MBBCh 1 and 2

As outlined in Chapter 1, MBBCh 1 and 2 are discipline-based years of study.

MBBCh 1 covers distinct basic sciences subjects – Physics, Chemistry and Biology;

and social sciences subjects – Sociology and Psychology. In 2010 a new course called Medical Thought and Practice 1 was added to introduce horizontal integration in the first year and vertical integration with the second year. This course Medical Thought and Practice 1 carries two components which are Health Systems

Dynamics and Integrating Skills. In Health Systems Dynamics students are taught to model systems so they appreciate the fact that everything functions as a system.

Integrating Skills is divided into three sections: Integrating Lectures, Logic and Critical Thinking and Medical Terminology. Integrating lectures are designed to teach students how to look for links in the various courses of the year and enable them to see that all the subjects are linked. All other components of Medical Thought and Practice 2 are assessed through multiple-choice question examinations while integrating skills are assessed through an assignment where students demonstrate their ability to link concepts.

MBBCh 2 covers Anatomy, Physiology, Molecular Medicine and Medical Thought and Practice 2. Medical Thought and Practice 2 is a carry-over of the same two components – Health Systems Dynamics and Integrating Skills – but at a higher level. The formative assessment for this course includes computer modelling of systems and an assignment which requires students to look for linkages in the courses that they are taking in the year, thus assessing students’ ability to carry out horizontal integration.

Students verbalised their various experiences of integration of learning in MBBCh 1 and 2 and these are presented below.

As mentioned earlier, one course in the first two years of the MBBCh programme was designed to strengthen integration of learning. Medical Thought and Practice is a course that teaches students how to integrate learning by consciously looking for linkages in the different subjects they take in the first and second years. This course was perceived as a good introduction to integration.

So, as I was saying that with Health Systems Dynamics with Medical Thought and Practice, the basis of how I was taught to approach questions and stuff; those things still haven’t left me...And, in first year you don’t realise how important these principles are in psycho-social development, of a person. Uhm... So, that’s why I’m saying that it’s those sort of systems that you keep having to going back to but they make sense once you know how to approach them… and I think...that’s, for me that’s been a great help. [Student 4, MBBCh 4]

…integration in certain courses, Medical Thought and Practice … the whole premise of our project was to integrate facts from different courses. So that certainly did [help with integration]… [Student 23, MBBCh 1]

I also find with like a lot of the graphs in Chemistry, they can be explained so well using Health Systems Dynamics… [Student 16, MBBCh 2]

The above student saw the relevance of the Health Systems Dynamics component and how it could be used in other courses to explain concepts and demonstrate systems better. Student 16 has experienced how the principles in one course can be used to explain concepts in another course.

…Uhm ... back to the Psychology and Sociology, I don’t think this year as opposed to as it would be next year...when we start seeing patients and that, I think the application of that would be greater…especially this year Logic, Sociology and Psychology, have become more related. We are doing more of critical thinking. Last year when we did the pure logic and the skills, we didn’t really look at that but this year when we were looking at moral dilemmas, we’re looking at like the Sociology, people sociology and how it affects, how they approach problems… [Student 16, MBBCh 2]

The above student’s conception is an anticipation of the vertical integration when they apply learning in the clinical area while seeing patients.

Well, sometimes I have been able to integrate them, like for example with Medical Terminology, it helps with Anatomy. Especially when you are studying Anatomy for the first time there is a lot of different… new words that you are not so familiar with. Sometimes because you did Medical Terminology you are able to realise

‘Oh, this word refers to the kidney’…Physiology and Molecular Medicine as well sometimes there are similar concepts, similar topics. I could say sometimes I have been able to integrate them… [Student 14, MBBCh 2]

The fact that Medical Thought and Practice carries over from the first year into the second year was seen as a positive factor in promoting vertical integration.

I’d say definitely at the beginning of last year when we started out, I wouldn’t have said integration was a very important thing, I would have said “Oh, you know these facts and those facts…you just know it and then it starts happening but…

even after the first like lecture when we were told about vertical and horizontal integration, I still don’t think I appreciated it as much,” … Uhm… but as the year went by and I saw how the things were brought together in the Integrating Lectures and that, I started to see how important it was, and then especially coming to this year, and how things build… [Student 15, MBBCh 2]

Similar to some of the perceptions of Teacher 3, Student 15 experienced horizontal integration in MBBCh 1 but partial vertical integration with MBBCh 2:

In MBBCh 1…I can definitely say amongst those subjects, there was integration happening but there is no vertical integration taking place between MBBCh 1 and MBBCh 2 because from what I have experienced, this year, all I think was really useful from last year was Biology and obviously the Medical Thought and Practice courses carry over. So as far as they are concerned, there is integration taking place there as well and that has also been quite helpful… [Student 15, MBBCh 2]

Students spoke further to programme structure issues that were perceived to prevent them from linking concepts from the subjects they were taking in each year (horizontal integration) and taking the learning up to the later years (vertical integration).

