Integrating of Anatomy and Physiology courses in basic medical sciences (case study in Mashhad Faculty of Medicine)

Introduction

Universities of medical sciences all over the country have the important task of training specialized human resources; therefore, medical education needs to be continuously evaluated and reviewed, and constantly improved by eliminating its defects. On the other hand, medical students who are selected in the universities of medical sciences through national entrance exam in a very strong competition have passed different units theoretically and practically through a long period of time. It is noteworthy that after their graduation, medical students are responsible for ensuring the health of patients and their compatriots in various aspects. According to Dadvar (2014), medical students acquire skills, and improve them in the educational opportunities obtained in the curriculum during their study in order to be able to perform their daily clinical tasks; however, it is obvious that achieving learning goals is considered as a criterion for measuring the success of universities as the educational providers (1).

A practical solution to facilitate the integration of curricula is to create experimental opportunities to observe clinical applications as well as to integrate these innovations with training in effective medical education methods (2). Integration has been accepted as an important educational strategy in medical education (3).

Knowledge of human anatomy is a basic requirement for all physicians and it is necessary to formalize the curriculum along with competency standards (4). Also it is important to assess the quality of educational design before integrating the curriculum, so that the quality of medical Massive Open Online Courses (MOOC) can be considered in relation to the quality of existing education(5). The increasing progress and inefficiency of the classic educational method in basic medical sciences have necessitated changes in the general medicine curriculum, especially the basic medical science stage in terms of content and layout in an integrated manner(6).

Educational design, predicting methods, and selecting the order of educational materials in specific situations are effective to achieve results (7).

Educational design is considered as one of the educational subsets with the production of educational materials (8). A good educational program should be designed to ensure that the desired capability and competency is achieved (9). The increasing progress of sciences in the world and the inevitable synchrony of medical sciences with this process have made it necessary to change the curriculum of general medicine, especially the basic medical sciences both in terms of content and layout in an integrated manner more than before (10). Integration in the curriculum means organizing the teaching subjects and making connections between different subjects of different stages. In this way, it forms a single concept (11).

In order to make the researchers more familiar, some research regarding the integration of the curriculum lessons are given below:

Zare Khormizi et al. (2016) examined the views of medical students towards the Integration plan of specific pharmacology and pathology lessons. This cross-sectional descriptive study was conducted on the attitudes of Yazd medical students in 2013 by census method. According to the research findings, students had a positive attitude towards the integration of these two courses (3).

Khedr et al. (2020) conducted a study entitled Medical Students' Perceptions of Pathology and a Proposed Curricular Integration with Histology. The research method was cross-sectional. The results showed that the integration of histology and pathology courses needs to be tested in the first year (12).

Giuritao et al. (2020) in a study entitled Anatomical Science in Chiropractic Education examined the lack of information on the content of anatomy. The results of this study confirmed that anatomy has a special place in chiropractic education programs in Australia (4).

Considering the mentioned cases, for the administration of the basic medical science program, it is necessary to integrate some lessons, such as anatomy and physiology, which have been discussed in this research.

Methods

The present study was a descriptive cross-sectional study which focused on the views of professors and students of the basic medical sciences in February 2018 and September 2018 in Mashhad University of Medical Sciences, on the presentation of anatomy and physiology lessons in the form of system organ and Integration.

Sampling method in this research was simple random sampling method. The inclusion criteria of this study were the professors involved in the administration of the horizontal integration plan of basic medical science lessons and also medical students in the second and higher semesters of basic medical science stage. The exclusion criteria were non-cooperation and incomplete or incorrect completion of the questionnaire.

In this research, first, by studying the research literature in the field of educational design and medical education, as well as the integration of some lessons including basic medical sciences lessons, a question was designed. This question was sent to research experts who were professors of basic science lessons to express their agreement on the design of the question and rate the relevance of the question to the title of the research.

It should be noted that in order to collect research data, at the end of the first semester of the 2020 academic year, students were asked to carefully complete the questionnaire in the Salam system (logbook). It should be noted that the data collection instrument was a researcher-made questionnaire which its validity was assessed by psychometricians.

The statistical sample of this research was 246 basic medical science students in the first and the second semesters of 2018 in February 2018 (126 students) and September 2018 (120 students) who had completed their lessons as integration.

