Presented by Dr Amir Maroof Khan and Dr Dinesh Kumar in IAPSM Preconference workshop held on 16th March 2021 - online. Focused on Community Medicine. Workshop convener: Dr Pankaj Shah

1. IAPSMCON 2021
Pre Conference CME
Integration
Presented by:
Dr Amir MK, Professor, Community Medicine, UCMS and GTB
Hospital, University of Delhi, Delhi
Dr Dinesh K, Professor, Community Medicine, PS Medical
College, Bhaikaka University, Karamsad
Date of presentation: 16 March 2021

2. 2

3. Acknowledgement
• Dr Somdatta Patra

4. Objectives of the session
At the end of this session participants should be
able to
-discuss some common methods of integration
-apply these methods in own teaching context

6. Fig. Steps and oversight required in development of aligned and integrated topics

7. What is alignment?
Alignment implies the
teaching of
subject material
that occurs under a
particular organ system/
disease concept
from the same phase in the
same time frame i.e.,
temporally.

8. What is integration?
Integration implies that concepts in a
topic / organ system that are
similar,
overlapping
or redundant
are merged into a single teaching
session in which subject based
demarcations are removed

9. What is not integration?
1 hour
1 hour
Medicine
Community
Medicine
Community
Medicine
Medicine
1 hour

11. Horizontal vs Vertical
• When integration takes place among the subjects
being taught in the same phase, it’s horizontal
integration
• When integration takes place among the subjects
taught across in different phases, it’s vertical
integration

12. Advantages of integration
• Can avoid redundancy
• Promote contextual learning
• Meaningful and relevant learning
• Correlation of contents between basic and
clinical sciences
• Better retention (Rosse – 1974)
• Promotes faculty communication
Reference: Academic Cell, Medical Council of India. Curriculum implementation
support program. Presentation on Integration.

13. Steps of integration

14. Techniques to integrate: CBME
• Sharing
• Nesting
• Correlation

16. Integration
• Plan jointly - Begins, when you plan your teaching session
• A meaningful outcome – agreed upon mutually
• Recommended techniques of integration – to be used
• Prerequisites – The SLOs of the competencies must be
ready with the departments which are planning to
integrate a topic
16

17. SOME COMMONLY USED INTEGRATION
STRATEGIES ….

18. 1. Symposium/ panel discussions
Basu M, Das P, Chowdhury G. Introducing integrated teaching and comparison with traditional
teaching in undergraduate medical curriculum: A pilot study. Med J DY Patil Univ 2015;8:431-8

19. 2. Case based discussions
• A 9 months old boy was brought by grandmother to a PHC
for being very weak and not yet able to sit up. On
examination the baby was found to have very low weight
[5kg], bloated abdomen and brownish hair. The child had
not received any vaccine.
1. Comment on the development status of the child.
2. What could be the most likely reason for his condition?
3. What is likely explanation for his bloated abdomen?
4. What other measurement should be taken to rule out
any immediate danger to the child?
5. What is the best advise related to vaccination of the
child?
19

20. Limitations of these
• Feasibility issue
• Competencies not linked
• Uniform standard not maintained i.e. which
competency to be integrated etc.

21. Sharing
Subject A (Competency n.n) Subject B (Competency n.n)
SLO a1 SLO b1
SLO a2 SLO b2
SLO a3 SLO b3
SLO a4 SLO b4
SLO a5
21

22. Sharing
Subject A (Competency n.n) Subject B (Competency n.n)
SLO a1 SLO b1
SLO a2 SLO b2
SLO a3 SLO b3
SLO a4 SLO b4
SLO a5
22

23. Sharing
Subject A (Competency n.n) Subject B (Competency n.n)
SLO b1
SLO a2 SLO b2
SLO a3 SLO b3
SLO a4
SLO a5
Remove redundancy
23

24. Sharing & Nesting example
CM 5.3 - Define and describe common
nutrition related health disorders (including
macro-PEM, Micro-iron, Zn, iodine, Vit. A),
their control and management
IM9.14 - Describe the national programs for
anemia prevention
SLO1 – Define anemia SLO1 – Enumerate the objectives of
National Anemia prophylaxis program
(NAPP)
SLO2- Define Protein energy malnutritoin SLO2 – Describe the strategies of NAPP
SLO3 – Describe the anemia control
strategy in India
SLO3 – Discuss the anemia prophylaxis
regimen for pregnant women
SLO4 – Describe the management of an
anemic pregnant mother
SLO4 – Discuss the anemia treatment
regimen for pregnant mother

25. Sharing
CM 5.3 - Define and describe common nutrition related
health disorders (including macro-PEM, Micro-iron, Zn,
iodine, Vit. A), their control and management
IM9.14 - Describe the national programs for anemia
prevention
SLO1 – Define anemia SLO1 – Enumerate the objectives of National Anemia
prophylaxis program (NAPP)
SLO2- Define Protein energy malnutritoin SLO2 – Describe the strategies of NAPP
SLO3 – Describe the anemia control strategy in India SLO3 – Discuss the anemia prophylaxis regimen for
pregnant women
SLO4 – Describe the management of an anemic pregnant
mother
SLO4 – Discuss the anemia treatment regimen for
pregnant mother
SLO5 – Define anemia (nested from CM5.3)
Nesting

