Lessons learned about integrating a medical school curriculum: perceptions of students, faculty and curriculum leaders.

OBJECTIVE: Recent educational reform in US medical schools has created integrated curricular structures. This study investigated how stakeholders in a newly integrated curriculum - students, course directors and curriculum leaders - define integration and perceive its successes and challenges during its first year.

METHODS: We conducted interviews with curriculum reform leaders, course directors and first year medical students. Interview transcripts were analysed for themes, which were compared within and across stakeholder groups.

RESULTS: Three curriculum leaders, four Year 1 course directors and six Year 1 medical students were interviewed. Fifteen students participated in a group interview. Four major themes emerged: interdisciplinary teaching; interdisciplinary faculty collaboration; building curricular links, and sequencing and framing curricular content. Cross-group analysis revealed participant agreement that an integrated curriculum required interdisciplinary teaching, clinical application and careful oversight. Differences among groups were also identified. Faculty (course directors and curriculum leaders) discussed faculty collaboration and the challenges of faculty buy-in and course implementation. Students highlighted the impact of integration on their learning and the challenges of sequencing and scaffolding content. Both students and course directors focused on course monitoring and conceptual links for student learning.

CONCLUSIONS: Integrating a curriculum is a complex process. It is differentially understood and experienced by students and faculty, and can refer to instructional method, content, faculty work or synthesis of knowledge in the minds of learners. It can occur at different rates and some subjects are integrated more easily than others. We point to some specific considerations as medical schools embark on curriculum reform.