 Hello all, in this video we are going to see about alignment and integration in medical education. As we all know, integration is the core pillar of this new graduate medical education regulations 2019 and in this new GMER 2019, integration is one of the core principle for implementation of competency based medical education. So before going to the integration, let me explain about the differences between alignment and integration. Alignment implies the teaching of subject material that occurs under a particular organ system or disease concept from the same phase in the same time frame, that is it is connected temporally or the temporal coordination between the organ system and the disease concepts. Whereas integration implies the concepts in a topic organ system that are similar overlapping or redundant or merged into a single teaching session in which the subject based demarcations are removed. So that is called as integration. So the temporal coordination is alignment and placing the same topics into a single session is called as integration. Linker is usually the term used for the session that allows the learner to link the concepts presented in an aligned and integrated topic. Now let us look at the integration more deeper. Integration has been described as the deliberate unification of separate areas of knowledge. In this case, it may be a disease concept or an organ system. The term horizontal integration is used to describe the bringing together of subjects in the same phase of the curriculum, whereas vertical integration is applied to the integration of subjects normally taught in different phases of curriculum. So when you bring together the subjects within the same phase of the curriculum that is called as horizontal integration and when you bring together the subjects that are taught in the different phases of the curriculum, then that is called as vertical integration. So across disciplines in a given phase of the course is horizontal integration and across different phases of the course, it is the vertical integration. People call this integration as a spectrum. This ladder is called as hard and slaughter of integration or integration continuum. Integration is presented as a continuum with full integration at one end. Here it is fully integrated and disciplined based teaching at the other end which is not integrated. So a position between two extremes may be adopted by as described on the integration ladder by hard and metal. So let us look into the hard and slaughter of integration more deeper and this slide is going to be the most important slide of this presentation. So to begin with, it's a continuum where this send is not at all integrated and this send is completely integrated. So as we ascend up, there will be less emphasis on the disciplines or the subjects with the greater communication needed between the teachers and also a greater central planning is needed as we ascend above. So for isolation, there is more emphasis on the disciplines or subjects. So at this stage of isolation, departments or subject specialists represented by the individual squares organize their teaching in isolation with no consideration of other subjects or disciplines. This is isolation that is the faculty of each department work individually while planning and also during implementation. As we ascend above the ladder, next step is the awareness stage. The teaching is subject based in case of isolation, but some mechanisms are in place whereby a teacher in one subject is made aware of what is covered in other subjects in the curriculum. So this is just an awareness between departments. So the teacher can take account of what colleagues cover in other parts of the course when planning for a class, avoiding redundancy and cross-referring. But there is no explicit attempt to provide integrated view of the subject to the student. Next, we move on to the third step in the ladder of integration that is harmonization. In harmonization, teachers responsible for different courses consult with each other and communicate about their course. So here, not only the awareness, they communicate with each other. Hence, the faculty from concerned departments consult through informal discussion between the teachers or through their curriculum planning committees. This encourages teachers to adapt their programs so that each course make an appropriate contribution to the curriculum and overall curriculum objectives are more likely to be achieved. As we ascend above, the next stage is called as nesting. In this integrated approach, the teacher includes within a subject-based course knowledge and skills relating to other subjects. That is, the teacher tries to bring in concepts from other subjects within a subject-based course. It could be the clinical skills concepts brought into pre-clinicals or paraclinical subjects or a basic skill introduced in clinical subjects. Next step in the hard-on-slatter of integration is the temporal coordination, where in this step, the timetable is adjusted so that the related topics within subjects are scheduled at the same time with similar topics being taught on the same day or week. This is otherwise called as alignment, which was described as one of the steps in the ladder for integration. This can be called as alignment also, that is the temporal coordination, which is also a step in this ladder of integration. Next step is the sharing. Some teaching is shared between two departments or disciplines implementing the teaching programs. So the concepts will be shared among themselves. The faculty from two disciplines come together and share a class so as to avoid repetitions. Such sharing of classes is effective and efficient in importing knowledge and skills to the students. As we move up, the next step is the correlation. Here, in addition to the subject-based teaching, an integrated session is introduced that brings together areas of common interest in each subjects. That is, the topic dealt or subject or discipline-based and they take up most part of the curriculum time. In a separate session on correlation, only areas of common interest are brought together. And as we ascend above, the next step is the complementary step. There is both subject-based and integrated teaching, but with integrated sessions representing a major future of the curriculum. That is, this type of integration is both subject-based as well as integrated. The focus of teaching is a theme or topic to which the disciplines will contribute. As we ascend the ladder, the next step is the multi-disciplinary step where a number of subjects are brought together in a single course with an integrated theme, but with the subjects clearly identified. That is, the topic is not dealt subject-based and it transcends subject boundaries. In one session, the staffs from various departments import knowledge as much necessary for the theme. Courses are developed around systems. A professional may have to deal in real-time, maybe considered for such integrations. Here, courses are developed around the systems. As we climb up the ladder, we move on to the next step, that is the interdisciplinary step. Here, subject loses their identity in a new integrated program that involves the use of two or more academic disciplines simultaneously. This is a higher level of integration where the content of all or most subjects is combined into a new course. There is no subject demarcation at this level. And the last step or the top of this ladder is the transdisciplinary. Here, the integration is built around the field of knowledge as exemplified in the real world, rather than a theme or topic selected for the purpose. That is, the emphasis is here on the knowledge as exemplified in the real world. It is the responsibility of the student to integrate all that is learned in different disciplines when a real-life situation is encountered. So this is the hardened ladder of integration. We complete this session by mentioning the advantages and disadvantages of integration. First with the advantages, it reflects the practice of medicine and it motivates the students and also it makes the learning interesting. Integration makes the theory to practice. The learning also becomes more effective. An integrated curriculum can help to avoid unnecessary re-dubligation. The integrated curriculum may be more cost-effective also and integrated approach promotes collaboration and communication between the staff. It matches what the curriculum aims and it achieves the higher level of objectives. The disadvantages with this integration and integrated approach requires meticulous planning and implementation and integrated approach requires collaboration and communication between the staff. It loses the subject identity and there are resources shortage needs to be considered not only in terms of the training of the manpower, but also the availability of the manpower itself. And this integration has become a mandate not a choice. It is the necessity and integration must be implemented in all sorts and the temporal arrangement within the integration is called as alignment. So thanks for watching this video. If you like this video, please click on the like button and share it with your friends. Thanks again.