I wasn’t really sure how first year kind of connected to second year because first year was your basic subjects, the Physics and the Chemistry… those were good to get a general understanding of how things worked but I am not quite sure how it linked to second year because we went from that to Anatomy. So there wasn’t like vertical integration, we just didn’t understand that… [Student 20, MBBCh 3]

They would probably have been a little bit different. Last year my integration was more on a vertical level, like you said which was like… I think because of high school, you come with what you learnt and I was able to integrate that quite well because I did Physics and now am doing first year Physics and a lot of it is the same. I was able to integrate even in Chemistry. So I feel like on a vertical integration level it was good, but on a horizontal level I didn’t really see how the subjects are connected to each other. To me they were all very different. None of them were really similar… [Student 14, MBBCh 2]

The perception of some teachers is that although there have been efforts to strengthen integration through Medical Thought and Practice, the integration may be less than what was envisaged:

OK, well I think people have made an attempt at integration right through from first year...I know that...the plan was to integrate a lot more I think than is actually happening… [Teacher 5]

… in first year and second year when we did… Medical Thought and Practice…

yes, … so there were sections of integration… they will give you an idea that everything that we do, it doesn’t end here, because remember there was a project… an assignment that we did in first year or second year, there would just… Uhm… take a particular disease in Medical Thought and Practice and then Uhm put them together and then… Uhm… say how do you describe this using different subjects you're learning and then…I remember I took… Uhm… a heart artery and I looked at it from the… Uhm… fluid flow in Physics and I looked at it

at it from the Sociology, why do people end up having it, so and…at some point in the clinical years, I’d have to understand this, … Uhm… so it would be easier for me…when I have to… Uhm… approach a particular disease it’s always easier for me looking at it from that, looking at everything I have learned from first year up to now… [Student 25, MBBCh 5]

The above is an experience of a fifth-year medical student who vividly recounts an experience of integration of learning in the first year. The student experienced that the ability to integrate learning horizontally and vertically was enhanced by the Medical Thought and Practice course.

I find the integrating lectures very useful to integrating information as well because I find they give you almost a new perspective sometimes on looking at it and two things that you thought might be totally unrelated, they can put them together in such a way that you are able to say…“I understand this now and how it works.” … Uhm, … for an example, we had that lecture last year on… Uhm… I think it was the conductive nature of the heart and then ECG and how it all works and that was incredible to see how the Physics and basically the more medical side in Biology come together… [Student 16, MBBCh 2]

We don’t get enough exposure of how to integrate and how to understand…

because in first year with the Integrating Lectures we were told Ok in Physics;

this is the topic and in Chemistry and in Bio here is the link. So that exposure in the first year it needs to change. Not saying now have a whole course for Integrating, but three lectures instead of one based on your actual projects it will make a difference… [Student 13, MBBCh 2]

From the accounts of Student 16 and Student 13, the course Medical Thought and Practice informs students about horizontal and vertical integration in Integrating Skills, a component which focuses on building skills for integration. The students refer to the Integrating Lectures in that course and how they found them helpful in enabling them to see links in other subjects.

…I am not sure, maybe we will see the outcome from Medical Thought and Practice you know because I think that having these opportunities to integrate…

Uhm… at an earlier level in the university system anyway even if they are not bringing it from school …Uhm,… one would hope… and certainly that’s the intention of it, ….will play out in them being able to do it effectively so, Ja [yes], I am really keen to see how the students who have had two years of integrating exercises and so on… Uhm… if they can actually cope differently so will wait to see how that happens… [Teacher 1]

The above teacher’s perception is that introducing courses that help the students to integrate learning earlier in the programme would help them to do it effectively. In addition to students’ experiences above, the experience of Student 4 below is an affirmation of how Medical Thought and Practice facilitates integration of learning:

So, as I was saying that with Health Systems Dynamics with Medical Thought and Practice the basis of how I was taught to approach questions and stuff; those things still haven’t left me...There are inputs and there are outputs and there is a system as a whole and the variables which then interplay to bring it about, they become more complex...but the fundamentals of how it is, they are still the same.

So that’s why I’m saying that, that’s how I have been able to apply it... I mean there are certain things that you’ve lost along the way, there are certain course contents that you have in Chemistry or Physics... I mean those things follow all the time, but...but you take the principles...and you sort of take what you’ve learnt and you sort of make it into this summed up nice picture that helps you understand...you just build on that; on those core principles and you are like:

“I was taught this in first year”...and those are the sort of integrative things you need to learn from first year and bring them up...and, in first year you don’t realise how important these principles are in psycho-social development, of a person...that’s, for me that’s been a great help... [Student 4, MBBCh 4]