we can assess the student by giving them formative assessment. What is the purpose of formative assessment? To help the student as well as teacher to know how the student is progressing and what remedial actions can be taken When the formative assessments are conducted? Through out the academic year Summative assessments :- They are conducted at the end of academic year What is the purpose :-
• In traditional assessment system we were not integrating assessments . • But now MCI tells us to use integration in assessments also . • It tells us that more integration should be there in formative assessment • Advantage of Integrated assessment: It provide an creative learning platform to the students so that whatever he learns can be linked to real life i.e., what will he/she experience in their practice.
Examples of Integrated Assessments Reflection FORMATIVE ASSESSMENTS Structured Essays Short answers Integrated OSPE /OSCE Case resolutions Assignments Integrated MCQ
Case resolutions FORMATIVE ASSESSMENTS Small Group Discussion A 3 year old toddler presents with recurrent pallor , jaundice and requiring recurrent blood transfusion since birth . The blood group of the child is O positive . The child clinically has an hepato-splenomegaly ………Lab values …….. Lead questions 1. What's happening in this child ? 2. What normal physiology that is deranged ? 3. What is the physiological deviations leading to the abnormal clinical findings ? 4. What is the normal parameters and why it has deviated in this child ? 5. What is the physiological basis of blood transfusion ? 6. How does blood transfusion help to restore normal physiology in this child ? PY 2.5 Describe RBC formation (erythropoiesis & its regulation) and its functions PA 13.I Describe hematopoiesis and extra medullary hematopoiesis • Objectives : • Describe erythropoiesis and regulation • Explain the functions of rbc • Discuss significance of medullary and extramedullary erythropoiesis Formative assessment Format of Small group discussion Examples of Integrated Assessments
TS Examples of Integrated Assessments
Examples of Integrated Assessments
Formative Assessment Integrated MCQ PA 14.1 Describe iron metabolism PA 15.1 Describe metabolism of Vitamin B12 and the etio- pathogenesis of B12 deficiency PY 2.11 Estimate RBC count and interpret normal Group B PY2.11 Estimate Hb, RBC indices and interpret Objective : a) Classify anaemia based on red blood cell morphology b) Interpret RBC indices c) Interpret peripheral smear Aligned to multiple lectures and Practical session
Formative Assessment Describe the components of blood . Outline the normal erythropoiesis and its regulation . Enumerate disorders of abnormal erythropoiesis . Structured Essays PY 2.1 Describe the composition and functions of blood and its components PY 2.5 Describe RBC formation (erythropoiesis & its regulation) and its functions PA 13.I Describe hematopoiesis and extra medullary hematopoiesis • Describe erythropoiesis and regulation • Explain the functions of RBC • Discuss significance of medullary and extramedullary erythropoiesis Multiple lectures and Practical session An 2 year old child presents with pallor , jaundice and recurrent transfusion requirements since 6 months of life. The child has a growth retardation and hepatosplenomegaly . Discuss the patho -physiological basis of this condition and explain its relation it to the clinical condition . OR
Write a short note on : Laboratory diagnosis of enteric fever Short answers MI3.3 Describe the enteric fever pathogens and discuss the evolution of the clinical course and the laboratory diagnosis of the diseases caused by them MI3.4 Identify the different modalities for diagnosis of enteric fever. Choose the appropriate test related to the duration of illness IM4.3 Discuss and describe the common causes, pathophysiology and manifestations and diagnosis of fever in various regions in India including bacterial, parasitic and viral causes (e.g. Dengue, Chikungunya, Typhus) Objectives 1. Discuss the laboratory diagnosis of enteric fever 2. Explain the significance of the tests relating it to the duration of the illness Multiple lectures and Practical session FORMATIVE ASSESSMENT
