Students' perception of vertical integration for topics of applied anatomy in 1st year MBBS

Shalini Kumar; Musharraf Hussain

doi:10.4103/JASI.JASI_91_19

ORIGINAL ARTICLE

Year : 2019 | Volume : 68 | Issue : 4 | Page : 295-298

Students' perception of vertical integration for topics of applied anatomy in 1^st year MBBS

Shalini Kumar¹, Musharraf Hussain²
¹ Department of Anatomy, Hamdard Institute of Medical Sciences and Research (HIMSR), Delhi, India
² Department of Surgery, MEU Coordinator, Hamdard Institute of Medical Sciences and Research (HIMSR), Delhi, India

Date of Submission	12-Jul-2019
Date of Acceptance	18-Jan-2020
Date of Web Publication	28-Feb-2020

Correspondence Address:
Dr. Shalini Kumar
Department of Anatomy, Hamdard Institute of Medical Sciences and Research (HIMSR), Delhi - 110 062
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JASI.JASI_91_19

Abstract

Introduction: There is a rapid change in medical education around the world; as a result, the Medical Council of India (MCI) has put forward guidelines for various medical colleges for effective and need-based curriculum for MBBS. Integrated teaching is most important aspect of this modified competency-based curriculum. Hence, the aim is to introduce the vertical integration and assess the students' perception for topics of applied anatomy in 1^st year MBBS students. Material and Methods: A prospective study was conducted on 93 1^st year MBBS students who consented for this study in the Department of Anatomy, HIMSR, Delhi, after getting approval from the institutional ethics committee. Integrated lectures for two applied anatomy topics were conducted by the faculty of anatomy and surgery. Questionnaire was provided for the feedback of the students. Results: A total of 93 MBBS students participated. Eighty-two percent of students like the session of integrated teaching and found it very useful to understand the topic. Seventy-three percent of students appreciated content, methods, and presentation of integrated teaching session, and hence, the learning objectives were achieved. Seventy-eight percent of students strongly agreed that integrated teaching helped them in better retention of topic. Eighty percent of students strongly felt that integrated teaching method should be incorporated as teaching–learning methods for some more topics of applied importance. Discussion and Conclusion: The students recognized the importance of integrated teaching. They found this session interesting and wish that these should be continued for other topics also regularly and frequently. Hence, integrated teaching should be implemented in medical curriculum for effective teaching.

Keywords: Competency-based curriculum, medical education, vertical integration

How to cite this article:
Kumar S, Hussain M. Students' perception of vertical integration for topics of applied anatomy in 1^st year MBBS. J Anat Soc India 2019;68:295-8

How to cite this URL:
Kumar S, Hussain M. Students' perception of vertical integration for topics of applied anatomy in 1^st year MBBS. J Anat Soc India [serial online] 2019 [cited 2023 Mar 29];68:295-8. Available from: https://www.jasi.org.in/text.asp?2019/68/4/295/279745

Introduction

Integrated teaching allows medical students to gather, explore, refine, and integrate the adopted knowledge for better implementation in clinical practice.^[1] Recently, the MCI has encouraged integrated teaching and early clinical exposure in its reform.^[2] Nowadays, owing to newer teaching modalities, there is an urgent need for clinical application in teaching and learning anatomy.^[3] In our present medical curriculum, each subject is taught separately in the respective department in an isolated manner. Hence, the present undergraduate curriculum is fragmented and discipline based.

There is little scope for the students to correlate the applied aspect of knowledge. Furthermore, in conventional teaching, some common topics are repeated thus a need-based curriculum for undergraduate medical education in India came into existence.^[4] Thus, certain topics of applied or clinical importance can be taught with the help of integration.

The integrated teaching will encourage interest and better retention of knowledge and hence its clinical correlation. Moreover, in anatomy teaching for the 1^st year medical students, more emphasis should be given for clinical anatomy which will help them correlate their anatomical knowledge for understanding clinical condition in their clinical years.

