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   Table of Contents      
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 85-91

Experiences with Horizontal and Vertical Integration in Competency-based Physiology Education

1 Department of Physiology, Maulana Azad Medical College, New Delhi, India
2 Department of Pathology, Maulana Azad Medical College, New Delhi, India
3 Department of Biochemistry, Maulana Azad Medical College, New Delhi, India

Date of Submission14-Oct-2021
Date of Decision22-Nov-2021
Date of Acceptance02-Jan-2022
Date of Web Publication29-Apr-2022

Correspondence Address:
Dr. Aarti Sood Mahajan
Department of Physiology and Department of Medical Education, Maulana Azad Medical College, New Delhi-110002
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mamcjms.mamcjms_112_21

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Integrated teaching is a well-known concept in medical education and has been reintroduced in the competency-based curriculum. The physiology department started the exercise in the topic of hematology in 2019 in the offline mode and again in 2021 in the online mode (due to the pandemic). This article is an attempt to describe what went through in its conceptualization and implementation. The background of integration, types of integration, how the exercise was planned, and the feedback of the faculty are included. This could benefit the phases 2 and 3 faculty members who must be planning similar exercises now. In addition, it would act as a screenshot to others, phase 1 faculty included, to help them do a similar or other exercises in the coming years. Integration in competency-based curriculum is here to stay. We can gradually improve upon it and innovate it.

Keywords: Competency, education, integrated, medical, teaching

How to cite this article:
Mahajan A, Rakheja G, Kaushik S, Arora P, Chitkara A, Verma R. Experiences with Horizontal and Vertical Integration in Competency-based Physiology Education. MAMC J Med Sci 2022;8:85-91

How to cite this URL:
Mahajan A, Rakheja G, Kaushik S, Arora P, Chitkara A, Verma R. Experiences with Horizontal and Vertical Integration in Competency-based Physiology Education. MAMC J Med Sci [serial online] 2022 [cited 2023 Jun 9];8:85-91. Available from: https://www.mamcjms.in/text.asp?2022/8/1/85/344348

  Introduction Top

The competency-based medical education was introduced in 2019 in our country. The basic science departments including the department of physiology were the first ones to put up the time table for the entire year on the college website to set the ball rolling. The workshops by competent authorities and the documents put online by the Medical Council of India (MCI), now National Medical Commission (NMC), for the first-phase departments, were instrumental in introducing the intricacies of the curriculum to all faculties throughout the country. In line with this, we started reading about the competencies and what was required from us and the other departments for the same. One of the initial topics in the curriculum was “blood” or the introduction to hematology, and for this, there are 13 competencies of which 12 are knowledge based and one is skill based.[1] There are no certifiable competencies. The competency for the “show how” level needs to be carried out by demonstrate, observe, assist, perform sessions and two of the competencies require demonstration. The other new elements are vertical and horizontal integration, methods of small group (SG) teaching, and assessment methods. Three competencies need horizontal integration with biochemistry and six require vertical integration with pathology.

A background of integration is required before beginning the process. Integration comes from the Latin word integer which means “whole.” Integrated teaching refers to a process where different departments may work together to ensure a better understanding of concepts and bridge the gap between knowledge and practical outcome. This can include horizontal integration, in the same phase or vertical integration across phases. Additionally, it is important to understand the concept of multidisciplinary, transdisciplinary, and interdisciplinary integration. There is no single approach and in fact, there are various models of integration such as traditional, inverted triangle, and brick wall methods to name a few.[2] The integration ladder begins from isolation and leads to transdisciplinary approach. It helps the teachers to understand just how much they can integrate and the final outcome depends upon various factors such as the regulations, the organizational setup, the curriculum, views, and experience of the faculty.[3] Besides the concept of integration, its types, purpose, challenges, and the difference between integrated teaching and an integrated curriculum must be understood.[4] In addition to topics mentioned in the MCI curriculum, other topics can also be integrated based on need and interest of concerned departments. A module has been prepared by the MCI to make it simpler to incorporate and follow for all medical colleges.[5] The aim of integration is to increase the element of recall and understand clinical aspects of the topic. It is required that experts of different departments are involved but they may all not necessarily be present in the final outcome of the lesson plan. This article describes some of the methods adopted for horizontal and vertical integration practices by the physiology department in the teaching of hematology topics and the outcome achieved. It is expected that this shall simplify things for other readers and phases, so that they may take tips to do integration in their respective departments and institutions.