This is the peripheral smear of 2 year old child with PICA and a Hemoglobin of 6 gm% a) Describe the RBC in the peripheral smear. b) Which other RBC indices are will you order as next step in the evaluation ? Integrated OSPE PY 2.11 Estimate RBC count and interpret normal Group B PY2.11 Estimate Hb , RBC indices and interpret PA13.5 Perform, Identify and describe the peripheral blood picture in anemia PA14.3 Identify and describe the peripheral smear in microcytic anemia PE13.2 Describe the causes, diagnosis and management of Fe deficiency Multiple lectures , Practical session and clinical rotations FORMATIVE ASSESSMENT
A 25 year old pregnant lady has come for routine antenatal check up . Perform general examination for the patient. Check list Introduces himself to patient Explains the procedure Ensures patient privacy Performs general examination looking for Pallor , Lymphadenopathy , Jaundice , edema , Cyanosis and clubbing Integrated OSCE PA 14.1 Describe the pahtogenesis and clinical features of iron deficiency anaemia IM 9.4 Demonstrate general examination of a patient in bed side clinics / out patient clinic / community clinics 9.4.1 Spot / recognize Pallor in the given picture / patient in bed side clinics 9.4.2 Demonstrate Pallor in bed side clinics as a part of general examination Multiple TL sessions Lectures / Clinical / Practical session FORMATIVE ASSESSMENT
Sample Time table for AIT Anemia – Phase 2 Linker here is a case of a child with anemia, blood transfusion , helminthic infestation and iron deficiency anemia Linker gives better integration in student mind if all learning experiences including lectures , practical sessions can provide a discussion correlation with the case ( Correlation, Harden ) Feed back CASE RESOL UTION 1-3 PM Skill assessm ent OSPE Skill assessme nt OSCE
Reference:- 1)https://www.slideshare.net/swanandpathak/integrated-teaching by Dr Swanand Pathak 2) Shilpa Khullar Integrated teaching in medical education in india Int. J Basic Appl. Physiol.,5(1),2016 ; 6-14 3)https://www.slideshare.net/Poligar/integrated-assessment-in- medical-education 4)Hedef D. El-Yassin Integrated assessment in medical education J Contemp Med Sci, Vol. 1, No. 4, Autumn 2015: 36–38 5)Ronald M Harden The integration ladder: a tool for curriculum planning and evaluation MEDICAL EDUCATION 2000;34:551–557 6)CISP module 4 for alignment and integration published by MCI 2019

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Final integration and alignment

  • 1.
    Alignment and Integration Dr.Prabhakar Patil Professor Department of Pharmacology Dr. Prasanna.N Assistant Professor Department of Pathology
  • 3.
    Traditional curriculum inMBBS:- 1st Phase:- Anatomy , Physiology , Biochemistry 2nd Phase : Pathology , Pharmacology , Microbiology, Forensic Medicine 3 rd Phase Medicine, Surgery & Orthopedics , Gynecology and obstetrics, Pediatrics, Community Medicine, ENT, Ophthalmology Internship
  • 4.
    Confused Doctor :- Itwas Myocardial Infarction. Everyone around me was acting very fast to save patients life. But I was totally in confusion. I started feeling the same pain and anxiety of the patient in front of me. Seniors started shouting at me. That made me more embarrassing. My eyes welled up with tears Then I started thinking Whatever I learnt . I was not able to apply it
  • 5.
    Whether that wasmy fault? Or My teachers fault? No . Not at all. Then what was the reason for my failure in practical aspects? We got education in Silos model:- Model of Compartmentalized education
  • 6.
    Things were nottaught to us as whole disease The concepts though taught were fragmented
  • 7.
    e.g. Myocardial Infarction 1)Anatomy :- Origin, course, branches of coronary arteries Anatomical basis of Ischemic heart disease 2) Physiology:- The functional anatomy of heart including chambers, sounds and pacemaker tissue and conducting system. Introduction to ECG:- Normal and abnormal patterns 3) Biochemistry:- Biochemical tests done in MI 4) Pathology :- Pathogenesis of MI 5) Pharmacology :- Classification ,Mechanism of action, PK/PD, doses and side effects of drugs used in MI 6) PSM :- Modifiable and non modifiable risk factors of MI 5) Internal Medicine:- Pathogenesis, causes, differential diagnosis, investigations and treatment.
  • 8.
    How we canovercome this situation?
  • 10.
    What are theadvantages of Integrating? 1) Can avoid redundancy 2) Promote contextual learning 3) Promote meaningful and relevant learning 4) Student will be able to correlate between basic and clinical science 5) Things learned are better retained 6) It promotes faculty communication
  • 11.
