Dr. Rehmah Sarfraz is the Head of the Department of Medical Education at Islamabad Medical & Dental College. She gave a presentation on integrated curriculum at the 3rd contact session of SZABMU CHPE on November 19, 2020. The presentation covered the history and models of curriculum, definitions and types of integration, principles of an integrated curriculum, and 12 tips for developing an integrated curriculum. The objectives were to outline curricular models, differentiate between vertical and horizontal integration, distinguish integration levels, and identify principles and tips for an integrated curriculum.

2. Dr. Rehmah Sarfraz
MBBS, M.Phil (Anatomy), MHPE
Professor of Anatomy
Head Department of Medical Education
Islamabad Medical & Dental College (IM&DC), Islamabad
Email Address: rehmah.sarfraz@imdcollege.edu.pk
drrehmahsarfraz-chpe@szabmu.edu.pk
Integrated
Curriculum
19th November, 2020
SZABMU CHPE 3rd Contact Session

3. • Objectives
• History of curriculum
• Curricular Models
• What is integration?
• Types of integration
• SPICES
• Principles
• Integration ladder
• Issues
• Activity
• Twelve tips for development of integrated curriculum
• Take home message

4. Ground Rules
• Keep the cell phone on silent mode.
• Switch on the camera.

5. Objectives
By the end of this session all participants will be able to:
• Outline the salient features of curricular models.
• Differentiate between vertical and horizontal integration.
• Distinguish between different levels of integration.
• Identify the principles of integrated curriculum.
• Use tips to develop an integrated curriculum.

6. History of Curriculum
• Curriculum: Derived from Latin word meaning “to run”
• Currere (verb): “to run or to proceed”
• The first known use in an educational context is by Professor Regia, a
work by University of Paris - Professor Petrus Ramus published
posthumously in 1576

7. Curriculum
• Myth-buster: Syllabus and curriculum
• Planned educational experience or activity
Extended version of
curriculum

8. Curricular Models

9. 1. Apprenticeship-based Model (Shadowing)
• Modelling: Observation by learner
• Coaching: Watch the learner practice, offer them guidance, critique
and feedback
• Scaffolding: Increase complexity of work undertaken by learner while
slowly fading out your input
• Articulation: Encourage learner to talk; what they are doing, why and
how providing rationale for the approaches taken
• Reflection: Analysis and comparison of learner’s performance with
expert-identify the gap
• Exploration: Provide new opportunities, prompt the learner to be
independent

10. 2. Outcome-based Model (OBE):
• Broad learning outcomes are clearly defined
• Decisions related to curriculum are based on specified learning
outcomes (e.g. content, strategies, assessment)
• Shift from process product
• Top bottom approach

11. 3. EPA-based Model
(Entrustable Professional Activity):
• Tasks or responsibilities to be entrusted to the unsupervised
execution by a trainee once he or she has attained sufficient specific
competence:
-Observation but no execution by the trainee, even with direct
supervision
-Execution with direct, proactive supervision
-Execution with reactive supervision, i.e., on request and quickly
available
-Supervision at a distance
-Supervision provided by the trainee to more junior colleagues

12. What is ?
“Integration is the organization of teaching matter to
interrelate or unify subjects frequently taught in
separate academic courses or departments.”
Harden et al., 1984
“Information in isolation is inert and unhelpful.”
Regehr and Norman, 1996

13. Types of Integration
1. Horizontal:
Information during same curricular
phase/year is taught together
Organized into blocks or units
corresponding to body systems
Basic
Sciences
Clinical
Sciences

14. Example of horizontal integration:
Musculoskeletal
Gastrointestinal
Cardiovascular
Renal
Reproductive
Anatomy, Physiology, Biochemistry along with their applied aspects

15. 2. Vertical:
Information in various curricular phases is taught together, focused
around key concepts or themes which run throughout all years-
revisiting of knowledge
Early introduction of clinical skills and their development alongside
basic sciences
Types of integration

16. • Clinical and communication skills
• Basic and clinical sciences
• Social, community and population health
• Law, ethics and professionalism
Example of vertical integration:

17. 18
Horizontal
Integration
Pathology
Pharmacology
Therapeutics

18. Example
An excess loss of water and electrolytes because of diarrhea can
result in changes in other body systems such as conservation of water
and electrolytes by the kidneys, a thirst response in the brain triggered
by hormones & a stress response by the cardiovascular system to
maintain adequate blood pressure.

19. Some facts about integration…
• Bridges the practice-theory gap.
• Teaching and learning methods will facilitate this process.
• Curriculum organization plays a vital role.
• Integration is within the brain of learner.

