The Integration Seminar: A First-Year Dental Course Integrating Concepts from the Biomedical,...

1322 Journal of Dental Education ■ Volume 71, Number 10

The Integration Seminar: A First-Year Dental Course Integrating Concepts from the Biomedical, Professional, and Clinical SciencesKarl Kingsley, Ph.D.; Susan O’Malley, M.Ed.; Tanis Stewart, M.B.A., M.S.; Gillian M. Galbraith, M.D.Abstract: This study describes the planning, implementation, and evaluation of a seminar course designed to facilitate discussion and understanding of cross-disciplinary concepts by first-year dental students. Dental and medical schools are implementing inte-grated curricula in which clinical courses are taught early in the curriculum and the clinical and basic sciences are taught not only concurrently, but in an integrated manner. This first-year course, Integration Seminar, was developed to cross traditional subject and departmental boundaries with the intent of fostering dental care providers who understand the interdependence of the major concepts within these areas. This report describes the development and structure of the Integration Seminar. Furthermore, student perception of this course was determined by evaluating year-end course surveys, and student performance outcomes were mea-sured by comparing student scores on the National Board Dental Examination Part I (NBDE-I) prior to and after the inception of this course. We determined that a substantial majority of students recognized the integrated nature of the course. In addition, NBDE-I scores were significantly higher for the cohorts of students who had participated in the course, although this observation is likely dependent upon many other factors. This report may thus provide a course model for other schools with a similar goal of achieving an integrated curriculum.

Dr. Kingsley is Assistant Professor, Department of Biomedical Sciences; Ms. O’Malley is Staff Research Associate, Department of Biomedical Sciences; Ms. Stewart is Director, Department of Information Technology; and Dr. Galbraith is Chair and Profes-sor, Department of Biomedical Sciences—all at the University of Nevada, Las Vegas, School of Dental Medicine. Direct cor-respondence and requests for reprints to Dr. Karl Kingsley, Department of Biomedical Sciences, University of Nevada, Las Vegas, School of Dental Medicine, 1001 Shadow Lane B315, Las Vegas, NV 89106-4124; 702-774-2623 phone; 702-774-2721 fax; [email protected].

Key words: dental education, integrated curriculum, knowledge integration, medical education

Submitted for publication 6/19/06; accepted 6/16/07

Traditional predoctoral medical and dental edu-cation begins with the first semesters concen-trated on the basic sciences while subsequent

semesters focus on the clinical sciences and, more directly, on clinical training. In an innovation known as “vertical integration,” many medical and dental schools now introduce clinical courses from the first semesters of the curriculum, thereby providing the opportunity for integration of the basic sciences and clinical subjects.1,2 In addition, these new curricula emphasize basic sciences within the later, mainly clinical parts of the curriculum.3-6 A related innova-tion, termed “horizontal integration,” emphasizes the concurrent teaching of basic science topics.7,8

The primary educational goal of the University of Nevada, Las Vegas, School of Dental Medicine (UNLV-SDM) is to “implement a vertical and horizontal integration of the Biomedical Sciences, Professional Studies, and Clinical Sciences curricula

to ensure competent, contemporary oral health care providers.”9 It is believed that accomplishing this goal of seamlessly integrating biomedical, behavioral, and clinical sciences in the UNLV-SDM curriculum will foster a dental workforce possessing an informed and holistic approach to oral health.10

The requirement for foundational knowledge from biomedical and professional studies to achieve clinical competency is recognized to be central to the UNLV-SDM curriculum.11 For instance, part of the teaching philosophy at UNLV-SDM is to prepare stu-dents for the complexities of the health profession by providing a predoctoral experience in which the ma-jority of courses within the curriculum are integrated. To this end, the timing of course offerings is struc-tured to present related subject matter concurrently; integration is evidenced when clinical presentations and discussions are included in biomedical courses (and vice versa) and professional studies (most nearly

October 2007 ■ Journal of Dental Education 1323

equating to behavioral studies in this curriculum) are offered in the context of the clinical setting. As a result, a better understanding of important biomedical principles is hopefully kindled, providing potential for improved retention of knowledge and an enhanced ability for students to apply basic science principles in the appropriate clinical settings.2,12

A first-year, two-semester course, Integration Seminar, was planned and designed prior to student matriculation to further facilitate horizontal and vertical integration of the basic and clinical sciences. During the first year, faculty from all departments (Biomedical, Clinical, and Professional) served as resources for developing Integration Seminar topics related to their specialties, creating a mechanism for vertical and horizontal integration intended to cultivate a dental workforce that is technically com-petent and equipped to evaluate and implement new biological approaches to diagnosis, therapeutics, and intervention.13