    How integration canbe done? Try to cover the whole organ system(CVS/RS/Endocrine/CNS),or a particular disease (Anemia, Myocardial infarction ) within certain time period. This can be done by 1) Aligning the topics(Subjects of same phase) 2) Integrating them (Subjects of different phase) 3) Link the concepts in alignment and integration by using linker
  • 12.
    1) Alignment ofthe organ systems/topics as much possible – (Temporal coordination) • It means that as much as possible organ systems/ topics in different subjects in the same phase that have similar threads will be grouped together in the timetable • Used for the majority of the curriculum (80% )allowing similar systems or topics in different subjects to be learnt separately but during the same time frame. • This is the principal method to be followed while creating the phase-wise timetable.
  • 14.
    How alignment candone? 1)We can align organ systems 2) We can align Topics 3) We can align both
  • 15.
    Examples of Alignment: 1) Organ system:- Cardiovascular system in anatomy, physiology and biochemistry can be scheduled simultaneously in the timetable (Organ system based Time table for CVS)
  • 16.
    2) Topics:- Aligned timetableusing Topics (Myocardial Infarction)
  • 17.
    3) Organ systemsplus topics Aligned timetable using organ system(CVS) and topic(MI)
  • 18.
    2) Integrate thetopics to the limited extent. :- Topics in different subjects in the same phase or different phases that have similar threads will be grouped together in the timetable Concepts in a topic / organ system that are similar, overlapping or redundant are merged into a single teaching session in which subject based demarcations are removed
  • 19.
    Directions of integration: A)Horizontal : Two or more disciplines of any phase of MBBS curriculum (preclinical, para-clinical or clinical) • The purpose of horizontal integration (within a phase) is to remove redundancy and provide interconnectedness
  • 20.
    B) Vertical :Two or more disciplines of two or more phases of MBBS curriculum. The purpose of vertical integration • In the earlier phases: It used is to emphasize on the applied aspect of the basic science • In the later phases: It is to used to give more information clinically oriented concepts
  • 21.
    The progression ofintegration How integration takes place?
  • 22.
    The 11 stepson the integration ladder described by Professor Ronald M Harden Professor Ronald M Harden, Centre for Medical Education Dundee university ,UK
  • 23.
    Methods of integrationsuggested MCI for new curriculum
  • 24.
    Liver function inphysiology and bilirubin metabolism in biochemistry can be planned jointly in one single session Mainly used for Horizontal Integration
  • 25.
    Used for vertical integration Mostof the part of Subjects are taught by using methods like temporal coordination (Covering large part of the syllabus) In the same time frame you add a session which brings together concepts common to each of the subjects
  • 26.
    Mainly used for verticalintegration The teacher identifies concepts and skills from other subjects and incorporate them while teaching his own subject
  • 27.
    How exactly shouldwe integrate? What are the steps involved? Step 1: Identify a list of topics or organ systems that will be accommodated in the timetable as aligned and integrated topics (AITo). E.g.:- Topics :- Anemia, Diabetes, Thyroid Diseases, Nutrition, Febrile Illness , Tuberculosis, Malaria, Diarrhea Ischemic Heart Disease ,Polycystic Ovarian Syndrome, Jaundice Organ system :- Cardiovascular System, Gastro-intestinal system, Endocrine system
  • 28.
    Here we aretaking example of Meningitis In which subjects Meningitis can be taught? Pathology(Phase 2) Microbiology (Phase 2) Internal Medicine(Phase 3)
  • 29.
    Step 2: • Usethe subject-wise competency document book developed by the MCI for noting down required competencies in each subject to teach that particular topic • Transfer the competences into a template • Arrange these competencies according to phase and subject
  • 30.
    Step 3: Foreach competency, derive learning objectives. Subject Pathology Microbiology Internal Medicine Competencies 2 1 3 Objectives 5 3 7
  • 32.
