Reports on undergraduate medical education in the recent decade clearly point towards a need for greater integration of content in the medical curriculum. The pedagogy of an integrated curriculum embraces many models of integration, representing a continuum where full integration sits at one end and disciplinebased teaching at the other, with many intermediate steps between the two extremes. A vertically integrated curriculum seeks to bridge the preclinical and clinical divide in content by teaching the content concurrently rather than sequentially, but still retaining discipline boundaries. A horizontally integrated curriculum seeks to further break down the distinctions between the basic and clinical sciences, with the early years of the program focusing on the basic sciences and introducing clinical features into the program wherever possible as part of a gradual shift to a more continued collaborative clinical focus. At the College of Medicine, University of Saskatchewan, the overall redesigned curricular program will be phased in over the next four years of the curriculum, with a greater emphasis towards an integrated approach of the teaching and learning of human disease. In the first year, this has led to the creation of a patchwork quilt teaching style, where a cross disciplinary functional system incorporates elements of the traditional basic science components of anatomy, physiology, embryology, and histology, and an introduction of core general pathological concepts in a vertical and horizontal integrated fashion. <p>The main objective of this research, detailed in Chapter 1, was to investigate the advantages and disadvantages of the two models of horizontal and vertical integration of the reorganized structural teaching of pathology through an analysis of the perceptions of medical educators and first- and second-year students in the undergraduate curriculum at the College of Medicine, and based contextually within a theoretical framework of the newly designed medical curriculum. <p>In this context, the literature review in Chapter 2 focused on four major areas that are the underpinnings of the pedagogy of pathology teaching in the undergraduate medical curriculum: (a) integration concepts in relation to medical education; (b) the practice of pathology teaching in the past, present, and future; (c) theories of curricular integration; and (d) its effects on the student learning environment. This resulted in the development of the pre-research conceptual framework for this study. <p>The in-service monitoring research design for this study included a triangulation of research methodologies using multiple data sources, multiple subjects, and multiple data collection techniques using comparative qualitative and quantitative research inquiry techniques. Data collected from the semi-structured interviews of the medical faculty provided not only an understanding of the educators perceptions towards the integrated curriculum, but also some insight towards their feelings of respect, power, and identity in this new integrative environment. Personal perceptions of fear, apathy, and stress and perceptions regarding accountability and sustainability of this integrative process were also observed as arising from this educational intervention. <p>Quantitative data analysis collected from the first-year student survey questionnaires derived the following grand mean responses with respect to the vertical integration of pathology teachings: student learning satisfaction with integration (3.6); the learning environment (3.8); student engagement (3.3); and student stress (2.9). The grand mean responses to horizontal integration showed a similar trend: student learning satisfaction (3.7); learning environment (4); student engagement (3.5); and student stress (3). Perceptions of the second-year medical students to horizontal integration of pathology teachings were comparable: student learning satisfaction (3.7); learning environment (4.2); student engagement (3.7); and student stress (3.1). A comparison of first- and second-year medical students showed a significant difference (p<0.05) with respect to the domains of student engagement with active independent learning. This difference may, perhaps, be directly related to the level of maturity of the first- versus second-year students, coupled with the receptiveness, awareness, and familiarity of the integration process between the two groups. There were no perceived differences between the horizontal and vertical integrative learning environments. Likewise, inter-modular and inter-system components within the vertical and horizontal integration did not demonstrate any major differences. These results are explored in greater detail in Chapters 4 and 5.<p>One of the noteworthy findings of this study was the statistically significant difference between the perceptions of first-year medical and dental students in both vertical and horizontal integrative environments in many domains, including student learning satisfaction (p<0.001); learning environment (p<0.001); and student engagement (p<0.01). There was no difference in student stress perceptions between the two groups of first-year students. The main theme linking these disparities seemed to be related to a lack of academic and vocational relevance of the undergraduate medical course teachings to the inter-professional composite cohort of dental students. This has led to the creation of an independent course dedicated to first-year dental students. This rapid in-service responsive evaluation thus recognized a major immediate dissatisfaction, resulting in curricular program change. Other curricular changes are underway to address student concerns of ineffective curricular content and time management. An unexpected emergent theme of this study was the recognition of a perception gap between students and faculty medical educators. This is probably nested in complex factors, such as generational learning differences and attitudes towards the learning environment, which are beyond the research scope of this study.<p>In conclusion, the results of this study strongly supports an overall balanced composite curricular design, including facets of horizontal, vertical, and diagonal integration that meet the needs of the student learner and satisfy the expectations of the medical faculty as the best practice plan for the instruction of pathology in the newly designed integrated medical curriculum. As learning is the central function of all education, perhaps the future of successful effective medical educational learning environments are those in which an intergenerational component of students and instructors can engage as true joint partners in curriculum organization to provide the right balance between faculty expectations and student learner needs.