This report describes the development and implementation of the Integration Seminar, address-ing the rationale and procedures for selecting the seminar topics as well as details on course format and structure. An example from the Integration Seminar has been included to illustrate how each course within the Integration series is structured to maximize inte-gration of the various departments. In addition, this study examines two key measures to evaluate the rela-tive success of this course: 1) student perceptions of course integration, and 2) student outcomes following inception of the course. Student perceptions of the course were derived from course-end surveys specifi-cally addressing the integrated nature of the course, while student outcomes were assessed by examining a key measure of student performance, scores on the National Board Dental Examination Part I (NBDE-I), prior to and following inception of this course.

Integration Seminar TopicsThe purpose of the Integration Seminar is to

take related course subjects that have traditionally been taught separately, such as immunology, micro-biology, and diagnosis and treatment planning, and deliver them to students in a manner that makes their interrelationships more obvious and the concepts more easily understood. To determine which topics should be represented in the Integration Seminar,

the dental school first-year (DS1) curriculum was assessed for the level of integration of each course.

The level of integration for each course in the curriculum was designated by the UNLV-SDM Curriculum Committee, based upon evidence from the syllabi, using the following guidelines: Level-1 (L1) indicates instructors and material from one department or intradepartmental integration; Level-2 (L2) represents instructors and material from two departments or interdepartmental integration; and Level-3 (L3) represents instructors and material from all three departments (Biomedical, Clinical, and Professional). Syllabi from courses that provided no evidence of integrated materials or instruction, within or between departments or disciplines, were considered to be nonintegrated.

Of the forty-three DS1 courses offered, thirty-five can be described as exhibiting some level of integration—twenty-two with L1 integration, eight with L2 integration, five with L3 integration—and eight were nonintegrated (Table 1). From the thirty-five integrated DS1 courses, the course directors of classes that exhibited the highest levels of integration (L2 and L3) were selected to participate in the Inte-gration Seminar courses and to determine which top-ics would be represented. Faculty who demonstrated L2 or L3 integration in their courses were deemed to have the expertise and foundational knowledge needed to plan and prepare each seminar. The pool of faculty included all full-time Biomedical Science (seven) and Professional Studies (five) faculty, as well as full- and part-time Clinical Science faculty (twenty-eight and thirty-two, respectively).

Subsequently, the individual course directors from the most integrated DS1 courses developed seminar topics with the broadest range of applicabil-ity. The topics applied methodology and skills from one primary course to multiple disciplines and other departmental courses in order to examine a central theme, issue, or contemporary health care problem. The topics were selected based on how well they correlated with information from multiple courses from more than one department. For example, one course director selected the topic of Nutrition and Oral Medicine, which correlated information from thirteen courses (Table 2, Week 4) including, but not limited to, Physiology and Anatomy, Microbiol-ogy and Immunology, Biostatistics, Epidemiology, Diagnosis and Treatment Planning, and Applied Human Nutrition, which is itself an example of an L3 integrated course (Table 1).


Table 1. DS1 course list (fall, spring, summer) and the assessed level of integration

Level 1 (L1): Intradepartmental integrationLevel 2 (L2): Integration between two departmentsLevel 3 (L3): Total integration among all three departments

