Theme
Curriculum Planning / Community Oriented Medical Education
INSTITUTION
Tehran University of Medical Sciences, School of Medicine
In an integrated curriculum, in which isolated end-of-semester discipline-based written tests have been replaced by multi-disciplinary examinations, serious challenges may arise. While reporting disciplinary scores goes against the grain of integration, and gives a message against the need to integrate, calculating an overall score poses the risk that some students will deliberately leave out the content of some disciplines, based on the fact that they have small share in each block exam.
In this study, we describe the experience of Tehran University of Medical Sciences, where an organ-based integrated curriculum has been launched since September 2011 as part of a curricular reform initiative.
At the end of the year, 54 medical students out of 159 (34%) did not achieve the required cumulative disciplinary score. In physiology, anatomy, histology, and embryology the number of failed students were 4, 8, 11, and 24, respectively. They were required to take a disciplinary examination before the beginning of the next academic year.
In the first academic year, students passed 4 blocks: Introductory, Respiratory, Cardiovascular, and Musculoskeletal. Each block included anatomy, histology, physiology, and embryology (figure 1). To perform integrated assessment, questions from each discipline were presented in a single booklet. Moreover, 10% of questions were truly interdisciplinary and assessed the students’ ability to integrate their knowledge (table 1).
The overall block score was reported at the end of each block. In addition, a cumulative disciplinary score was calculated at the end of the academic year by adding up the weighted sub-scores of each discipline in each block (table 2). Achievement in the block exam was considered as a requisite for proceeding to the next block. Passing the cumulative evaluation was also necessary for moving to the next phase of the curriculum.
Comparing the number of students who failed disciplines with low credits (e.g. histology) versus number of failed students in disciplines with high credits (e.g. physiology) suggests that the latter had systematically been ignored by some students. The calculation of a cumulative disciplinary score may reduce concerns regarding this problem in an integrated assessment.
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