    Step 3: Derive learningsessions to teach these objective a.Put together a bunch of objectives that can be accomplished in the allotted time and require a similar method of instruction and create a learning session b.While creating a learning session Review the objectives / competencies in each phase for particular topic so that Redundancy can be reduced C. Put together a bunch of learning sessions for alignment and integration that covers a particular objectives from different subjects Subject Pathology Microbiology Internal Medicine Competencies 2 1 3 Objectives 5 3 7 Objectives those can aligned and integrated 3(2) 2(1) (2) Learning methods(Instruction ) Lecture ,Practical Small group discussion Case study
  • 34.
    Objectives which canbe aligned and integrated 3(2) 2(1) 5(2) Derive assessment methods for each objective. Subject Pathology Microbiology Internal Medicine Competencies 2 1 3 Objectives 5 3 7 Objectives those can aligned and integrated 3(2) 2(1) (2) Learning methods Lecture ,Practical Small group discussion Case study Assessment method Structured essay Viva Skill assessment Structured essay Viva Skill assessment Structured essay Viva Skill assessment
  • 36.
    Step 4: Createa adding a linker to each AITo so that we can introduce it into time table A linker is a session that will be helpful in connecting the concepts(helps the student to Correlate) in different subjects while learning about a particular topic or organ system The linker is most commonly a case. Linker can be creatively written and used in each phase (often the same case) to allow students to correlate what they have learnt and apply into understanding disease process, diagnosis and care.
  • 37.
    When you usethe case discussion at different time points in integration students will be able to link concepts appropriately In addition, encourage the student to go for collaborative and self-directed learning
  • 38.
    Step 5: Ensurethat while making table adequate time should be given to AITos (Aligned and Integrated topics) ,Non aligned topics and assessment methods
  • 39.
    Which things wemust take into consideration according to GMR 2019 while doing integration:- • Integration should not to exceed 20% of the total curriculum • The integration session most preferred will be a case based discussion so that student will learn concepts as well as their connection with other subjects
  • 40.
    • Prime importanceshould be given to achieve phase - based objectives • The integrative elements from lower phases are used only to provide adequate recall of applied concepts and understand their clinical application in higher phases • Objective writing and session planning must be done with teachers of all subjects involved in the aligned and integrated topic (AITo) and their inputs taken for the integrated session
  • 41.
    • It mustbe emphasized that integration does not necessarily require multiple teachers(the concepts should be integrated. It is not necessary to integrate teachers) in each class. Experts from each phase and subject may be involved in the lesson planning but not it in its delivery unless necessary • Topics that cannot be aligned and integrated(Non- aligned topics) must be provided adequate time in the curriculum throughout the year
  • 42.
    • Assessment willcontinue to be subject based. However, efforts must be made to ensure that phase appropriate correlates are tested to determine if the learner has internalized and integrated the concept and its application (This is nothing but integrated assessment)
  • 43.
  • 47.
    Step 2 ALIGNIT same Phase ( 2 ) – and sequence it (Pathology and Microbiology ) No. Competencies Pathology PA 13.1 Describe haematopoiesis and extra medullary haematopoiesis PA 13.3 Define and classify and anemia PA 13.4 Enumerate and describe the investigations of anemia PA 13.5 Identify and describe the peripheral blood picture in anemia PA 14.1 Describe iron metabolism PA 14.2 Decribe the etiology investigations and differential diagnosis of microcytic hypochromic anemia PA 14.3 Identify and describe the the peripheral and smear in hypochromic anmeia PA 15.1 Describe the metabolism of Vitamin B12 and the etiology and pathogeneisis of B12 deficiency PA 15.2 Describe the laboratory investigations of macrocytic anemia PA 15.3 Identify and describe the peripheral blood picture of macrocytic anemia PA 15.4 Enumerate the differences and describe the etiology and distinguishing features of megaloblastic and non megaloblastic anemia Microbiology MI 4 List the common microbial agents causing anaemia. Describe the morphology, mode of infection and discuss the pathogenesis, clinical course, diagnosis and prevention of the common microbial agents causing Anaemia. Pharmacology PH 1.35 Description of drugs used in haematological disorders and discuss mechanism/s of action, types, doses, side effects, indications and contraindications, like 1. Drugs used in anemias2. Colony Stimulating factors PA 16.1 Define and classify hemolytic anemia PA 16.2 Describe the pathogeneis and clinical features and hematologic indices of hemolytic anemia PA 16.3 Describe the pathogenesis features, hematologic indices and peripheral blood picture of sickle cell anemia and thallasemia PA 16.4 Describe the etiology pathogenesis, hematologic indices and peripheral blood picture of Acquired hemolytic anemia PA16.5 Describe the peripheral blood picture in different hemolytic anaemias. PA 17.1 Enumerate the etiology, pathogenesis and findings in aplastic anemia PA17.2 Enumerate the indications and describe the findings in bone marrow aspiration and biopsy
  • 49.