Reports on undergraduate medical education in the recent decade clearly point towards a need for greater integration of content in the medical curriculum. The pedagogy of an integrated curriculum embraces many models of integration, representing a continuum where full integration sits at one end and disciplinebased teaching at the other, with many intermediate steps between the two extremes. A vertically integrated curriculum seeks to bridge the preclinical and clinical divide in content by teaching the content concurrently rather than sequentially, but still retaining discipline boundaries. A horizontally integrated curriculum seeks to further break down the distinctions between the basic and clinical sciences, with the early years of the program focusing on the basic sciences and introducing clinical features into the program wherever possible as part of a gradual shift to a more continued collaborative clinical focus. At the College of Medicine, University of Saskatchewan, the overall redesigned curricular program will be phased in over the next four years of the curriculum, with a greater emphasis towards an integrated approach of the teaching and learning of human disease. In the first year, this has led to the creation of a patchwork quilt teaching style, where a cross disciplinary functional system incorporates elements of the traditional basic science components of anatomy, physiology, embryology, and histology, and an introduction of core general pathological concepts in a vertical and horizontal integrated fashion. <p>The main objective of this research, detailed in Chapter 1, was to investigate the advantages and disadvantages of the two models of horizontal and vertical integration of the reorganized structural teaching of pathology through an analysis of the perceptions of medical educators and first- and second-year students in the undergraduate curriculum at the College of Medicine, and based contextually within a theoretical framework of the newly designed medical curriculum. <p>In this context, the literature review in Chapter 2 focused on four major areas that are the underpinnings of the pedagogy of pathology teaching in the undergraduate medical curriculum: (a) integration concepts in relation to medical education; (b) the practice of pathology teaching in the past, present, and future; (c) theories of curricular integration; and (d) its effects on the student learning environment. This resulted in the development of the pre-research conceptual framework for this study. <p>The in-service monitoring research design for this study included a triangulation of research methodologies using multiple data sources, multiple subjects, and multiple data collection techniques using comparative qualitative and quantitative research inquiry techniques. Data collected from the semi-structured interviews of the medical faculty provided not only an understanding of the educators perceptions towards the integrated curriculum, but also some insight towards their feelings of respect, power, and identity in this new integrative environment. Personal perceptions of fear, apathy, and stress and perceptions regarding accountability and sustainability of this integrative process were also observed as arising from this educational intervention. <p>Quantitative data analysis collected from the first-year student survey questionnaires derived the following grand mean responses with respect to the vertical integration of pathology teachings: student learning satisfaction with integration (3.6); the learning environment (3.8); student engagement (3.3); and student stress (2.9). The grand mean responses to horizontal integration showed a similar trend: student learning satisfaction (3.7); learning environment (4); student engagement (3.5); and student stress (3). Perceptions of the second-year medical students to horizontal integration of pathology teachings were comparable: student learning satisfaction (3.7); learning environment (4.2); student engagement (3.7); and student stress (3.1). A comparison of first- and second-year medical students showed a significant difference (p<0.05) with respect to the domains of student engagement with active independent learning. This difference may, perhaps, be directly related to the level of maturity of the first- versus second-year students, coupled with the receptiveness, awareness, and familiarity of the integration process between the two groups. There were no perceived differences between the horizontal and vertical integrative learning environments. Likewise, inter-modular and inter-system components within the vertical and horizontal integration did not demonstrate any major differences. These results are explored in greater detail in Chapters 4 and 5.<p>One of the noteworthy findings of this study was the statistically significant difference between the perceptions of first-year medical and dental students in both vertical and horizontal integrative environments in many domains, including student learning satisfaction (p<0.001); learning environment (p<0.001); and student engagement (p<0.01). There was no difference in student stress perceptions between the two groups of first-year students. The main theme linking these disparities seemed to be related to a lack of academic and vocational relevance of the undergraduate medical course teachings to the inter-professional composite cohort of dental students. This has led to the creation of an independent course dedicated to first-year dental students. This rapid in-service responsive evaluation thus recognized a major immediate dissatisfaction, resulting in curricular program change. Other curricular changes are underway to address student concerns of ineffective curricular content and time management. An unexpected emergent theme of this study was the recognition of a perception gap between students and faculty medical educators. This is probably nested in complex factors, such as generational learning differences and attitudes towards the learning environment, which are beyond the research scope of this study.<p>In conclusion, the results of this study strongly supports an overall balanced composite curricular design, including facets of horizontal, vertical, and diagonal integration that meet the needs of the student learner and satisfy the expectations of the medical faculty as the best practice plan for the instruction of pathology in the newly designed integrated medical curriculum. As learning is the central function of all education, perhaps the future of successful effective medical educational learning environments are those in which an intergenerational component of students and instructors can engage as true joint partners in curriculum organization to provide the right balance between faculty expectations and student learner needs.