Integration is the organization of teaching methods to interrelate subjects taught in separate departments. The integration ladder is a useful tool for medical teacher and can used as an aid in developing, implementing, and evaluating the medical curriculum.^[5]

Integration can be done in two ways:

Horizontal integration – two or more departments teaching concurrently and merge their educational identity
Vertical integration – integration between disciplines traditionally taught in different phases of curriculum.^[6]

In our institute, we were having traditional subject-based curriculum where the students were largely dependent on memorizing facts and did not correlate their learning with applied aspect. There is a high need that the student should correlate their learning in basic sciences with the clinical sciences.^[7]

Aims and objectives

The aim was to introduce the vertical integration and assess the students' perception for topics of applied anatomy in 1^st year MBBS students.

Methodology

The project was carried out in the Department of Anatomy, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, from November 2018 to February 2019. After approval from the institutional ethical committee, informed consent was obtained from 93 1^st year MBBS students participating in the study. The time table was framed, meeting for the topics selected varicose veins and lymphedema was done with the head of the department of surgery, anatomy curriculum committee members, and medical education unit. Learning objectives were set and integrated lecture of 2 h by joint teaching was decided to be taken. Departmental faculty and students were sensitized to vertical integration by discussing with them about this method. Students were also informed about the learning objectives. Prevalidated questionnaire and feedback forms for the students were finalized with the help of the faculty of the department of anatomy, surgery, and medical education unit. Integrated session on selected topics of applied anatomy in the lower limb region was planned. Conventional anatomy lectures of the lower limb region were taken along with the cadaver dissection in anatomy department by anatomy faculty for the duration of 2 months. After that integrated teaching session for the selected topics was taken by showing them clinical case where photos of the varicose veins were shown, clinical features, examination, clinical tests for varicose veins, perforators of great saphenous vein, Trendelenburg's test, Perthes test along with the differential diagnosis for inguinal and lower limb swellings were discussed. The session was taken by both anatomy and surgery faculties.

The total duration was 1 h for each topic. After the session, an interactive session of about 15 min was conducted. At the end, the feedback of the students was taken by a prevalidated questionnaire.^[8] The questionnaire consisted of students' perception and feedback on the vertical integration session. Statistical analysis was done by expressing the responses to the questionnaire on the Five-point Likert scale as frequencies. The computer program Microsoft Excel version 10 and SPSS (Version 22, SPSS Inc., Chicago, USA) was used for the statistical analysis.

Results

Ninety-three students who consented for the study responded by filling all the questions of questionnaire. The analysis of results shows that 82% of students strongly agreed that the session of integrated teaching was useful to them. About 78.5% of students strongly agreed that integrated teaching program should be made part of curriculum of basic sciences. 60.2% students strongly felt that integrated teaching has motivated them to read more about the topic. This method helped in understanding the topic better was strongly supported by 78.5% of students. 77.4% of students strongly agreed that this method had helped them in better retention of the topic. Eighty-two percent of students agreed that there was teacher–student interaction [Table 1].{Table 1}

Discussion

Integration means to unite, coordinate, or blend into a functioning or unified whole. There is a high need to integrate several topics, especially in preclinical subjects with the clinical subjects. In traditional curriculum, the topics are taught by each department at different times without any knowledge what other departments are teaching at the same time. Horizontal integration combines or links the disciplines at a given stage of conventional curriculum. Thus, it includes combined teaching of anatomy, physiology, and biochemistry. Vertical integration, on the other hand, links the subjects which are conventionally taught at different stages. Thus, teaching anatomy with surgery or physiology with medicine would be an example of vertical integration.^[9]

This study shows that integrated teaching is possible even in 1^st year MBBS and is effective for better understanding of topic and improvement in learning by integration of subjects.

Our results show that integrated teaching was perceived to be highly useful to the majority of students. About 78.5% of students strongly agreed that this method helps them in understanding the topic better, and this should be made a part of curriculum of basic sciences. Overall impact of the session was positive as 84% of students strongly agreed that the method was useful in studying clinical subjects later. They all were satisfied with this session and preferred integrated lecture as compared to conventional lecture. Most of the students found the lecture to be interesting and easy to understand as has been suggested by other studies.^{[10],[11],[12],[13]}

Similar studies were also conducted in physiology by Shah et al. where integration was done in anatomy, physiology, and pharmacology.^[14] They observed that 80.6% of students appreciated content, method, and presentation of integrated teaching module. Almost 83.67% of students wanted integrated teaching program for regular teaching every month. Out of 144 students, only 7 students were not in favor of integrated teaching.