  Methodology Top

The intervention was carried out in 2019 and 2021, in offline and online modes, respectively. The online mode was performed in 2021 due to the pandemic and appropriate university rules. No ethical clearance was taken as it was part of the ongoing curriculum. However, the integration was planned through proper channel, through head of departments as timing and availability of the concerned faculty member had to be ensured. The students were belonging to the first year of MBBS students of both years. Offline classes were scheduled as per the time table on website in 2019 and in addition web-based online method, provided by the institution was used in 2021. For this online class links were prepared and shared with the concerned faculty, who participated in the online lecture as planned. In the offline method, the concerned biochemistry faculty shared their investigation sheets and power points, whereas the pathology faculty came to take part of the scheduled lecture. In the online method, all concerned faculty spoke on the topic they were assigned.

  Plan of integration Top

The planning requires details as shown in [Figure 1]. In addition, feedback is to be taken as it helps in all future planning. As the competencies and the integrating departments are known from the MCI document, volume 1, the resource faculties from the requisite departments are to be identified, through official permission and suggestions of the departments’ heads. Thereafter, there could be several meetings to deliberate upon the lesson plan, what will be taught, what is the contribution of the departments, what is duplication, and so must be removed and the extent of pathologic or biochemistry investigations required. Topics for integration and the relevant competencies, the objectives, and the teaching–learning methods are mentioned in [Table 1]. To have a successful curriculum plan, all of this the objectives of the main department must be clearly laid down. It must be noted that in the integrating departments, there are competencies related to similar topics, as shown in [Table 2]. A listing should be carried out, on what will be taught in the integrating class and what remains, so that the repetitions are avoided and smooth integration is ensured. Thereafter, the teaching–learning method is identified, that is, whether is it a lecture, a SG discussion, a visit to the laboratory for seeing instruments, or a clinical case is going to be discussed to incorporate integrated teaching. The AV aids required are the next considerations and must be planned. An article by Malik and Malik describes the 12 tips of integrated teaching. It is important to note that assessment, revision, and re-evaluation are important steps involved.[6]
Figure 1 Plan of carrying out integration.

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Table 1 The competencies of physiology (blood) integrated with their objectives and teaching–learning methods

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Table 2 Related competencies in three departments on topics integrated

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  Feedback Top

It would have been ideal to take feedback from both the students and faculty. It was not taken from the students, as hematology is one of the first topics they attend. They do not have enough experience with lectures and it would not be advisable to ask them to benchmark a lecture with or without integration at this stage of their course. Moreover, to actually compare, they should have heard both versions of the lecture (integrated and nonintegrated), which could only have been carried out, had this teaching been part of an individual project and not a normal curricular teaching. Also if this has to be carried out, the time table has to be made accordingly whether a topic has to be taken, once or twice during the semester. The feedback taken from the faculty included 10 open-ended questions, given to them in a Google form.

  Outcome and the experience shared Top

The lesson plan of one of the topics is shown in [Figure 2]. The feedback of the faculty is summarized in [Table 3]. The teaching–learning material shared by the biochemistry department included graphs and investigations in addition to presentations made by both departments. Both the online and offline modes had their share of benefits. In the offline mode, the interest of the students was directly perceived in the classroom environment, whereas in the online mode, time management was better. Internet accessibility and connectivity were the common problems experienced in the online mode of teaching. On the basis of this experience, a checklist was prepared to help the integration process, as shown in [Table 4].
Figure 2 Lesson plan for integrated lecture on jaundice.

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Table 3 Faculty perception and feedback

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Table 4 Checklist for horizontal and vertical integration

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  Discussion Top

It is interesting to know that integration is not new to medical curriculum and has been practiced before the MCI or NMC introduced it in the curriculum.[7] It is known and expected that integrated teaching is useful to gain knowledge and skills.[8] Previous studies have concluded that it improvises teaching and student response has been very good.[9] It provides a holistic view with a deeper understanding. The scores related to learning are better and variability of scores decreases, provides better correlation of basic sciences to clinical science student. It also saves the time for faculty as repetitions are decreased.[10] The advantages also come with challenges and the availability of trained and motivated faculty is one of the major concerns.[11]

