1. INTRODUCING INTEGRATED LEARNING PROGRAM IN NERVOUS SYSTEM FOR FIRST YEAR UNDERGRADUATES : EXPERIENCE FROM INDIAN MEDICAL SCHOOL SARMISHTHA GHOSH, HIMANSHU PANDYA, SK SINGH, RAKSHA BHAT, N.HARIDAS, HH AGRAVAT PRAMUKHSWAMI MEDICAL COLLEGE KARAMSAD, GUJARAT 388325

2. INTRODUCTION Dividing medicine into disciplines is an artificial construct The real world of medical practice is transdisciplinary in a large part. Learning facts become easier when they are learnt in a relevant and meaningful way GPEP report, GMC[UK] recommendations stress the need for greater integration of subjects in medical curriculum Medical Council of India recommends both horizontal and vertical integration in undergraduate medical education Modular approach has also been recommended alongwith incorporation of problem based learning.

3. OBJECTIVES Curriculum Committee and Basic Science faculty of the Pramukhswami Medical College designed an Integrated Learning Program for the Central Nervous System for the First year MBBS batch 2006-2007 students To develop and implement an integrated module on Central Nervous System in basic sciences To focus on integrated learning using multiple teaching learning modalities To demonstrate the feasibility and importance of an integrated learning program in preclinical phase of medical education in a college following traditional medical curriculum

4. METHODOLOGY Series of meetings Formal meeting with all faculty of basic Science Departments Identification of Learning Objectives on CNS Content delivery 1. Didactic Lectures 2. Interactive Lectures 3. Case Based Learning [CBL] 4. Group Seminars by students 5. Dissection/ Demonstration / Practical Laboratory exercises 6. Hospital Visits with patient contact Histology, Embryology

5. DURATION OF THE MODULE - 6 WEEK TOTAL NUMBER OF HOURS : 199 END OF MODULE INTEGRATED ASSESSMENT ON ANATOMY, PHYSIOLOGY & BIOCHEMISTRY OF CNS IN A CASE VIGNETTE FORMAT Evaluation of the program by a structured questionnaire STUDENTSBASIC SCIENCE FACULTY

8. RESPONSES OF THE STUDENTS

10. RATING OF INDIVIDUAL TEACHING/LEARNING METHODS BY THE STUDENTS

12. RESPONSES OF THE BASIC SCIENCE FACULTY

14. 1.Interdepartmental discussions amongst basic science faculty 2. Interdepartmental discussions amongst basic and clinical science faculty 3. Integrated assessment of Students of Phase I 4. Coordination & Group activity towards implementation of ILP

16. Recommendations

17. 1. ILP has improved the understanding & application of basic science knowledge of first year students in health & disease 2. ILP will help the students perform better in University exam [Oct 2007] 3.ILP will help students to perform better in later days of their clinical exposure 4. The concept of ILP is interesting

18. 5. ILP has helped me develop positive attitude towards medical education 6. I developed better interpersonal skills in terms of listening, giving, discussing, receiving criticism 7. ILP requires too much of time and is not worth all the effort 8. ILP helped me develop the ability to accept and work with faculty of different nature and subject background

19. ILP- better performance in University Phase I exam. FACULTY OPINION STUDENT OPINION

20. ILP - better performance in later days of clinical exposure FACULTY OPINIONSTUDENT OPINION

21. Conclusions It is possible to introduce Integrated Learning Program in Phase I of a conventional medical curriculum A lot of cooperation and coordination between departments is required to make such a program a success. Majority of students rated the program as good to very good with reference to appreciation, understanding and application of basic science knowledge in health and disease Different teaching learning methods were rated differently by the students. Lectures with interaction, group seminars, hospital visits with patient contact as well as hands on practicals were more appreciated as compared to other methods.

22. Faculty expressed overall satisfaction towards ILP[CNS] though they showed concern over the implementation of ILP approach for all systems in basic sciences The interaction amongst the basic science faculty and between basic and clinical science faculty resulted in cooperation and collaboration which is reflective of attitudinal change in faculty Considerable success in the implementation of this program for the first time in our Institution laid the foundation of adopting ILP in other systems in Phase I as well as for Phase II and Phase III.

23. References Smith SR, Toward an Integrated Medical Curriculum. Medicine and Health Rhode Island. Aug 2005. FindArticles.com available at http://findarticles.com/p/articles/mi_qa4100/is_200508/ai_n1489557, accessed on 10 October 2007. Association of American Medical Colleges. Physicians for the Twenty-first Century: Report of the project panel on the General Professional Education of the Physicians and college Preparation for Medicine. J Med Educ 1984; 59. Part 2:1- 208. Anderson MB, Swanson AG. Educating medical students- ACME-TRI report with supplements. Acad Med, 1993; 68(suppl): S1-46. General Medical Council Tomorrow's doctors:Recommendations on Undergraduate medical education. London : General Medical Council 1993. Medical Council of India. Salient features of Regulations on Graduate Medical Education, 1997 Available at :http://www.mciindia.org/know/rules/rules_mbbs.htm, accessed Oct 08, 2007 Pring R. Curriculum integration, p 265-72. In : Hooper, R ed. The Curriculum : Context Design and Developemnt Education. Edinburgh : Oliver & Boyd, 1970 Shimura, T, Takumi A, Shimizu K,Miyashita S,Adachi K,Teramoto A,Implementation of Integrated Medical Curriculum in Japanese Medical Schools, J Nippo Med Sch 2004; 71:11-16, Jamkar A,Yemul V, Singh G. Integrated teaching programme with student- centered case- based learning.Medical Education, 2006; 40:466-467.

24. Acknowledgement Mr. Sandeep Desai, CEO, HM Patel Center for Medical Care & Education, Karamsad for initiating and driving the process All faculty members of the departments of Anatomy, Physiology & Biochemistry who took special interest in planning and implementation of timetable and then gave a feedback at the end of the program The students of batch 2006-2007 who participated in the program enthusiatically in spite of hurdles and gave a constructive feedback at the end of the program