Level of Course Credit Semester Course Title Integration Number Hours

Fall Physiological and Anatomical Concepts (Human Structural and Functional Concepts) L1 7101 3Fall Microbiological and Immunological Concepts L1 7102 3Fall Head and Neck Anatomy (and Neuroscience) L2 7109 3Fall Introduction to Human Development L1 7112 2Fall Integration Seminar I L3 7501 1Fall Health Care Delivery: Patient Record and HIPAA Regulations L1 7154 1.5Fall Patient Communications and Cultural Proficiency 7157 1.5Fall Biostatistics in Oral Health Sciences L1 7160 1Fall Epidemiology in Oral Health Sciences L1 7161 1.5Fall Introduction to Infection Control 7120 1Fall Diagnosis and Treatment Planning L1 7123 1Fall Dental Anatomy and Occlusion Laboratory L2 7124 2Fall Dental Anatomy and Occlusion Lecture L2 7125 1Fall DSI: General Clinic L1 7140 3 Spring Cellular and Molecular Concepts L1 7103 3Spring Special Senses and Oral Health L1 7106 2Spring HIV/AIDS and Oral Disease L3 7108 1.5Spring Oral Pathogens and Oral Immunology L1 7110 1.5Spring Integration Seminar II L3 7502 1Spring Healthcare Financing and Public Health L1 7151 1.5Spring Specialty Practices I L2 7153 1.5Spring Community Outreach: Pediatric Education L2 7156 1.5Spring Practice Management Technology L2 7159 1.5Spring Professional Studies Integration Seminar 1 L3 7509 1.5Spring Critical Thinking in Contemporary Health Care L2 7510 1Spring Principles of Clinical Dentistry: Operative Dentistry 7121 1Spring Principles of Clinical Dentistry: Operative Dentistry Lab 7133 2Spring Basics of Periodontal Instrumentation and Preventive Intervention 7136 2Spring DSI: General Clinic L1 7140 3 Summer Oral Developmental Anatomy and Histology (Oral Histology) L1 7111 2Summer Patient Communications L1 7152 1.5Summer Applied Human Nutrition L3 7358 3Summer Summer Enrichment Project 7505 3Summer Foundations in Fixed Prosthodontics 7122 1Summer Foundations in Fixed Prosthodontics Lab 7137 2Summer Local Anesthesia and Nitrous Oxide Sedation L1 7126 2Summer Introduction to Intraoral and Panoramic Radiology L1 7127 1Summer Diagnosis and Treatment Planning II L1 7129 1Summer Principles of Dental Materials I L1 7130 1.5Summer Periodontal Anatomy and Pathogenesis of Periodontal Disease L2 7135 1Summer Preclinical Dental Laboratory L1 7138 5Summer Clinical Occlusion L1 7139 2Summer DSI: General Clinic L1 7140 3

Course FormatThe UNLV-SDM DS1 curriculum is currently

offered in three nearly equal trimesters (Table 1). The fall DS1 semester includes many introductory,

integrated concept courses, such as Physiological and Anatomical Concepts, Head and Neck Anatomy, Diagnosis and Treatment Planning, Microbiological and Immunological Concepts, and Epidemiology in Oral Health Sciences. The spring DS1 semester consists of many integrated concept courses that


build upon the foundational knowledge introduced in the fall semester, including Special Senses and Oral Health (Neuroanatomy), Oral Pathogens and Oral Immunology, Critical Thinking in Contemporary Health Care, and Diagnosis and Treatment Planning. The summer DS1 semester includes various applied clinical courses, such as Intraoral and Panoramic Radiology, Principles of Dental Materials I, and the Preclinical Dental Laboratory.

Since the DS1 curriculum includes numer-ous integrated introductory courses during the fall and spring semesters, the Integration Seminar was designed to run during these two semesters. In this way, integrated seminar topics parallel and strengthen the course concepts being addressed in the students’ other courses. All DS1 students take both fall and spring semesters of the Integration Seminar, com-prising two, sequential fourteen-week schedules, although the actual number of class meetings may vary due to final exams, university holidays, and other administrative conflicts (Tables 2 and 3). Students receive one credit each semester and are graded on a pass/fail system, determined primarily by attendance and participation.

After selecting topics specific to the learn-ing objectives and outcomes for each semester, the participating DS1 course directors each designed a one-hour, active participation seminar that directly correlated with other DS1 courses being taught dur-ing that semester. For example, in the spring semes-ter, a clinical faculty member selected the topic of Xerostomia, which was designed to include materials and concepts from, and highlight correlations with, various other spring courses, such as Cellular and Molecular Biology, Oral Pathogens and Oral Immu-nology, and General Clinic (Table 3, Week 2).

An example of a fall DS1 seminar from the course director of Applied Human Nutrition (Pro-fessional Studies-Behavior Sciences) demonstrates the degree to which integration can be facilitated within each seminar. This seminar, on the topic of Nutrition and Oral Medicine, covered a broad range of biomedical, professional, and clinical topics in a coordinated, integrated seminar designed to engage the student in interactive discussions and applied critical thinking (Table 2, Week 4).

In this seminar example, adapted from Touger-Decker et al.,14 the planned foci for this session were to 1) describe the synergy between general health and oral health, 2) describe the overall relationship between nutrition and oral health, 3) discuss select diseases and conditions with known nutrition and oral

health relationships, and 4) discuss patient education and appropriate clinical applications. Specific topics within these foci, such as dental caries, were used to demonstrate the concepts and relationships between the various courses from each department.