  • 50.
  • 51.
    Creating Integrated sessions(Single session ) Correlation NestingSharing
  • 56.
    Step 3 b Bunchobjectives and create learning sessions Subject 1 Subject 2 Obj Anemia Phase 1 Obj Obj Obj Obj Obj Obj Obj Obj Obj Obj Obj Obj Obj Obj Phase 2 Obj Obj Obj Obj Subject 4 Subject 5 Subject 6 Obj Obj Obj Phase 3 Obj Obj Obj Obj Subject 7 Subject 8 Integration - Correlation Choose objectives from a different phase can be used to link the concepts in various sessions Correlation LinkerCase PA 14.I DESCRIBE THE IRON METABOLISM PA 14.2 DISCUSS THE AETIOLOGY, INVESTIGATIONS AND DIFFERENTIAL DIAGNOSIS OF HYPOCHROMIC MICROCYTIC ANAEMIA A) Discuss absorption , transport , storage, functions and degradation of iron B) Discuss etio-pathogenesis , clinical features, diagnosis of iron deficiency anaemia PY 2.5 DESCRIBE RBC FORMATION (ERYTHROPOIESIS) AND FUNCTIONS • Describe the formation and regulation of erythropoiesis PE 13.1 DISCUSS RDA , DIETARY SOURCES AND ROLE OF IRON IN HEALTH AND DISEASE A) Discuss the RDA and dietary sources of iron B) Discuss role of iron in Health and disease A child with iron deficiency Anaemia Principle Integration CORRELATION
  • 60.
    • Step 4c : The objective writing and session planning should be done by teachers of all subjects in the AIT - Anemia • Step 4 d : The concept and not necessarily teachers should be integrated
  • 62.
    . Anemia Session s Anemia Session Anemia Anemia Anemia IAnemiaAnemia Step 5 b ANEMIA By reviewing objective / competencies across phases redundant ones and those with a common thread can be identified for Vertical integration Aligned and integrated Anemia sessions Anemia Session s Anemia Anemia Anemia IAnemia Anemia Anaemi a Anemia Anemia IAnemia Anemia Phase 1 Phase 2 Phase 3
  • 63.
    . Anemia Session s Anemia Session Anemia Anemia Anemia IAnemiaAnemia Step 5 b ANEMIA Consider Adding a Linker ( Aligned and Integrated ) Aligned and integrated Anemia sessions Vertically Common thread Linker is usually a case Anemia Session s Anemia Anemia Anemia IAnemia Anemia Anaemi a Anemia Anemia IAnemia Anemia Phase 1 Phase 2 Phase 3
  • 64.
    Look at thevertically aligned document of “ Anaemia” What are the common problems that the IMG will have to solve, as a first contact physician in the community with respect to the disease (Anemia) ? Anemia in children , Pregnant women , elderly , Poly trauma To what degree of complexity can they solve the problem ? Recognition , evaluation , management and referral Create cases 1. An infant with repeated blood transfusion , anemia and jaundice 2. A pregnant women with iron deficiency anemia 3. An elderly alcoholic with GI bleed 4. A patient with POLY TRAUMA and acute blood loss , pre Operative , Post operative management Cases should address objectives from the various phases from “ Anemia” topic How to create linker ? What cases to link ?
  • 66.
  • 67.
  • 68.
    When ever wecomplete a topic or session we can assess the student by giving them formative assessment. What is the purpose of formative assessment? To help the student as well as teacher to know how the student is progressing and what remedial actions can be taken When the formative assessments are conducted? Through out the academic year Summative assessments :- They are conducted at the end of academic year What is the purpose :-
  • 69.
