Introduction of integrated teaching in obstetrics and gynaecology

Abstract

Integrated teaching aims to unify subjects taught in separate courses or departments. Students apply knowledge and skills from various disciplines to address clinical cases. It is surprising to see how many trainees in obstetrics and gynaecology fail to demonstrate an understanding of basic sciences when they become registrars. If learning has to be made more sound and reproducible, it has to be integrated. Integration is a key feature in modern curriculum development. A concept of an integration ladder has been introduced. Examples of integration used here include: harmonization (teachers responsible for different courses/ different parts of a course communicate with each other), nesting (in a subject based course, the teacher targets skills from other subjects: for example in the teaching of gynaecological oncology one makes use of pharmacological principles in the rational use of drugs), temporal coordination (refers to parallel or concurrent teaching: the anatomy of the obturator spaces and the techniques on insertion of the transobturator tape). The philosophical principle underlying integrated learning is the concept of ‘context specificity’ (what is learnt in one context is readily retrieved in another context). There are two ways to address context specificity. Horizontal integration is integration between parallel disciplines traditionally taught in the same phase of the curriculum. Let’s take a third year topic: the aim is to learn vulval cancer. Trainees are urged to learn the topic using anatomic principles (lymph drainage of the vulva for example), pathology (the common types and their specific behaviour), the pathogenesis (association with the HPV virus), the epidemiology (the worldwide distribution of vulval cancer) before they actually apply these principles to a clinical case. Learning becomes immediately satisfying with a high chance of retention in the future. Vertical integration is integration between disciplines traditionally taught in different phases of the curriculum. Let’s take the learning of reproductive medicine. For example, the science of IVF is difficult for a first year trainee to understand whereas the same trainee understands well the physiological principles behind IVF. For the fourth year trainee, the situation may well be