For example, content from this seminar, specifi-cally relating to dental caries, was designed to initiate and facilitate interactive discussions with students regarding concepts and relationships concurrently taught in other fall DS1 courses (Figure 1). The first slide was used as an introduction to the concepts of the interdependent and integrated nature of materials from Clinical Science, Biomedical Science, and Pro-fessional Studies courses, providing a more complete understanding of dental caries formation, treatment, and prevention. Subsequent slides facilitated more detailed discussions using material derived from, and building upon, information from other fall DS1 courses, such as Clinical Sciences course mate-rial regarding tooth structure from Dental Anatomy (7125) and clinical manifestations of dental caries from Diagnosis and Treatment Planning (7123), Biomedical Sciences course material regarding S. mutans and other lactic-acid producing bacteria from Microbiology and Immunology (7102), and Professional Studies material regarding prevalence of dental caries from both Biostatistics (7160) and Epidemiology (7161).

The second slide in Figure 1 was used to refocus the classroom discussions on the integrated nature of this material. This slide, which contains information from a dietary analysis for a particular patient, served as a secondary focal point to build more elaborate and complex discussions of material derived from other fall DS1 courses. For example, additional concepts from Professional Studies courses, such as Patient Communications and Cultural Proficiency (7157) relating to prevalence of dental caries among ethnic groups, builds upon information taken from Biostatistics and Epidemiology. Further discussion of clinical diagnosis and treatments for the caries lesions most commonly observed in the UNLV-SDM clin-ics utilized course information from General Clinic (7140) and expanded upon information taken from Diagnosis and Treatment Planning. The ensuing dis-cussions of biomedical concepts relating to Physiol-ogy and Anatomy (7101), including the mechanisms for mediating oral pH, were built upon information taken from Dental Anatomy.

This particular seminar is representative of the Integration Seminar structure and format utilized for the other seminars within the Integration Seminar


Tabl

e 2.

Fal

l sem

este

r, 75

01In

tegr

atio

n Se

min

ar c

ours

e pr

esen

tati

ons

for

each

w

eek,

top

ics

cove

red,

and

spe

cifi

c co

rrel

atio

ns t

o ot

her

DS1

cou

rses

(nu

mbe

r, ti

tle,

dep

artm

ent)

Sem

inar

In

stru

ctor

(D

epar

tmen

t) To

pic

Cou

rse

Cor

rela

tions

(Dep

artm

ent)

Wee

k 1

H

PV

7102

Mic

ro &

Imm

unol

ogy

(Bio

med

ical

) (B

iom

edic

al)

75

01 In

tegr

atio

n Se

min

ar (B

iom

edic

al)

7160

Bio

stat

istic

s (P

rofe

ssio

nal)

7161

Epi

dem

iolo

gy (P

rofe

ssio

nal)

7123

Dx

and

Trea

tmen

t Pla

nnin

g (C

linic

al)

7140

Gen

eral

Clin

ic (C

linic

al)

7103

Cel

l & M

olec

ular

Bio

logy

(Bio

med

ical

)

71

10 O

ral P

ath

& O

ral I

mm

uno

(Bio

med

ical

)

75

10 C

ritic

al T

hink

ing

(Pro

fess

iona

l)

Wee

k 2

Team

bui

ldin

g 71

02 M

icro

& Im

mun

olog

y (B

iom

edic

al)

(Pro

fess

iona

l)

7157

Pat

ient

Com

mun

icat

ions

(Pro

fess

iona

l)

75

09 P

rofe

ssio

nal S

tudi

es (P

rofe

ssio

nal)

7153

Spe

cial

ty P

ract

ices

I (P

rofe

ssio

nal)

7140

Gen

eral

Clin

ic (C

linic

al)

7505

Enr

ichm

ent P

roje

ct (B

iom

edic

al)

Wee

k 3

Peri

odon

tal

7101

Phy

sio

& A

nato

my

(Bio

med

ical

) (C

linic

al)

ther

apy

7102

Mic

ro &

Imm

unol

ogy

(Bio

med

ical

)

71

60 B

iost

atis

tics

(Pro

fess

iona

l)

71

61 E

pide

mio

logy

(Pro

fess

iona

l)

71

23 D

x an

d Tr

eatm

ent P

lann

ing

(Clin

ical

)

71

40 G

ener

al C

linic

(Clin

ical

)

71

03 C

ell &

Mol

ecul

ar C

once

pts

(Bio

med

ical

)

