My college is one of the few institutions in India that has introduced 'integrated learning' in which a group of five students from each year of study (I, II, III, IV, Intern and PGs) are assigned to one department and they work together under one clinical case and present an integrated seminar on that topic, We have a fortnightly integrated seminar so that all students have an equal exposure about all the departments.  For example, for a case of Oral cancer under department of Maxillofacial Surgery all the students studied the case and it went like - the second year student prepared the pathology part while the intern correlated it with the case presentation. This was followed by a first year explaining the anatomy and the final year explaining the signs, symptoms, grading and staging, The surgical part was correlated with anatomy by the postgraduate. At the end a simple research question is framed and some research papers are cited supporting the research question, A PICOT analysis is done. All the staff and students are invited. The presentation is usually scheduled in Saturday morning.

This helps integrating the clinical and basic sciences. The students love participating.

In our institution, Integrated teaching is not for graduate or postgraduate ,but we have integrated teaching ,in which teacher from various department according to the topic specific present their presentation, and after this question answer session is arranged to clarify the query of the other faculty staff members and Postgraduates students. Topics are chosen according to their importance in the current situation.But In thinking integrated teaching require a lot of efforts to evaluate the level of knowledge and skills of the students.For this effective planning,implementation and evaluation should be planned.

I congratulate Ankur and his University on achieving the elusive goal of Integrated teaching in Dentistry. It takes a lot of guts and will power. More importantly, it requires a vision. I wish you all the best.

Thanks Arshad,

However, it is just a beginning. The goal has to be achieved. I feel that we need to dispense with the archaic system of dental education which we follow and with which the British left us and develop it specific to the needs of the subcontinent.

So far as guts and will power, yes, I must say a lot of both is required. The program is actually a brainchild of Major General (Retd)(Dr) PN Awasthi who is the advisor to my institute and has earlier served as Chief of the Army Dental Corps and General Secretary, Dental Council of India. So the credit of the vision goes to him.

Vertical integration of the basic and clinical sciences is a major goal of most US dental education programs since the adaptation of such a standard by the commission on dental accreditation. The idea consists of introducing the concept of basic science integration with the clinical sciences from year one to year four with continue reinforcement of the basic sciences through years 3 and 4 which appear to be the most challenging. As Dr. Sharma pointed out, the use of clinical pathological conferences/cases combined with PICOT analysis and precise questions to be answered is a simple and reliable method of introducing this concept from year 1 to 4. There are other strategies to be employed that are more involved beyond this forum.

Thanks, Robert. Can you please elaborate briefly on those 'other strategies'.

It would be great if the other strategies could be shared. It would benefit all.

Dear Ankur

I think what you have developed is very laudable. I would add the additional strand of patient communication as an important and frequently neglected area that all students should develop as it is one of the areas that we have found in the UK to be problematic  once students have left the undergraduate environment..

Thanks Bob, I second your opinion on patient communication. I believe that patient communication is a part of  core skill of a dentist and we have been wrongly labelling it as a 'soft skill' in the past. I think that patient psychology is another dimension in this strand which would make our services to patients more conducive to them and our practice more patient oriented. There should be more emphasis on scientific study on this topic so that it could be incorporated into dental teaching in the future.

Agreed. For instance, its so difficult to convince the patients to get rid of useless third molars. This can be converted into a scenario and patient communication can be taught using such scenarios. 