    • In traditionalassessment system we were not integrating assessments . • But now MCI tells us to use integration in assessments also . • It tells us that more integration should be there in formative assessment • Advantage of Integrated assessment: It provide an creative learning platform to the students so that whatever he learns can be linked to real life i.e., what will he/she experience in their practice.
  • 70.
    Examples of IntegratedAssessments Reflection FORMATIVE ASSESSMENTS Structured Essays Short answers Integrated OSPE /OSCE Case resolutions Assignments Integrated MCQ
  • 71.
    Case resolutions FORMATIVE ASSESSMENTS Small Group Discussion A3 year old toddler presents with recurrent pallor , jaundice and requiring recurrent blood transfusion since birth . The blood group of the child is O positive . The child clinically has an hepato-splenomegaly ………Lab values …….. Lead questions 1. What's happening in this child ? 2. What normal physiology that is deranged ? 3. What is the physiological deviations leading to the abnormal clinical findings ? 4. What is the normal parameters and why it has deviated in this child ? 5. What is the physiological basis of blood transfusion ? 6. How does blood transfusion help to restore normal physiology in this child ? PY 2.5 Describe RBC formation (erythropoiesis & its regulation) and its functions PA 13.I Describe hematopoiesis and extra medullary hematopoiesis • Objectives : • Describe erythropoiesis and regulation • Explain the functions of rbc • Discuss significance of medullary and extramedullary erythropoiesis Formative assessment Format of Small group discussion Examples of Integrated Assessments
  • 72.
  • 73.
  • 74.
    Formative Assessment Integrated MCQ PA 14.1Describe iron metabolism PA 15.1 Describe metabolism of Vitamin B12 and the etio- pathogenesis of B12 deficiency PY 2.11 Estimate RBC count and interpret normal Group B PY2.11 Estimate Hb, RBC indices and interpret Objective : a) Classify anaemia based on red blood cell morphology b) Interpret RBC indices c) Interpret peripheral smear Aligned to multiple lectures and Practical session
  • 75.
    Formative Assessment Describe thecomponents of blood . Outline the normal erythropoiesis and its regulation . Enumerate disorders of abnormal erythropoiesis . Structured Essays PY 2.1 Describe the composition and functions of blood and its components PY 2.5 Describe RBC formation (erythropoiesis & its regulation) and its functions PA 13.I Describe hematopoiesis and extra medullary hematopoiesis • Describe erythropoiesis and regulation • Explain the functions of RBC • Discuss significance of medullary and extramedullary erythropoiesis Multiple lectures and Practical session An 2 year old child presents with pallor , jaundice and recurrent transfusion requirements since 6 months of life. The child has a growth retardation and hepatosplenomegaly . Discuss the patho -physiological basis of this condition and explain its relation it to the clinical condition . OR
  • 76.
    Write a shortnote on : Laboratory diagnosis of enteric fever Short answers MI3.3 Describe the enteric fever pathogens and discuss the evolution of the clinical course and the laboratory diagnosis of the diseases caused by them MI3.4 Identify the different modalities for diagnosis of enteric fever. Choose the appropriate test related to the duration of illness IM4.3 Discuss and describe the common causes, pathophysiology and manifestations and diagnosis of fever in various regions in India including bacterial, parasitic and viral causes (e.g. Dengue, Chikungunya, Typhus) Objectives 1. Discuss the laboratory diagnosis of enteric fever 2. Explain the significance of the tests relating it to the duration of the illness Multiple lectures and Practical session FORMATIVE ASSESSMENT
  • 77.
    This is theperipheral smear of 2 year old child with PICA and a Hemoglobin of 6 gm% a) Describe the RBC in the peripheral smear. b) Which other RBC indices are will you order as next step in the evaluation ? Integrated OSPE PY 2.11 Estimate RBC count and interpret normal Group B PY2.11 Estimate Hb , RBC indices and interpret PA13.5 Perform, Identify and describe the peripheral blood picture in anemia PA14.3 Identify and describe the peripheral smear in microcytic anemia PE13.2 Describe the causes, diagnosis and management of Fe deficiency Multiple lectures , Practical session and clinical rotations FORMATIVE ASSESSMENT
  • 78.