71

10 O

ral P

ath

& O

ral I

mm

uno

(Bio

med

ical

)

71

53 S

peci

alty

Pra

ctic

es (P

rofe

ssio

nal)

7510

Cri

tical

Thi

nkin

g (P

rofe

ssio

nal)

7136

Per

iodo

ntal

Inte

rven

tion

(Clin

ical

)

71

27 In

trao

ral R

adio

logy

(Clin

ical

)

Wee

k 4

N

utri

tion

and

7101

Phy

sio

& A

nato

my

(Bio

med

ical

) (P

rofe

ssio

nal)

oral

med

icin

e 71

02 M

icro

& Im

mun

olog

y (B

iom

edic

al)

7160

Bio

stat

istic

s (P

rofe

ssio

nal)

7161

Epi

dem

iolo

gy (P

rofe

ssio

nal)

7140

Gen

eral

Clin

ic (C

linic

al)

7123

Dx

and

Trea

tmen

t Pla

nnin

g (C

linic

al)

7125

Den

tal A

nato

my

(Clin

ical

)

71

03 C

ell &

Mol

ecul

ar C

once

pts

(Bio

med

ical

)

71

10 O

ral P

ath

& O

ral I

mm

uno

(Bio

med

ical

)

71

53 S

peci

alty

Pra

ctic

es (P

rofe

ssio

nal)

7156

Ped

iatr

ic E

duca

tion

(Pro

fess

iona

l)

75

10 C

ritic

al T

hink

ing

(Pro

fess

iona

l)

73

58 A

pplie

d H

uman

Nut

ritio

n (P

rofe

ssio

nal)

Tabl

e 3.

Spr

ing

sem

este

r, 75

02 I

nteg

rati

on S

emin

ar c

ours

e pr

esen

tati

ons

for

each

wee

k, t

opic

s co

vere

d, a

nd s

peci

fic

corr

elat

ions

to

othe

r D

S1 c

ours

es

(num

ber,

titl

e, d

epar

tmen

t)

Sem

inar

In

stru

ctor

(D

epar

tmen

t) To

pic

Cou

rse

Cor

rela

tions

Wee

k 1

Prof

essi

onal

71

09 H

ead

& N

eck

Ana

tom

y (B

iom

edic

al)

(Pro

fess

iona

l) po

rtfo

lios

7123

Dx

and

Trea

tmen

t Pla

nnin

g (C

linic

al)

7140

Gen

eral

Clin

ic (C

linic

al)

7157

Pat

ient

Com

mun

icat

ions

(Pro

fess

iona

l)

75

09 P

rofe

ssio

nal S

tudi

es (P

rofe

ssio

nal)

7153

Spe

cial

ty P

ract

ices

I (P

rofe

ssio

nal)

7505

Enr

ichm

ent P

roje

ct (B

iom

edic

al)

Wee

k 2

Xer

osto

mia

71

02 M

icro

& Im

mun

olog

y (B

iom

edic

al)

(Clin

ical

)

7160

Bio

stat

istic

s (P

rofe

ssio

nal)

7161

Epi

dem

iolo

gy (P

rofe

ssio

nal)

7123

Dx

and

Trea

tmen

t Pla

nnin

g (C

linic

al)

7140

Gen

eral

Clin

ic (C

linic

al)

7103

Cel

l & M

olec

ular

Bio

logy

(Bio

med

ical

)

71

10 O

ral P

ath

& O

ral I

mm

uno

(Bio

med

ical

)

71

53 S

peci

alty

Pra

ctic

es I

(Pro

fess

iona

l)

71

57 P

atie

nt C

omm

unic

atio

ns (P

rofe

ssio

nal)

7510

Cri

tical

Thi

nkin

g (P

rofe

ssio

nal)

Wee

k 3

Cra

niof

acia

l 71

09 H

ead

& N

eck

Ana

tom

y (B

iom

edic

al)

(Clin

ical

) an

omal

ies

7112

Hum

an D

evel

opm

ent (

Bio

med

ical

)

71

60 B

iost

atis

tics

(Pro

fess

iona

l)

71

61 E

pide

mio

logy

(Pro

fess

iona

l)

71

23 D

x an

d Tr

eatm

ent P

lann

ing

(Clin

ical

)

71

40 G

ener

al C

linic

(Clin

ical

)

71

53 S

peci

alty

Pra

ctic

es I

(Pro

fess

iona

l)

