ادغام: ضرورت و

انواعدکتر محمد جلیلی

مرکز مطالعات و توسعه آموزش دانشگاه

mjalili@tums.ac.ir

سمینار علمی پروژه بازنگری دوره علوم ( و ادغام1390پایه )پزشکی

- تاالر ابن سینا88 اسفند 6

مقدمه

توصیه های سازمان های معتبر آموزشی در

مورد ادغام

مبانی تئوری های یادگیری در مورد ادغام

انواع ادغام

اشکال ادغام

نردبان ادغام

موضوعات

مقدمه: سیر تحوالت برنامه های آموزشی

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

Traditional curriculum

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

Course of developments

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.

During the past decade, integrated curricula have become the norm in North American medical schools.

Course of developments

Apprenticeship

Discipline

based

Organ system

Problem

based

Clinical present

ation

Medical curriculum reform in NA

1765.… - 1871…- 1951…- 1971.…- 1991…-

توصیه های سازمان های علمی معتبر

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)

Institutional

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

International standards

General Medical Council: ◦ Tomorrow Doctors (1993 & 2003)

Carnegie Foundation for the Advancement of Teaching: ◦ Calls for Reform of Medical Education:

1910 and 2010 (2010)

Institutional

دانشكده پزشكي بايد برنامه مصوب دوره پزشكي عمومي خود 6-2 .را، با رعايت موارد زير بطور كامل اجرا كند

آموزش سازمان يافته در خصوص اخالق پزشكي، مهارت هاي .1-6-2.برقراري ارتباط و عدالت در سالمت

ادغام استفاده از راهبردهاي نوين در آموزش پزشكي (مانند .2-6-2، ادغام آموزش وارائه خدمات سالمت، علوم پايه و باليني

انتخابي بودن دروس، آموزش در جهت نيازهاي آموزشي دانشجو، يادگيري مبتني بر مساله، آموزش رفتار حرفه اي، و جامعه

.محوري) طبق مصوبات مراجع ذيصالح قانوني

استانداردهای ملی پایه دوره پزشکی عمومی

شواهد علمی

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.

Cognitive theory

Lessons learned about integrating a medical school curriculum: perceptions of students, faculty and curriculum leaders. Medical Education 2008: 42: 778–785

students trained within an integrated curriculum made more accurate diagnoses than did students trained in a conventional curriculum

one study

Schmidt HG, Machiels-Bongaerts M, Hermans H, ten Cate TJ, Venekamp R, Boshuizen HP. The development of diagnostic competence: comparison of a problem-based, an integrated, and a conventional medical curriculum Acad Med 1996;71: 658–64.

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, Behrbohm Fallsberg 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.

Another study

The most frequently mentioned reason why medical students from Harvard appreciated their studies was the emphasis on integration between basic science and clinical medicine

(Wilkerson & Abermann, 1993)

Student support

استراتژي هاي آموزشي

Teacher centeredInformation gathering Discipline basedHospital basedStandards courseApprenticeship

Student centeredProblem based

IntegratedCommunity oriented

ElectivesSystematic

SPICES model

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.

Integration in assessment

Evaluating the impact of moving from discipline based to integrated assessment. Medical Education 2004; 38: 832–843

انواع ادغام

Horizontal◦ coordination of presentations on relevant topics,

that would traditionally have been covered in different courses in the same contiguous block of time, is being seen as a way to achieve a conceptual framework with “horizontal integration

Vertical ◦ The addition of relevant information from those

disciplines traditionally covered at the end of the basic science years, or only when the students were “on the wards,” provides for “vertical integration”

Types of integration-I

Vidic B, Weitlauf HM. Horizontal and verticalintegration of academic disciplines in the medicalschool curriculum. Clin Anat 2002;15:233–5.

Horizontal and vertical integration

Within the basic sciences

The basic sciences and clinical sciences

The humanities and biopsychosocial

sciences within the other two

Types of integration-II

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

Within the basic 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

The basic sciences and clinical sciences

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

The humanities and biopsychosocial sciences within the other two

طیف ادغام

Discussions about integration are often polarized with some teachers arguing in favor and others against integrated teaching.

The question to be asked of teachers and curriculum designers is not whether they are for or against integration, but rather where on the continuum between the two extremes should they place their teaching.

Integration ladder

Integration ladder

Different stages of integration

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 مشکالت در

کنار بروز مشکالت جدید دور از انتظار نیست.

جمع بندی