The research instrument was a questionnaire consisting of 14 questions about the need for integration and the system organ program. The questions were graded based on a five-point Likert scale including 5- very high, 4- high, 3- medium, 2- low, and 1- very low.

In this questionnaire, the integration program of the basic medical sciences was evaluated from the perspective of professors and students of the target group.

To analyze the data, SPSS software was used and the results were expressed by one-factor t-test, mean, and standard deviation.

Results

The research findings are divided into two parts: findings collected from professors and findings collected from students, which are mentioned below.

The descriptive and demographic statistics of the professors in this research are as follows: the total number of professors was 16, of which 10 were male and 6 were female. The frequency showed that 6 individuals are assistant professors, 4 individuals are associate professors, and 6 individuals are professors.

As shown in table 1, the average results of the professors' opinions of integrated teaching indicated that according to the sign test, which is related to non-parametric statistics, the median of 2.893 with a standard deviation of 0.52 was obtained which was significantly higher than the median score (2.893). It means that the professors were satisfied with the integration of anatomy and physiology lessons. 

As can be seen, the views of the professors are higher than the average and shows that the satisfaction of the professors with the integration of the lessons is higher than the average level. Also, the following is a survey of students about the integrated lessons, which is shown in Table (2).

Descriptive and demographic statistics of students in this study are as follows: 246 students of basic medical sciences were in their first semester of 2018 (126 students) and the second semester of 2018 (120 students). The above table shows the frequency, average, and standard deviation. Also, in order to test students' satisfaction with the lessons integration plan, t-test was used, the results of which are shown in Table (3).

Based on the results of the students' opinions on integrated teaching, the findings indicated that with 95% confidence, students agreed with teaching lessons as integrated (basic medical sciences). According to the test results, in terms of students, the statistical value was 5.287 and the significance level, which was less than 0.05, showed that the level of students' satisfaction with the integration of anatomy and physiology lessons is significant.

Discussion

As mentioned in the previous sections, the purpose of this study was to organize basic medical science teaching materials by integrating anatomy and physiology lessons in order to improve the knowledge, attitude, and skills of medical students and train professionals through a codified educational program. The results showed that professors are satisfied with the integration of anatomy and physiology lessons. The results also showed that the students' satisfaction level with the integration of anatomy and physiology lessons is significant and is more than average.

As mentioned, after the announcement of the National General Medicine Program in 2017 by the Ministry of Health and the requirement to change the way of teaching in the universities of country the stage of basic medical sciences also had some changes. Mashhad University of Medical Sciences should have changed the lessons arrangement according to the curriculum sessions of each university. Lessons in this university were presented as system organ and integrated (anatomy and physiology lessons). In the classic curriculum, all topics of anatomy and physiology were taught separately. While in the integration, anatomical sciences of the organ were also taught at the same time with the topics of physiology, which according to the present study, the views of professors and students toward the integration plan was moderate to high. In other words, professors and students of Mashhad University of Medical Sciences were satisfied with the integration of anatomy and physiology lessons. Because all curriculum decisions are to improve the quality of student education, this study is very useful in evaluating the changes in the arrangement and integration of these lessons. The results of this study are similar to the results of Zare Khormizi et al. (2016) who examined the views of medical students towards the integration program of specific pharmacology and pathology lessons (3). Also, the results of this study are similar to the findings of Teymouri Jrokani et al. (2015) in the research on evaluating the changes in the layout of the basic medical science stage of Isfahan University of Medical Sciences: Students' views, that are satisfied with the integration plan (13). These results are not similar to the results of Khedr et al. (2020) whose research results showed that the integration of histology and pathology lessons in the first year needs to be tested and a lot of effort is made to increase students' dependence on anatomical pathology. Overall, according to opinions of professors and students of Mashhad University of Medical Sciences, it can be said that the integration of basic medical science lessons, including anatomy and physiology, is useful; however, it is suggested that studies and researches be conducted to evaluate the method of integrating curricula in other lessons and stages and the opinions of more professors and experts should be used regarding the questions related to the field of research.

By developing a basic medical science education program that has been the subject of this research and has been administered in Mashhad University of Medical Sciences, it is possible to improve the knowledge, attitude, and skills of medical students along with increasing students' learning, which is one of the important strengths of this research. Also, since this program is to eliminate the defects of the previous program and has been developed to meet the needs of the country's medical education, so this educational design and integration of lessons can be used in other universities in the country as needed.