75

05 E

nric

hmen

t Pro

ject

(Bio

med

ical

)

Wee

k 4

Endo

dont

ics

7102

Mic

ro &

Imm

unol

ogy

(Bio

med

ical

)(C

linic

al)

71

60 B

iost

atis

tics

(Pro

fess

iona

l)

71

61 E

pide

mio

logy

(Pro

fess

iona

l)

71

23 D

x an

d Tr

eatm

ent P

lann

ing

(Clin

ical

)

71

40 G

ener

al C

linic

(Clin

ical

)

71

03 C

ell &

Mol

ecul

ar B

iolo

gy (B

iom

edic

al)

7110

Ora

l Pat

h &

Ora

l Im

mun

o (B

iom

edic

al)

7153

Spe

cial

ty P

ract

ices

I (P

rofe

ssio

nal)

7510

Cri

tical

Thi

nkin

g (P

rofe

ssio

nal)

7127

Intr

aora

l Rad

iolo

gy (C

linic

al)

Wee

k 5

Pa

thol

ogy

7101

Phy

sio

& A

nato

my

(Bio

med

ical

) (B

iom

edic

al)

conc

epts

71

02 M

icro

& Im

mun

olog

y (B

iom

edic

al)

7109

Hea

d &

Nec

k A

nato

my

(Bio

med

ical

)

71

60 B

iost

atis

tics

(Pro

fess

iona

l)

71

61 E

pide

mio

logy

(Pro

fess

iona

l)

71

23 D

x an

d Tr

eatm

ent P

lann

ing

(Clin

ical

)

71

40 G

ener

al C

linic

(Clin

ical

)

71

03 C

ell &

Mol

ecul

ar C

once

pts

(Bio

med

ical

)

71

08 H

IV/A

IDS

Ora

l Dis

ease

(Bio

med

ical

)

71

10 O

ral P

ath

& O

ral I

mm

uno

(Bio

med

ical

)

71

53 S

peci

alty

Pra

ctic

es (P

rofe

ssio

nal)

7510

Cri

tical

Thi

nkin

g (P

rofe

ssio

nal)

7129

Dx

& T

reat

men

t Pla

n II

(Clin

ical

)

71

36 P

erio

dont

al In

terv

entio

n (C

linic

al)

7127

Intr

aora

l Rad

iolo

gy (C

linic

al)

Wee

k 6

Intr

oduc

tion

to

7101

Phy

sio

& A

nato

my

(Bio

med

ical

) (C

linic

al)

sim

ulat

ed p

atie

nt

7123

Dx

and

Trea

tmen

t Pla

nnin

g (C

linic

al)

ca

re

7138

Pre

clin

ical

Den

tal L

ab (C

linic

al)

7130

Den

tal M

ater

ials

I (C

linic

al)

7138

Clin

ical

Occ

lusi

on (C

linic

al)

7140

Gen

eral

Clin

ic (C

linic

al)

Wee

k 7

Mec

hani

sms

7101

Phy

sio

& A

nato

my

(Bio

med

ical

) (C

linic

al)

unde

rlyi

ng

7160

Bio

stat

istic

s (P

rofe

ssio

nal)

os

teon

ecro

sis

and

71

61 E

pide

mio

logy

(Pro

fess

iona

l)

bisp

hosp

hona

te

7123

Dx

and

Trea

tmen

t Pla

nnin

g (C

linic

al)

th

erap

y 71

40 G

ener

al C

linic

(Clin

ical

)

71

03 C

ell &

Mol

ecul

ar C

once

pts

(Bio

med

ical

)

71

53 S

peci

alty

Pra

ctic

es (P

rofe

ssio

nal)

7510

Cri

tical

Thi

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Figure 1. Two (of sixty) slides from Integration Seminar: Nutrition and Oral Medicine

Source: Adapted from Touger�Decker R�� Sirois DA�� Mobley C. Nutrition and oral medicine. Totowa�� N�: Humana PR Inc.�� 2004.Touger�Decker R�� Sirois DA�� Mobley C. Nutrition and oral medicine. Totowa�� N�: Humana PR Inc.�� 2004.Nutrition and oral medicine. Totowa�� N�: Humana PR Inc.�� 2004.


series. In this way, the integrated nature of related concepts from each department is introduced to first-year students. Using this format, specific information relating to, or derived from, other concurrent courses can facilitate more elaborate discussions that reveal complex and interdependent relationships among the disciplines.

