1. 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.  مقدمه  توصیه های سازمان های معتبر آموزشی در مورد ادغام  مبانی تئوری های یادگیری در مورد ادغام  انواع ادغام  اشکال ادغام  نردبان ادغام

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

11.  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. 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.  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. 6-2 دانشكده 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.

16.  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.  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, 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.

18.  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.

19.  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)

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

21.  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

23.  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” Vidic B, Weitlauf HM. Horizontal and vertical integration of academic disciplines in the medical school curriculum. Clin Anat 2002;15:233–5.

25.  Within the basic sciences  The basic sciences and clinical sciences  The humanities and biopsychosocial sciences within the other two

26.  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.  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.  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

30.  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.

33.  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.