    A 25 yearold pregnant lady has come for routine antenatal check up . Perform general examination for the patient. Check list Introduces himself to patient Explains the procedure Ensures patient privacy Performs general examination looking for Pallor , Lymphadenopathy , Jaundice , edema , Cyanosis and clubbing Integrated OSCE PA 14.1 Describe the pahtogenesis and clinical features of iron deficiency anaemia IM 9.4 Demonstrate general examination of a patient in bed side clinics / out patient clinic / community clinics 9.4.1 Spot / recognize Pallor in the given picture / patient in bed side clinics 9.4.2 Demonstrate Pallor in bed side clinics as a part of general examination Multiple TL sessions Lectures / Clinical / Practical session FORMATIVE ASSESSMENT
  • 80.
    Sample Time tablefor AIT Anemia – Phase 2 Linker here is a case of a child with anemia, blood transfusion , helminthic infestation and iron deficiency anemia Linker gives better integration in student mind if all learning experiences including lectures , practical sessions can provide a discussion correlation with the case ( Correlation, Harden ) Feed back CASE RESOL UTION 1-3 PM Skill assessm ent OSPE Skill assessme nt OSCE
  • 82.
    Reference:- 1)https://www.slideshare.net/swanandpathak/integrated-teaching by Dr SwanandPathak 2) Shilpa Khullar Integrated teaching in medical education in india Int. J Basic Appl. Physiol.,5(1),2016 ; 6-14 3)https://www.slideshare.net/Poligar/integrated-assessment-in- medical-education 4)Hedef D. El-Yassin Integrated assessment in medical education J Contemp Med Sci, Vol. 1, No. 4, Autumn 2015: 36–38 5)Ronald M Harden The integration ladder: a tool for curriculum planning and evaluation MEDICAL EDUCATION 2000;34:551–557 6)CISP module 4 for alignment and integration published by MCI 2019

Editor's Notes

  • #4 We all products of traditional teaching. In traditional curriculum we came across all these subjects in different phases. Followed by this there was compulsory internship. I also went through this process and joined as medical officer in a hospital. I was very happy that I became a doctor. I started working with great enthusiasm.
  • #5 The first case came was myocardial infarction. Everyone around me was acting very fast to save patients life. But I was totally in confusion. . I started feeling the same pain and anxiety of the patient in front of me. Seniors started shouting at me. That made me more embarrassing. My eyes welled up with tears Here what was expected from me as a doctor. I should be able to handle most of the things independently. Then I started thinking (what wrong has happened to me?) and the answer to this was whatever I learnt for last five and half years. I was not able to apply it in practical situations.
  • #6 I learnt each subject as a compartment which is not connected with the other compartment(Other subject) regarding therotical and practical aspects. In the United States of America, silos in education was used. In this one teacher per room, every subject its own class or time frame, and every child his or her own desk! Compartmentalized, organized, safe. Students attend a lecture on anatomy on CVS, and then move on to a lecture in physiology where they will attend lecture on Endocrinology and in biochemistry carbohydrate metabolism.
  • #7 Things were not taught to us as whole disease.Every teacher taught me myocardial infarction in his compartment compartments. Similar concepts were taught but in different time frames. So it was not possible to internalize a particular topic as whole.
  • #8 Whether my teacher taught me MI.Yes definitely . They all were great teachers They taught MI in bits and pieces. Every teacher was the expert in his subject. He used to deliver loads of knowledge to me. One more problem we faced teacher were trying to make us experts in their subjects delivering unnecessary loads of knowledge to us(We can call it as redundant. Which means exceeding whatever is necessary). There was lot of repetition which made learning boring.
  • #9 The new curriculum proposed by MCI
  • #10 Teach the concept as whole in integrated manner by breaking the barriers between to subjects.
  • #11 Redundancy:- Which means exceeding whatever is necessary Contextual learning:- is a method of instruction that enables students to apply their knowledge and skills to real-life situations
  • #12 These are some ways by which we can arrange our syllabus so that student will be able to learn and able to implement his knowledge and skill in his day to day practice.
  • #13 Teaching related systems or topics from different subjects in the same phase
  • #14  This temporal coordination is called as alignment in the guidelines given by MCI for new curriculum. Here you can see example of temporal coordination between all subjects of phase 2.