Human Subjects ExemptionAnonymous course evaluation data for the

Integration Seminar courses (DEN7501 Integration Seminar I, Fall; DEN7502 Integration Seminar II, Spring) from 150 students in the two most recent UNLV-SDM classes were retrieved and provided in non-identifiable, summarized format by the Office of Student Affairs to prevent the disclosure, and ensure the confidentiality, of any potentially personally identifiable private information.

In addition, performance data (NBDE-I scores) from 225 students of the first three UNLV-SDM classes (admitted 2002, 2003, 2004) were retrieved, and each record was assigned a numerical, nondu-plicated identifier by the Office of Student Affairs prior to dissemination of 210 NBDE-I records to the study authors, to prevent the disclosure and ensure the confidentiality of personally identifiable private information. These data were originally sought for another study to evaluate the relationship between admissions variables and student outcomes (NBDE-I scores).15

We filed and received approval for our pro-tocol from the Institutional Research Board (IRB), as an exemption to human subjects research under the Basic HHS Policy for Protection of Human Re-search Subjects, (46.101) Subpart A (b) regarding IRB Exemption for 2) research involving the use of education tests (cognitive, diagnostic, aptitude, achievement) where the subjects cannot be identi-fied or linked, directly or through identifiers, to the individual subjects.

Assessment and EvaluationThe current study collected qualitative course

evaluation data over a two-year period, using an anonymous survey-style evaluation instrument given to students at the end of each Integration Seminar. This survey instrument included standard questions designed to gauge opinions from the students’ per-

spective regarding course format and organization. One specific question related directly to the integrated nature of the course, requesting that students evalu-ate the course as “integrated into the curriculum” by selecting one of the following choices: “strongly agree,” “agree,” “disagree,” “strongly disagree,” or “NA” (not applicable).

The analysis of student perception responses revealed that an overwhelming majority of students recognized the integrated nature of this course (Fig-ure 2). Greater than 50 percent of students in the two years of data analyzed (2004-05, 2005-06) were in strong agreement that the course was integrated. Moreover, between 88 and 96 percent of students had positive responses to this survey question, responding with either “strongly agree” or “agree.” These data suggest that the vast majority of UNLV-SDM stu-dents recognized the integrated nature of this course, which provides valuable insight into the evaluation of student perception as it relates to the goals of these courses and the vertical and horizontal integration of the curriculum.

To provide a quantitative measure of student outcomes, NBDE-I scores were analyzed for three cohorts of dental students (Figure 3). The first cohort (C1) matriculated into UNLV-SDM prior to the in-ception of the Integration Seminar (2002), while the second and third cohorts (C2 and C3) matriculated into UNLV-SDM after the course was in place (2003 and 2004). These cohorts were analyzed using two-tailed t tests, a common test for inferring differences between the means of two population samples.16,17

ANOVA was performed to confirm differences and to protect against Type I error. All statistical analyses were completed using SPSS, at a significance level p=0.05.16-19

The analysis of NBDE-I scores found that scores of C2 and C3 students were significantly higher than those of C1 students (n=210, p<0.05). Student outcomes, as measured by NBDE-I scores, thus revealed an increase for two successive years after the inception of the Integration Seminar courses. Though this measure is important in demonstrating student proficiency, it is recognized that many other variables are integral to student achievement and that various other curricular interventions and site-specific changes among the faculty are likely responsible, in part, for these observations. Conversely, we propose that the Integration Seminar courses, in conjunction with other aspects of vertical and horizontal integra-tion, may be partially responsible for these increases in NBDE-I scores.


Discussion and ConclusionThe Integration Seminar at the UNLV-SDM is a

novel course designed to integrate the core concepts of the biomedical, clinical, and professional stud-ies. While the concept of integration is not new, the format and design of courses and curricula that best facilitate integration of curricular content for dental students remain under development.4,7,8 This report is among the first to discuss the selection of topics, planning of the format, and subsequent evaluations for such a course, designed specifically to address the needs of first-year dental students.

Due to continual advancements in the field of dental medicine and to the contemporary nature of this course and its topics, various facets of the Integration Seminar and curriculum are continually developing. Three main areas are currently being addressed and will be the subject of future studies. These are as follows: 1) the integration of current research and dental researchers into the dental curriculum and, specifically, into the Integration Seminar; 2) more specific and in-depth assessment from students and faculty of the Integration Seminar courses; and 3) the use of technology in the delivery and assessment of the Integration Seminar by stu-dents, faculty, and staff.

