Purpose: Integration in medical education was first defined as an educational strategy that unifies subjects frequently taught in separate departments. (1) In the years since it first appeared in the literature, the popularity of integration in medical education has steadily increased, with leaders in the field calling for enhanced integration throughout the curriculum, particularly of basic science knowledge. (2) This call to action is supported by several applicable learning theories. Foremost that medical students, as adult learners, desire to understand the relevance of a topic to clinical practice. (3) Second, enhanced integration can promote long-term retention when learning is organized in a way that mimics the way knowledge will be recalled during clinical practice. (4) An additional consideration is that the content within undergraduate medical curriculum is ever-expanding while the length of time remains the same. As the body of scientific and clinical knowledge increases, so does the emphasis on social sciences and humanities. (2) Through enhanced integration of all content, educators can decrease the extraneous cognitive load, which is imposed on the learner when they are required to integrate content outside of class, and increase the germane cognitive load, enabling the learner to devote their cognitive resources to applying the content rather than reorganizing the material. (5) Interactive team teaching enhances integration by drawing on the knowledge of two or more disciplines to present mechanisms of disease in the context of clinical scenarios. In this pre-conference workshop, participants will utilize a rubric to analyze integration at the session level and design a team teaching plan for their home institution.

Goals: The goals of this pre-conference workshop are to: 

1. Apply relevant learning theories to support integration in medical education.
2. Differentiate the levels of integration within curricula, courses, and individual sessions.
3. Allow opportunities for discussion and application of the basic models of team teaching.
4. Explore the challenges and solutions to implementing team teaching in integrated curricula.

Timeliness and Significance to the Field: In 2015, the Association for Medical Education in Europe (AMEE) reported that published uses of integrated curriculum had increased significantly in the past two decades, yet definitions and application of the integrated curriculum still vary greatly. This report noted that creating an integrated curriculum does not automatically establish cognitive interaction and made a call for synchronous presentation of material (6). Many integration practices fail to integrate at the course and session level because the foundational sciences are taught asynchronously and without connection to the clinical sciences. When the basic and clinical sciences are applied in the same session, it enhances integration and ensures organization of foundational knowledge for clinical practice.

Workshop description including teaching methods and timeline for educational activities: (20 min) Introduction: Facilitators will define integration, address relevant learning theories to support it, and present the integration rubric as a tool for evaluation. Facilitators will use polling and Socratic questioning to enhance audience participation. (30 min) Using the Integration Rubric: In small groups, participants will evaluate two case studies using the session-level integration rubric. Large group discussion will follow, where participants will compare their ratings and offer solutions for enhancing integration. (10 min) Break (15 min) Overview of Team-Teaching: Facilitators will present models of team teaching and the learning theories to support them as enhancing integration. Facilitators will use polling and Socratic questioning to enhance audience participation. (15 min) Apply Team Teaching Models: Small groups of participants will be assigned a specific team-teaching model. Groups will come up with an example of how to use this model and share in a large group report out. (20 min) Challenges: In small groups, participants will use think, pair, and share to explore challenges to implementation. Large group report out will focus on how to apply the multiple models and theories to solve challenges. (10 min) Break (25 min) Team Teaching Implementation Plan: Individually and then in small groups, each participant will utilize a template to create a plan for implementation of team teaching at their home institution and receive feedback from peers. Participants are encouraged to explore their own practices and work toward improving their least integrated session(s). (15 min) Report out Implementation Plan: Participants will share their specific challenges and potential solutions. Facilitators will attempt to elicit a diverse pool of experiences and solutions. (10 min) Wrap-Up: Conclusions and final thoughts from the facilitators, who will then field audience questions.

Presenter's qualifications/expertise in area Dr. Amber J. Heck is an Associate Professor of Physiology at the TCU and UNTHSC School of Medicine. She earned her Ph.D. in Biomedical Sciences at UNTHSC. Her current responsibilities include curriculum design and development, and active learning facilitation in cell biology and physiology for medical students. She has nine years of experience as a facilitator using multiple learning modalities within integrated preclinical medical education curricula. She has three years of experience developing integrated active learning courses and has been founding faculty at two new medical schools. Dr. Heck's current interests include creating faculty development interventions where participants develop tangible solutions to challenges imposed by modern medical school curriculum practices. She has been active in IAMSE for six years and has presented two focus sessions, one oral presentation, and four poster presentations at the IAMSE annual meetings. She is involved in research and mentoring nationally and internationally and was a 2016 IAMSE fellow. Dr. Heck currently serves as Chair of the IAMSE Educational Scholarship Committee and serves on the IAMSE Board of Directors.

Dr. Amanda J. Chase is an Associate Professor of Medical Education at Nova Southeastern University School of Allopathic Medicine. She earned her Ph.D. in Cellular and Molecular Medicine at Johns Hopkins University School of Medicine. She has seven years of experience facilitating in integrated medical curricula and has taken part in the development and implementation of curriculum and assessment at two new medical schools. Her approach to facilitation is problem-centered, in which she engages learners by asking questions, designing integrative activities, and developing case-based scenarios for small group discussion. Dr. Chase's research interests center on the integration of communication into the pre-clerkship years to increase learner proficiency with the application of biomedical knowledge to clinical practice. She participates in faculty development with a focus on course design and the implementation of case-based instructional methods to integrate the basic and applied sciences.

Outcomes - What skills will attendees acquire? Participants will take part in large and small group discussions and activities to

1. Articulate the role of team teaching in enhancing integration and the need for enhanced integration.
2. Map current practices and new ideas to the integration rubric.
3. Develop a list of strategies to implement team teaching at your home institution.
4. Design a personalized team teaching implementation plan, informed by educational learning theory, to enhance session and course level integration.

References

1. Harden RM, Sowden S, Dunn WR. Some educational strategies in curriculum development: The SPICES model. ASME Medical Education Booklet number 18. Med Educ 1984;18:284-97.
2. Finnerty EP, Chauvin S, Bonaminio G, Andrews M, Carroll RG, Pangaro LN. 2010. Flexner revisited: The role and value of the basic sciences in medical education. Acad Med 85(2):349-355.
3. Knowles MS. 1980. The modern practice of adult education: From pedagogy to andragogy. Chicago, IL: Follett.
4. Ambrose SA, Bridges MW, DiPietro M, Lovett MC, Norman MK. 2010. How learning works: Seven research-based principles for smart teaching. San Francisco, CA: Jossey-Bass.
5. Sweller, J. (1988). Cognitive load during problem solving: Effects on learning. Cognitive Science. 12(2). 257-285.
6. Brauer DG, Ferguson KJ. The integrated curriculum in medical education: AMEE Guide No. 96. Med Teach. 2015; 37(4): 312-22.