Integration is an essential strategy in any curriculum that focusses to create work-ready individuals who can serve society in a caring and professional approach. The dental education preparing students to become general dentists is one area where integration facilitates student centered learning. Harden in his seminal paper on integration outlines the 11 stepped ladder that describes the continuum along the two extremes, isolation to integration. Harden based most of his arguments based on Fogarty book.  I have explained the 11 stepped ladder in the context of dental education. Your views and comments are important to revise my article.

Step 1: Isolation – Each subject or discipline delivers learning without knowledge of each other and in isolation. Students are expected to integrate and make sense how each disciplines affect and complement each other in their professional work later. The traditional dental curriculum where each subject like anatomy, physiology etc are handled by respective experts, but with no idea what each discipline is delivering, what, when and how.

Step 2 – Awareness. The teachers are aware of what is happening in other subjects but deliver their content independent of each other. The awareness could be in form of a timetable or published curriculum which tells what content of other disciplines is delivered when.  The teacher of prosthodontics will know that Periodontics faculty also deal with effect of prosthesis on periodontally compromised dentition. There are no active steps to integrate in terms of patient care.

Step 3 – Harmonization: The teachers communicate with each other formally and informally and attempts made that each discipline contribute to achieving overall curriculum objectives. Explicit connections to other disciplines are explained to students by each subject teacher in their delivery. Efforts are made to show connections of various disciplines rather than assuming the students can make the connections. The anatomy teacher explains how knowledge of physical structure can help him perform surgery safely. The materials teacher shows how bonding of composite is essential to prevent secondary caries. Here, the teachers are aware of the purpose of dental education and actively strive to show the connections.

Step 4 – Nesting: The teacher targets and delivers the skills/knowledge of other disciplines in his subject content. This enriches the learning of the subjects. Using the same example as step 4, when the materials teacher shows how micro-locking and bonding to the tooth structure prevents the formation of plaque and thus affects the pathological process of caries is ‘nesting’.

Step 5 – Temporal Coordination. The disciplines are delivered isolated, but the delivery of related content is coordinated to be delivered at same time. The anatomy of mandible and muscles of mastication are taken when training for nerve blocks and understanding effect of occlusion happen.

Step 6- Joint teaching – Closely related subjects, conceptually and complementary, come together in the planning and delivery of a shared course. Managing child patients can be an example of an integrated course where oral anatomy, mixed dentition, eruption patterns, plaque control can be learned integrated through delivery by the respective experts.

Step 7 – Correlation – There is a sustained and regular attempt in the curriculum to try to correlate the relevance of each subject to each other. For example, an activity like a seminar is conducted every week to integrate the learning done in the separate subjects/disciplines. The conduct of PBL at end of some subject courses can show how the various disciplines come together to solve patient problems.

Step 8 – Complementary Programme – The integrated sessions described in Step 7 takes a main position in the curriculum. The integrated sessions are placed at a priority to the subject based teaching. The subject based teaching contributes to the learning in integrated sessions. The assessment needs to reflect the content being delivered integrated as well as in separate subjects. I think this and Step 9 are the formats for most of the integrated dental curriculum where subject experts deliver the subject content in relation to integrated sessions and integrated assessments.

Step 9 – Multidisciplinary – Several subject areas are brought together under a themed course. The themes allow the student to learn the various subject component in an integrated manner. The course can be developed on tasks taken by a dentist, for example, preventive management through plaque control requires learning of various disciplines like Cariology, Periodontology, Clinical dentistry etc. Though the theme/integrated problem is what the student learns, the different subjects preserve their identity as subject experts have their bias and leanings when delivering content.

Step 10 – Interdisciplinary The individual identities and perspectives of the different disciplines in contributing to the integrated theme is lost when interdisciplinary status is achieved.

Step 11 – Transdisciplinary. The student learns real life in real situations.

I am not able to identify examples for Step 10 and 11 as I must yet to experience it in my thoughts and environment. If you can help me understand, should be wonderful. This blog will be updated based on comments received.

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