Another study where integrated lectures from anatomy and physiology for topic autonomic nervous system were done where 84% of students were in favor of these types of integrated lecture and 80% felt that such sessions increased their understandability.^[15] Similarly, in our study, 80% of the students strongly agreed that this method should be incorporated as teaching–learning methods for some more topics of applied importance. As this form of teaching was new to students, it created enthusiasm among the 1^st year MBBS students. Thus, integrated teaching can enhance teacher–student interaction, reducing redundant content, and integrate disciplines.

This study showed that it was feasible to adopt integrated teaching under a conventional curriculum. It will further help in improving the clinical application. The students will be able to correlate the basic sciences with clinical sciences.

The limitation of study was its short duration and only two topics of applied importance were selected. If this duration of study is increased, then it will be possible to arrange more integrated topics in future. This type of integrated teaching requires a lot of planning by faculty and to formulate modules for integrated teaching.

After the integrated teaching session, the faculty has become more confident in organizing such sessions, and moreover, the students will also benefit from such sessions. The students will be motivated for reading clinical topics, correlate them with anatomy, and hence will give them confidence in seeing clinical cases in final year. Moreover, the interdepartmental collaboration can be promoted by these sessions.

Conclusions

The present study clearly states that desired objectives can be accomplished by joint efforts of the clinicians and anatomists. The MCI in its Vision 2015 has advocated integrated teaching. Integrated teaching, though challenging, is a way to motivate students and help in better retention of the knowledge. Including more such integrated interactive sessions will prove to be significant and an effective tool for teaching and learning.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Harden RM. Integrated teaching: what do we mean? A proposed taxonomy. Med Edu 1998;32:2167.
2.	MCI Booklet:Vision 2015. Available from: www.mciindia.org MCI_booklet.pdf. [Last Accessed on 2018 Aug 03].
3.	Vyas R, Jacob M, Faith M, Isaac B, Rabi S, Sathishkumar S, et al. An effective integrated learning programme in the first year of the medical course. Natl Med J India 2008;21:21-6.
4.	Medical Council of India. Salient Features of Regulation on Graduate Medical Education; 1997.
5.	Harden RM, Sowden S, Dunn WR. Educational strategies in curriculum development: The SPICES model. Med Educ 1984;18:284-97.
6.	Raman VL, Raju SK. Study on effectiveness of integrated lecture module versus didactic lecture module in learning skills. IOSR J Dent Med Sci 2015;14:14-6.
7.	General Medical Council. Tomorrow's Doctor: Recommendation on Undergraduate Medical Education London: General Medical Council; 1993.
8.	Sawant SP, Rizvi S. Role of clinical anatomy in first MBBS curriculum. MOJ Anat Physiol 2017;3:1-5.
9.	Curriculum Implementation Support Program, Medical Council of India; May 2012.
10.	Malik AS, Malik RH. Twelve tips for developing an integrated curriculum. Med Teach 2011;33:99-104.
11.	Lohitashwa R, Narendra SS, Mufti M. Evaluation of impact of integrated teaching over didactic lecture on student learning. J Educ Res Med Teach 2014;2:14-6.
12.	Dandannavar VS. Effect of integrated teaching versus conventional lecturing on MBBS phase I students. Recent Res Sci Technol 2010;2:40-8.
13.	Spencer AL, Brosenitsch T, Levine AS, Kanter SL. Back to the basic sciences: an innovative approach to teaching senior medical students how best to integrate basic science and clinical medicine. Acad Med 2008;83:662-9.
14.	Shah S, Saiyad S, Mahajan N. Introduction of integrated teaching in 1^st MBBS: Perspective of students. Int J Basic Appl Physiol 2014;3:277-80.
15.	Singh A, Min AK, Ghosh S. Introduction of an integrated interactive lecture in the early blocks of 1^st year medical students: A pilot study. Med J DY Patil Uni 2016;9:484-8.