20. 21
Abraham
Flexner
Ronald M.
Harden

21. SPICES Model of Educational Strategies: A tool
for planning/evaluating curriculum
The place where a given curriculum stands within the above continuum is
dependent upon multiple factors such as outcomes, readiness of the students and
staff and practical logistics

22. Spiral approach for Integrated Curriculum

23. “When students learn complex tasks in an integrated manner, it will be
easier for them to transfer what they have learned to the reality of
day-to-day work settings.”
Janssen-Noordman et al-2006

24. Principles of Integration
1. Focus on key issues:
• Promotes learning in context
• Adopts holistic approach
• Focuses around core curriculum
2. Enhances construction of knowledge:
• Integration
• Deep understanding of new concepts
• Identification of gaps
• Problem-solving approach

25. 3. Promotes application of knowledge in real life situation:
• Learning through problems
• Using the knowledge gained to solve new problems /new situations
• Getting feedback and improving the learning
4. Fosters critical thinking and life long thinking skills:
• Interpreting data
• Searching evidence
• Making decisions
• Finding relationships
5. Enforces staff development:
• Improving teaching skills
• Mastering new techniques
• Giving constructive feedback

26. Integration Ladder
Ronald M. Harden, 2000

27. 1. Isolation (Fragmentation/Anarchy):
Teaching is organized without consideration of other subjects or disciplines.
2. Awareness:
Teacher in one subject is made aware of what is covered in other subjects.
No explicit attempt to help the student to take integrated view.
3. Harmonization (Connection/Consultation):
Teachers responsible for different courses or different parts of the same course consult
each other and communicate about their course.
The disciplines remain separate but the teacher may make explicit connections within the
subject area to other subject areas

28. 4. Nesting (Infusion):
Teacher targets within a subject-based course,
Generic skills and skills relating to other subjects.
Content drawn from different subjects in the curriculum may be used to enrich the
teaching of one subject.
Nesting in Pathology course which introduces aspects of clinical medicine to demonstrate
the application of pathological principles-develop problem solving skills
5. Temporal Coordination (Parallel teaching/Concurrent teaching):
Each subject remains responsible for its own teaching programme.
The timings of teaching of topics within a subject is however is done in consultation with
other disciplines.

29. 6. Sharing (Joint teaching):
Two disciplines may agree to plan and jointly implement a
teaching programme.
Involvement of two disciplines with overlapping concepts.
Community child health programme run jointly by Community Medicine and
Paediatrics departments
7. Correlation (Concomitant programme/Democratic programme):
An integrated teaching session is introduced in addition to
subject-based teaching.
The emphasis remains on subjects.

30. 8. Complementary (Mixed programme):
Integrated sessions represent a major feature of
Curriculum.
Subject-based curriculum still exists.
9. Multi-disciplinary (Webbed/Contributory):
It brings together a number of subject areas in a single course
with themes, problems, topics or issues as the focus for the
students’ learning.
Whatever the nature of the theme, it is viewed through the lens of subjects or
disciplines.

31. Block: Endocrine
System
Module: Thyroid
Anatomy:
Thyroid gland
(Gross, microscopic
& developmental
features)
Physiology:
Synthesis &
regulation of TH
Pathology:
Underlying disease
process
Pharmacology:
Anti-thyroid drugs
Surgery:
Management of
goiter
Medicine:
Clinical
manifestations &
investigations
Multidisciplinary

32. 10. Inter-disciplinary (Monolithic):
A study of a phenomenon that involves the use of two or
more academic disciplines simultaneously.
Content of all or most subjects combined into a new course with a new menu.
There may be no reference to individual disciplines/subjects.
Subjects are not identified in the time table.
11. Trans-disciplinary (Fusion/Immersion/Authentic):
There is only one subject-LIFE
The teacher provides a structure/framework of learning opportunities but
integration is done in the mind of student, based on hi-fidelity situations in the real
world of clinical care.

33. • Dundee model (1-3 years of integrated around body systems, 4-5
years students are attached for periods of time to a range of
specialties in the hospital & community, 113 clinical problems/tasks
with guide).
• Authentic: Learning occurs in real world
• Fusion: Complete integration with mastery of competencies related to
tasks
• Immersion: Disciplines become part of learner’s experience

34. Steps 1-4 (Isolation, awareness, harmonization, nesting):
Emphasis is on disciplines
Steps 5-10 (Temporal coordination, sharing, correlation,
complementary, multi-disciplinary, inter-disciplinary):
Emphasis is on integration across several disciplines
Step 11 (Trans-disciplinary):
Emphasis is on student taking responsibility for learning and being
given the tools to do that.

35. • Leader
• Vision
• Build on the status quo
• Clarity of stake holders
• Faculty involvement
• Logistics
• Journey which needs a long-term strategic approach

36. Twelve Tips for Developing an Integrated
Curriculum
Alam Sher Malik & Rukhsana Hussain Malik, 2011

37. 1. Train the staff members
2. Decide on scope of integration
3. Choose the level of integration
4. Go for both vertical & horizontal integration
5. Establish working groups & calculate their
responsibilities
6. Determine the learning outcomes

38. 7. Identify the contents (knowledge, skill & attitude)
8. Create themes
9. Prepare a comprehensive timetable
10. Select assessment methods
11. Communicate with students and staff
12. Commit to re-evaluation and revision