Dear Asaad Javaid Mirza, first of all, I would like to thank u so much for the shared question. I'm from Brazil and I teach in dental school (public, at Ribeirão Preto, University of São Paulo) since 1989. Since that time I act in clinical disciplines, the first was the Integrated Clinic,ever for the students in last period. So for 23 years I taught in discipline for students of the seventh and eighth periods and since two years ago I minister classes for students of the ninth and tenth periods (semesters), because the course has graduated the first class with five years content. Our discipline also changed its name (but is still with the same objectives), today is called Integrated Clinical College. We are in 6 professors with at least one specialty each but we all were trained to teach in all areas of clinical knowledge of dentistry. All already are or operate in private practices, with enough clinical experience. Our pedagogical structure was always vertical, with basic subjects, laboratory, preclinical (in different laboratories, as with use of PPE for example) and then the clinical disciplines. In that quarter of a century I have worked here, we went through two major curricular restructuring. Given a requirement of the MEC - Ministry of Education and Culture, some 10 years ago our curriculum were formed "mini integrated clinical disciplines", distributed since the first half until the last (eighth) semester, mixing at least two clinical areas of knowledge (clinics adequacy = prevention, family health program, adequacy of oral environment, social dentistry, etc .; clinical training I. II, III and IV where students met dentistry plus endodontics ; periodontics plus restorative dentistry, dentistry + FPDs and removable, full and partial dentures) and ending with the professional integrated clinic, where we guide from diagnosis, planning, treatment planning, to execution of all clinical stages of an oral rehabilitation with at least four distinct areas of specialization involved. The idea was great, integrate content watertight integrating disciplines, correlating them. Students worked with integration of horizontal content and also vertical, for students of the first half shared clinical (in pairs) with students of the fifth semester; second half of the students shared with medical students in the eighth semester, and so on. The idea was great in theory, because there was a humanization of care, where more advanced students practiced clinical and students from more basic periods learned from the teachers and colleagues at clinics. On the other hand, more advanced students resumed the service more human when students of the first half peeking out the service bringing more accountability to students in earlier semesters. But in practice, we ended up losing in two senses: our students have become much more prevention and less restorative action / rehabilitative on the one hand, and on the other, several ethical conflicts occurred when, in trying to integrate different disciplines of content, we come across the difficulty of integrating teachers from different areas and departments. Today I work in the curriculum of five years duration in Clinical disciplines Integrated College, Odontogerontologia, Oral Rehabilitation and Advanced Procedures in Dental Practice. And our curriculum returned to work vertically, with watertight disciplines, the way it was 10 years ago, only preserve two months of extramural stages that were included in the intermediate curriculum where our students for a month in the fourth and one month in fifth years working in UBS (Basic Health Units) in the city, where they learn to interact with multidisciplinary teams (doctors, nurses, social workers, pharmacists, speech therapists, physiotherapists, etc.) so that they have a training for clinical practice in offices / clinics but also to act in the public sector in the SUS - National Health System of the Federal Government. This is my experience. I am your disposal for further details. Big hug and a wonderful 2015 to you and your family. Vinicius

Beautiful curriculum

Many thanks, dear Ankur. Unfortunately our school changed the middle version. Now we are trying to recover our clinical skill for the undergraduation...

Very good curriculum.

Dear Asaad Javaid Mirza, as Prof. Vinícius said, thanks for sharing this concern that is indeed a challenge for our curricula on Denstistry.

In our Dental School, at the Catholic University of Córdoba, Argentina, we have introduced an activity that aims to achieve vertical integration as well as developing an interdisciplinary vision at the same time. For that purpose, the students from the second to the fifth year are distributed in groups, having each group members of each year (which means, that each student may contribute to a certain extent, according to the skills they developed so far). Two teachers are asigned to follow up and guide each group. During a first meeting, the members a each group: 1) select a topic of their interest, choosing between solving a community or an individual dental problem; 2) Define the roles of their members and the way they plan to interact; 3) Determine the title, hypothesis and aims of the project; 3) Write a preliminary work plan and a schedule to develop the project.

Throughout the academic year, these teams develop their workplans as they are being followed up by their teachers/mentors until they present their outcomes in a final public meeting, where they share their production with the other groups/teams.

All activities that are proposed in each work plan are carried out as curricular activities in the different disciplines of the carreer. The students receive credits for these practises.

Of course, these ideas could be further explained or discussed. All the best,

Gustavo Molina

Dear Prof. Molina it seems that our schools are within the new hood practice i.e. interdisciplinarity. Big hug, saludos de Brasil.

Dear Prof. Pedrazzi, I am glad to know that and hope we´d reach the goals we are dreaming. Otro abrazo!

Gustavo

Dear Respected Sir, It is an honor for me to answer this question and contribute my part. What we did in our institution in order to integrate clinical learning into basic sciences (Vertical Integration) was we designed a very small clinical rotation of 2nd year students to visit Dental Diagnostic department where they stay for around 20 or 30 mins(once or twice weekly) . They visit and observe the patient on their first visit. In parallel to this the basic knowledge of various oral diseases was provided to them in preclinical subjects.  They prepare the clinical case in their future visits in dental diagnostics and enter into the log book which helps them to correlate various clinical conditions with basic sciences knowledge. Now the student has to present these clinical cases with the present patho-physiological or pharmacological correlation in a focused group discussion with a tutor (mainly in community dentistry practicals). This gives them breif idea about the frequent community oriented clinical cases. How they look clinically and what were the etiological factors leading to such condition. 

Very good. In addition I true believe that we shaw promove inter trans multi pluri disciplinarity to give to students the best information in their field but also how to deal with matters with both direct and indirect relationship to their future profession. And true understand what is their competency and what must to be accomplished by partnership with others from different expertise.

Dear Qaiser

Nice to hear from you. Your idea sounds good. But still feel, this could integrate a bit of the courses the students are taught. They are taught good amount of Anatomy, Physiology, Pathology, Phamacology and Biochemistry. 

But no doubt, your students performane will be better in this regard than other students.