26. Nesting
Subject A (Competency n.n) Subject B (Competency n.n)
SLO a1 SLO b1
SLO a2 SLO b2
SLO a3 SLO b3
SLO a4 SLO b4
SLO a5
26

27. Nesting
Subject A (Competency n.n) Subject B (Competency n.n)
SLO a1 SLO b1
SLO a2 SLO b2
SLO a3 SLO b3
SLO a4 SLO b4
SLO a5
27

28. Nesting
Subject A (Competency n.n) Subject B (Competency n.n)
SLO a1 SLO a3
SLO a2 SLO b1
SLO a3 SLO b2
SLO a4 SLO b3
SLO a5 SLO b4
Introduction
Reinforcement
28

29. Correlation
Subject A (Competency n.n) Subject B (Competency n.n)
SLO a1 SLO b1
SLO a2 SLO b2
SLO a3 SLO b3
SLO a4 SLO b4
SLO a5
29

30. Correlation
Subject A Subject B
SLO a1 SLO b1
SLO a2 SLO b2
SLO a3 SLO b3
SLO a4 SLO b4
SLO a5
LINKER CASE
30

31. Linker case – must be relevant for more than one discipline
• A 42 year old man visits a primary care physician complaining of
shortness of breath and weakness. He also complains of weight loss,
and fever since the last two months. The doctor asks for an X-ray to
be done and complete hemogram. He is an occasional smoker, works
as a factory worker, with family income of 10000 per month. He lives
in a nuclear 3-member family, his wife is pregnant, and there is a
four year old child in the family.
• He returns after one week with the investigation reports. There is
evidence of pleural effusion in his X-ray report.
• The physician prescribes the medicines and asks him to report after
one week.

32. Next step
• Look at the competency table of CM and see which
competencies are needed for this case
• Ask the faculty from other specialties which you think
are needed for this case
• Then identify the specific SLOs which are to be covered
in the ‘integration session’
• Never lose sight of the case and the IMG

33. Linker case – relevant competencies
• Competencies of Community Medicine:
• CM8.1 - Describe and discuss the epidemiological and control measures
including the use of essential laboratory tests at the primary care level for
communicable diseases
• CM8.3 - Enumerate and describe disease specific National Health Programs
including their prevention and treatment of a case
• Competencies of Microbiology:
• MI8.4 - Describe the etiologic agents of emerging Infectious diseases.
Discuss the clinical course and diagnosis
• Competencies of General Medicine:
• IM4.9 - Elicit document and present a medical history that helps delineate
the aetiology of fever that includes the evolution and pattern of fever,
associated symptoms, immune status, comorbidities, risk factors, exposure
through occupation, travel and environment and medication use

34. • Competencies of General Medicine: (contd…)
• IM4.11 - Generate a differential diagnosis and prioritise based on clinical
features that help distinguish between infective, inflammatory, malignant
and rheumatologic causes
• IM4.12 - Order and interpret diagnostic tests based on the differential
diagnosis including: CBC with differential, peripheral smear, urinary analysis
with sediment, Chest X ray, blood and urine cultures, sputum gram stain
and cultures, sputum AFB and cultures, CSF analysis, pleural and body fluid
analysis, stool routine and culture and QBC
Linker case – relevant competencies

35. Timetable
• Correlation - Linkers (most visible as an
integrated teaching session is introduced here)
• Nesting – these are in the lesson plans
• Sharing – these are in the lesson plans
35

36. Reference: MCI Course Material. Integration. Curriculum implementation support. Medical council of India. 36

37. Integration in assessment??
• The integration strategies mentioned earlier are to be used
in teaching-learning and not in assessment.
• The exam questions will be set by the concerned
department only e.g. Community Medicine exam paper will
be set by Comm Med faculty only
• Ask questions related to competencies of Comm Med
• Assess the student based on the competencies expected in
Community Medicine
37

38. Challenges – proposed solutions
• Some faculty unaware about integration makes it difficult to
communicate – Hold regular online sessions on new topics;
documentation; or show this webinar’s video
• Interpersonal problems - write through HOD for nominating
faculty
• The idea about integration varies between faculty – Be liberal
• Overzealous faculty – Ask them to do medical education project
with the unique idea and then scale it up

39. Summary
• Plan jointly is a must
• Don’t lose sight of the learner and the IMG
• Use the recommended techniques
• Nesting and sharing can be easily done in the
competency tables
• Linker cases need to be based on
organ/topic/disease/health condition
• Share ideas and agree to disagree when planning
integration with other faculty

40. Questions
40