In this exercise, elements of integration, such as sharing and correlation between topics of the three departments, were carried out.[3] However, at this point, the topic was taught in different departments also. It can be argued that once integration has been performed, individually less time is needed to teach the topic in various collaborating departments. As these exercises have started recently, we expect that in time to come; this will be taken care of. Therefore, it can be said that we started from the step of isolation and have proceeded toward the level of multidisciplinary approach through this exercise.[3] In a study, the lesson plan has been shown when integration was practiced and the feedback of the students was taken for overall organization, time management, use of AV aids, clarity of communication, and skills learned.[12] This would be our future endeavor as the students are important stakeholders. However, for this, the students have to be exposed to the traditional method first and then the integrated teaching carried out to ensure a complete and useful feedback. This has been performed by a group of researchers who found a better response in the comparison.[13] We asked the participating faculty on what they thought the process would be like and what they learned from it. It was heartening to note that their comments were favorable and that they were planning similar exercises in their departments. It has been previously suggested that an in-depth understanding of the setting is required if integration has to be introduced, a change is desired, and the program evaluation must be carried out to incorporate the favorable changes.[14]

  Conclusion Top

Integrated teaching is not something to be afraid of. It just requires co-ordination and a group of motivated faculties to move out of the pedagogy of teaching in silos and innovate to have a wholesome learning outcome for the student. This was an experience, carried out in both offline and online modes, and hopefully it will motivate others to carry out the same to make the competency-based medical education program successful.


The authors thank the respective teaching incharges and heads of departments for their co-operation.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Medical Council of India. Competency based undergraduate curriculum for the Indian Medical Graduate. MCI 2018;1:92-4.  Back to cited text no. 1
Mathur M, Mathur N, Saiyad S. Integrated teaching in medical education: the novel approach. J Res Med Educ Ethics 2019;9:165-73.  Back to cited text no. 2
Harden RM. The integration ladder: a tool for curriculum planning and evaluation. Med Educ 2000;34:551-7.  Back to cited text no. 3
Husain M, Khan S, Badyal D. Integration in medical education. Indian Pediatr 2020;57:842-7.  Back to cited text no. 4
Medical Council of India. Alignment and Integration Module for Undergraduate Medical Education Program. 2019: p. 1–34  Back to cited text no. 5
Malik AS, Malik RH. Twelve tips for developing an integrated curriculum. Med Teach 2011;33:99-104.  Back to cited text no. 6
Shah S, Saiyad S, Mahajan N. Introduction of integrated teaching in I st MBBS: perspective of students. IJBAP 2014;3:277-80.  Back to cited text no. 7
Neeli D, Prasad U, Atla B, Kukkala S, Konuku V, Mohammad A. Integrated teaching in medical education: undergraduate student’s perception. Int J Res Med Sci [Online] 2019;7:7.  Back to cited text no. 8
Muthukumar T, Konduru RK, Manikandan M et al. Scope of integrated teaching in a medical college: a study from South India. J Med Soc 2017;31:127-30.  Back to cited text no. 9
  [Full text]  
Kumar DL, Mangal N, Chauhan MM, Mathur M, Parmar PC, Varghese KA. Assessment of attitudes of medical students and faculty toward integrated teaching. Ann Community Health 2021;9:181-6.  Back to cited text no. 10
Patel M, Shah HD. Alignment and integration in competency-based medical education curriculum: an overview. Indian J Physiol Pharmacol 2020;64(Suppl_1):S13-5.  Back to cited text no. 11
Mishra AK, Mohandas R, Mani M. Integration of different disciplines in medicine: a vertical integrated teaching session for undergraduate medical students. J Adv Med Educ Prof 2020;8:172-7.  Back to cited text no. 12
Kanwar G, Shekhawat M, Saxena N, Mehra MC. Introduction and impact of integrated teaching learning method for first professional medical students. IOSR J Res Method Educ (IOSR-JRME) e-ISSN: 2320–7388, p-ISSN: 2320–737X Volume 7, Issue 1 Ver. III (Jan.–Feb. 2017). p. 10-13. Available at: https://www.iosrjournals.org/iosr-jrme/papers/Vol-7%20Issue-1/Version-3/C0701031013.pdf  Back to cited text no. 13
Quintero GA, Vergel J, Arrendondo M, Ariza MC, Gomez P, Pinzon-Barrios AM. Integrated medical curriculum: advantages and disadvantages. J Med Educ Curr Dev 2016;3:133-7.  Back to cited text no. 14


  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3], [Table 4]


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