Overview of Integrated Learning
Two Approaches
Horizontal Integration
Definition
Integration among a variety of disciplines in any
one year or each year of the medical education
program.
Approach
Early years courses are organized into blocks of
units with corresponding body systems such as
cardiovascular, respiratory, renal, gastrointestinal,
endocrine/reproductive, musculoskeletal.
Generally problem- based cases are constructed
with a one or two week focus and the cases are
organized by system blocks. However each case in
itself is integrated.
Students are required to draw knowledge, ideas
and concepts from across the disciplines to
generate and pursue learning goals.
Vertical Integration
Definition
Integration of disciplines taught in different phases
or years of the medical program. The disciplines
are organized into themes, which recur throughout
all years.
Approach
Generally, focuses on four main themes – cliché
and communication skills; basic and clinical
sciences; social, community and population health;
personal and professional development.
Achieved by using a spiral approach whereby a
theme is organized into sub-themes or blocks,
which provide the basis for integration across the
years of the course.
Students are introduced to clinical skills early in the
medical program and are developed alongside
basic and clinical sciences.
Key points
 Results in a more relevant, meaningful and student-centred curriculum.
 Important to match the integrated learning program with integrated learning contexts e.g.
clinical experiences in general practice, family medicine or primary care. Such contexts enable
students to experience a broad spectrum of illness to which they can apply the integrated
knowledge from the course studies.
 Curriculum designers are challenged to design learning tasks that enable students to construct
their learning in integrated ways.
 Construction of knowledge must be supported by a process of rigorous inquiry
Identified ways to facilitate students in constructing their learning in
an integrated manner
Study guides
Evidence of such within Present
UGME Curriculum
Yes
No
√
Working in small problem-based learning groups
√
Learning logs
√
Portfolios
√
Use of online materials
√
Independent projects
√
Pros of Integrated Learning
Focus on problem-based cases.
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UGME Alignment Based on Interim Accreditation Report
Positive Alignment with the Pros
Negative Alignment with the Pros
Presently offers problem-based learning
Resources are a challenge, especially
in Med I and Med II. Student satisfaction recruitment of a sufficient number of
Med 1 – 61% and Med II - generally
high quality tutors.
positive feedback.
The quality of the program is tutor
Overall, there are 156 Essential Clinical
Presentations for the clerkships although
there are some that are repeated (e.g.
abdominal pain).
dependent.
Additional and improved learning space
required.
Human beings have an inveterate need
to classify, organize, categorize, arrange,
systematize, subdivide, sort, tabulate;
these instincts are the driving force for
disciplines and sub disciplines.
UGME Alignment Based on Interim Accreditation Report
Positive Alignment with the Cons
Negative Alignment with the Cons
Student performance is assessed in a
While there is a system for ensuring that
variety of ways, including multiple choice mid-clerkship feedback to students is
internal exams, NBME subject exams,
provided in a timely manner, in two of
laboratory and practical exams, oral
the major specialties (surgery and
exams, presentations, papers, and
medicine), this is not done for one third
OSCEs. The simulation lab is particularly
to one half of the students.
well-developed and extensively used,
especially in assessing problem solving,
clinical reasoning, communication, and
other skills, behaviors, and attitudes.
The school has a self-developed course
management system, the Online Portal
for Advanced Learning.
Overall, there are 156 Essential Clinical
Presentations for the clerkships although
there are some that are repeated (e.g.
abdominal pain).
The basic science departments have an
excellent understanding of and
contribute directly to the school’s
mission and goals. The basic science
faculty who met with the team were
enthusiastic and no major problems were
identified in the institutional self-study or
in interviews. Their facilities and
resources were described as sufficient.
Contemplating unity and integration of
knowledge creates the possibility that we
will try to create connections when there
really are not any.
Clinical departments are all responsible
for medical education and their members
are currently actively engaged in the
educational mission.
Cons of Integrated Learning
In a vertically integrated curriculum there
must be effective evaluation strategies
that directly assess the curricular goals
and objectives and ensure valid
outcomes. There must be variety of
formative and summative assessments
including multiple-choice questions,
objective structured clinical
examinations, learning contracts.
Designing learning tasks that enable
student to construct their learning in
integrated ways. This is best achieved
through study guides, learning logs,
portfolios, online materials and
independent projects.
“Progress humankind has enjoyed has
come from the toil of specialists toiling in
their well-bounded disciplinary garden”.
The possibility of negative effects on
university faculty. Who would agree to
announce themselves as qualified to
teach across all the disciplines?
References
Balasooriya CD, Hughes C, Toohey S. Impact of a new integrated medicine program on students’
approaches to learning. Higher Education Research & Development. 2009;28(3):289-302.
http://connection.ebscohost.com/c/articles/37818992/impact-new-integrated-medicine-programstudents-approaches-learning/37818992
Bridge PD, Schenk M, Popp S. Evaluating a primary care vertically integrated curriculum in undergraduate
medical education. Fam Med 2000;32(8):525-7.
http://www.ncbi.nlm.nih.gov/pubmed?term=Bridge%20%5BAuthor%5D%20and%20%20Evaluating%20a
%20primary%20care/11002861
Dent T, Hardon RM. A Practical Guide for Medical Teachers 3rd Ed. New York: Elsevier, 2009.
Tritton TR. Integrated learning. Passing fad or foundation for the future? Ann N Y Acad Sci. 2001.
May;935:266-74. http://www.ncbi.nlm.nih.gov/pubmed?term=11411172
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