ادغام: ضرورت و انواع

1. ادغام: ضرورت و انواع دکتر محمد جلیلی مرکز مطالعات و توسعه آموزش دانشگاه mjalili@tums.ac.ir سمینار علمی پروژه بازنگری دوره علوم پایه (پزشکی 1390) و ادغام 6 اسفند 88- تالار ابن سینا

2. موضوعات • مقدمه • توصیه های سازمان های معتبر آموزشی در مورد ادغام • مبانی تئوری های یادگیری در مورد ادغام • انواع ادغام • اشکال ادغام • نردبان ادغام

3. مقدمه: سیر تحولات برنامه های آموزشی

4. Traditional curriculum • Schools that have traditional departmentally organized basic science curricula recognized (or suspected) many redundancies, content gaps, and failures to highlight the relationship pf a topic in one discipline to the same topic in another discipline (that lack of horizontal integration). • In addition, students (and even practicing physicians) considered large portions of the basic sciences irrelevant to clinical practice (that is lack of vertical integration). • Most schools approached the teaching of biopsychosocial issues as a series of separately taught courses

5. Course of developments • Within traditional undergraduate medical education the first terms usually concentrate on basic science and subsequent ones on clinical sciences and clinical training. • Development within medical education has led to efforts to integrate traditional basic science subjects such as physiology, chemistry and anatomy by teaching these related disciplines concurrently

6. Course of developments • In the later part of the twentieth century medical education reformers advocated the combination of the disciplines and the organization of integrated learning experiences for students • Horizontally integrated courses are becoming more popular as increasing number of medical schools around the world adopt PBL or case based learning approaches.

7. Course of developments • During the past decade, integrated curricula have become the norm in North American medical schools.

8. Medical curriculum reform in NA

10. توصیه های سازمان های علمی معتبر

11. Institutional • Integration has been emphasized by: • World Federation for Medical Education: • International standards for Basic Medical Education Programs (2003) • Association of American Medical Colleges: • GPEP report • Implementing the Vision(2006)

12. International standards Quality development: • Basic sciences and clinical sciences should be integrated in the curriculum. Annotations: • Integration of disciplines would include both horizontal (concurrent) and vertical (sequential) integration of curricular components. World Federation for Medical Education

13. Institutional • General Medical Council: • Tomorrow Doctors (1993 & 2003) • Carnegie Foundation for the Advancement of Teaching: • Calls for Reform of Medical Education: 1910 and 2010 (2010)

14. استانداردهای ملی پایه دوره پزشکی عمومی 6-2دانشكده پزشكي بايد برنامه مصوب دوره پزشكي عمومي خود را، با رعايت موارد زير بطور كامل اجرا كند. 1-6-2. آموزش سازمان يافته در خصوص اخلاق پزشكي، مهارت هاي برقراري ارتباط و عدالت در سلامت. 2-6-2. استفاده از راهبردهاي نوين در آموزش پزشكي (مانند ادغام علوم پايه و باليني، ادغام آموزش وارائه خدمات سلامت، انتخابي بودن دروس، آموزش در جهت نيازهاي آموزشي دانشجو، يادگيري مبتني بر مساله، آموزش رفتار حرفه اي، و جامعه محوري) طبق مصوبات مراجع ذيصلاح قانوني.

15. شواهد علمی

16. Cognitive theory • Cognitive theories of learning suggest that an integrated approach to education may have important benefits for learning and retention because it facilitates contextual and applied learning, and can promote development of the well organized knowledge structures that underlie effective clinical reasoning. Lessons learned about integrating a medical school curriculum: perceptions of students, faculty and curriculum leaders. Medical Education 2008: 42: 778–785

17. one study • students trained within an integrated curriculum made more accurate diagnoses than did students trained in a conventional curriculum Schmidt HG, Machiels-Bongaerts M, Hermans H, ten Cate TJ, VenekampR, BoshuizenHP. The development of diagnostic competence: comparison of a problem-based, an integrated, and a conventional medical curriculum Acad Med 1996;71: 658–64.

18. Another study • vertical integration between basic sciences and clinical medicine in problem-based learning curricula stimulated better understanding of biomedical principles than did conventional curricula, Dahle LO, Brynhildsen J, BehrbohmFallsberg M, Rundquist I, Hammar M. Pros and cons of vertical integration between clinical medicine and basic science within a problem-based undergraduate medical curriculum: examples and experiences from Linkoping, Sweden. Med Teach 2002;24 (3):280–5.

19. Student support • The most frequently mentioned reasonwhy medical students from Harvard appreciated their studieswas the emphasis on integration between basic science andclinical medicine (Wilkerson & Abermann,1993)

20. استراتژي هاي آموزشي Teacher centered Information gathering Discipline based Hospital based Standards course Apprenticeship SPICES model Student centered Problem based Integrated Community oriented Electives Systematic

21. Integration in assessment • Investing time in changing from discipline-based to integrated assessment, integrating theory and practice, resulted in gains in assessment reliability, validity and educational impact on both staff and students. Evaluating the impact of moving from discipline based to integrated assessment. Medical Education 2004; 38: 832–843

22. انواع ادغام

23. Types of integration-I • Horizontal • coordination of presentationson relevant topics, that would traditionally have beencovered in different courses in the same contiguousblock of time, is being seen as a way to achieve aconceptual framework with “horizontal integration • Vertical • The addition of relevant information from those disciplinestraditionally covered at the end of the basicscience years, or only when the students were “on thewards,” provides for “vertical integration” Vidic B, Weitlauf HM. Horizontal and vertical integration of academic disciplines in the medical school curriculum. ClinAnat 2002;15:233–5.

24. Horizontal and vertical integration

25. Types of integration-II • Within the basic sciences • The basic sciences and clinical sciences • The humanities and biopsychosocial sciences within the other two

26. Within the basic sciences • Subtype 1: • Normal structure & function in first part • Abnormal structure & function in second part • Subtype 2: • Normal and abnormal within single course • Horizontal integration around: • Organ systems • Life cycle

27. The basic sciences and clinical sciences • Clinical in basic: • PBL learning format in PBL curricula • Cased based learning in small groups, lab work • Physical examination aligned with related anatomy courses • Courses co-taught by clinical faculty members • Community based experiences during basic science period • Basic in clinical: • Seminar series on basic sciences during clerkship phase • Learning sessions on basics sciences during clerkship • Return to the classrooms

28. The humanities and biopsychosocial sciences within the other two • Such issues as: • Ethics • Communication skills • Preventive medicine • Public health • ……. • By Introduction of courses such as medicine and society • Usually throughout the basic and clinical phases

29. طیف ادغام

30. Integration ladder • Discussions about integrationare often polarized with some teachers arguing in favorand others against integrated teaching. • Thequestion to be asked of teachers and curriculum designersis not whether they are for or against integration,but rather where on the continuum between the twoextremes should they place their teaching.

31. Integration ladder

32. Different stages of integration

33. جمع بندی • شواهد بسیار متنفی وجود دارد که یکی از رویکردهای اساسی در بحث بازنگری دوره پزشکی عمومی موضوع ادغام می باشد. • ادغام دارای اشکال و انواع مختلفی است. • انتخاب شکل و نوع مناسب ادغام متناسب با شرایط محلی یک ضرورت است. • ادغام آخر مسیر بازنگری نیست بلکه به نوعی شروع آن محسوب می شود. بنابر این تداوم برخی از مشکلات در کنار بروز مشکلات جدید دور از انتظار نیست.