  • #16  So this is the time table of one week having six hours per day teaching Example given is CVS shown in green colour. If you take example of Monday All three subjects of first year can go for aligned teaching related to some part of CVS(Here you can see first four classes). But last two classes are Non aligned topics (Topics other than CVS )they are from physiology and community medicine. That means we have to give some time to non aligned topics in the time table. Examples of Non aligned topics:-Anatomy :- Upper limb, lower limb , Physiology:- Exercise physiology, Aviation physiology, Biochemistry:- Chemistry of Carbohydrates and lipids Pharmacology:- Adverse drug reactions, Drug development. Same thing can be followed for whole week Similarly while teaching infectious disease you can align Pathology, Microbiology and Pharmacology. In this time table you can see rectangles with blue and red outline. These are examples of integrated session.I will discuss this later.
  • #17 Similarly you align a particular topic. Here the example is of Myocardial infarction.
  • #18 Similarly you can also align a topic while teaching organ system. Here example is Myocardial infarction and Cardiovascular system.
  • #19 After alignment second method is integration. It is done in limited extent.Topics in different subjects in the same phase or different phases that have similar threads will be grouped together in the timetable Concepts in a topic / organ system that are similar, overlapping or redundant are merged into a single teaching session in which subject based demarcations are removed . In this method we break the barriers between subjects.
  • #23 To answer this question Professor Ronald M Harden proposed 11 step integration ladder. In this ladder the teaching starts as isolated teaching (Silos teaching/ Compartmentalized teaching) by each subject. But the further steps of ladder leads to integration. The success of integration depends on communication and joint planning between teachers from different subjects
  • #24 From these 11 steps MCI has suggested only three steps to be used in teaching.
  • #25 So let us see these methods in details.
  • #26 Similarly Case of Myocardial Infarction can be used to recap the concepts in subjects like Biochemistry and Pathology while teaching Internal Medicine.
  • #28 Now I want the participants to tell which subjects can be aligned or integrated to teach one of the topic.
  • #29 Again the question to you is which subjects can be aligned or integrated while teaching meningitis. Here as I am going to tell you example of creating time table of II phase I will try to include subjects from 2nd year. Then align them according to need. Then I will think which subjects can be integrated to these subjects within phase and outside the phase.
  • #33 As we are making timetable of Phase II, in this table you can see digits shown in red colour tells us About objectives that can be aligned. The digits shown in bracket tells us about the objectives that can be integrated.
  • #38 e.g. In this example we can see a case which create a link between concepts of pathology, microbiology and internal medicine
  • #43 So we will see some examples integrated assessment after dr prassana will give you example of making time table for particular topic in detail.
  • #67 There are two types of assessments :- Formative and summative.
  • #68 In traditional assessment system we were not integrating assessments .But now MCI tells us to use integrated assessments. It tells us that more integration should be there in formative assessment.
  • #72  this is the example of case resolution which can be used to assess objectives in physiology and pathology related to topic anemia. It can be conducted as small group discussion in practical sessions.
  • #73 This is the example of reflective writing which can be used to assess objectives in physiology and pathology related to anemia . Here student is expected to reflect on experience taken in a particular situation (Experience is Visit to blood bank). This assessment can be conducted as reflective writing as a question in theory.
  • #74 In this example of integrated assignment for iron deficiency anemia which can be used to assess objectives from Pathology, Pharmacology and Internal medicine. This can be conducted during lecture or practical session.
  • #75 Similarly integrated MCQs can be conducted during lectures or practicals
  • #76 Here is the example of integrated structured essay which can be used to assess objectives in physiology and pathology related to anemia. Here structured assays can be given during lectures or practical sessions
  • #77 Here the example of integrated short answer on lab diagnosis of enteric fever which can be used to assess objectives from microbiology and Internal medicine. This can be conducted in lecture or practical session.
  • #78 Here it is example of Peripheral smear of iron deficiency anemia. Which can be used as integrated OSPE (Objective Structured Practical Examination)in practical session.
  • #79 Here the example of case of iron deficiency anemia. It can be used to asses objectives from pathology and Internal medicine can be assessed as integrated OSCE(Objective structured clinical examination) . This can be conducted in practical session.