0

10

20

30

40

50

60

70

Response

2004- 05 2005-06

1 2 3 4 5 1 2 3 4 5

R e s p o n s e

Figure 2. Student perception of course integration

Anonymous surveys�� routinely administered at the conclusion of all UNLV�SDM courses�� including the Integration Seminar courses (DEN7501 Integration Seminar I�� Fall; DEN7502 Integration Seminar II�� Spring)�� were retrieved from two consecutive years (2004�05�� n=120; 2005�06�� n=117) and analyzed. The majority of students over both years (57%�� n=120; 55.74%�� n=117�� respectively) “strongly agreed” that the course was integrated. Positive responses (“strongly agree��” “agree”) accounted for 95.5% (2004�05) and 88.5% (2005�06) of responses.

1=Strongly Agree�� 2=Agree�� 3=Disagree�� 4=Strongly Disagree�� 5=NA


Curriculum integration is an exciting concept development in education, currently employed in many K-12 systems and more recently in select centers of higher education.12 Arizona State Uni-versity and Texas A&M at Kingsville, for example, have implemented curriculum integration involving the colleges of Engineering and Applied Sciences (Mechanical, Electrical, Chemical), Liberal Arts and Sciences (Chemistry, English, Mathematics, Physics, Psychology), and Business (Economics).20 These universities subsequently reported marked improve-ment in student capabilities and depth of student understanding, compared with students in the same courses taught in traditional formats. These curricu-lar innovations have taken root in many European medical and dental programs and are beginning to gain acceptance among U.S. and Canadian programs as the evidence supporting curriculum integration develops.2,7,8,12

At a minimum, this report describes how curriculum integration is being facilitated at UNLV-SDM, in part, through a seminar format, first-year course. Because this integrated teaching and learn-

ing model may result in improved understanding of important principles, better retention of knowledge, and the ability to apply these principles and concepts in the appropriate clinical settings, a further goal of this report is that the Integration Seminar may be utilized as an example for other dental, medical, and professional schools with a similar goal of achieving curriculum integration.

AcknowledgmentsThe authors thank their Associate Dean for

Research, Dr. Connie Mobley, for her assistance and the use of her seminar and text in this article.

REFERENCES1. Nierenberg DW. The use of “vertical integration groups”

to help define and update course/clerkship content. Acad Med 1998;73(10):1068-71.

2. Dahle LO, Brynhildsen J, Behrbohm Fallsberg M, Rundquist I, Hammar M. Pros and cons of vertical integra-tion between clinical medicine and basic science within a problem-based undergraduate medical curriculum: examples and experiences from Linköping, Sweden. Med Teach 2002;24(3):280-5.

Figure 3. Analysis of student outcomes

The inaugural class of UNLV�SDM matriculated prior to the inception of the Integration Seminar courses�� comprising the first cohort (C1�� n=72). NBDE�I scores from C1 were compared to those from the two subsequent cohorts (C2�� n=66; C3�� n=72) who matriculated following the implementation of the Integration Seminar. The comparison of means using two�tailed t tests of population means (C1:C2�� C1:C3) and ANOVA confirmed a significant difference between the C1 NBDE�I mean of 82.6 and C2 and C3 NBDE�I means of 85.4 and 86.4�� respectively (p<0.05�� n=210). NBDE�I averages for both C2 and C3 cohorts exceeded the NBDE�I national average�� p=85.

70

75

80

85

90

95

C 1 C 2 C 3

U N L V -S D M c o h o rt

µ = 8 5


3. Geffen LB, Birkett DJ, Alpers JH. The Flinders experiment in medical education revisited. Med J Aust 1991;155(11-12):745-50.

4. Elliot MK. Are we going in the right direction? A survey of the undergraduate medical education in Canada, Aus-tralia, and the United Kingdom from a general practice perspective. Med Teach 1999;21(1):53-60.

5. Blue AV, Garr D, Del Bene V, McCurdy L. CurricularCurricular renewal for the new millennium at the Medical University of South Carolina College of Medicine. J S C Med Assoc 2000;96(1):22-7.

6. Harden R, Crosby J, Davis MH, Howie PW, Struthers AD. Task-based learning: the answer to integration and problem-based learning in the clinical years. Med Educ 2000;34(5):335-6.

7. Allen KL, More FG. Clinical simulation and foundation skills: an integrated multidisciplinary approach to teach-ing. J Dent Educ 2004;68(4):468-74.

8. Snyman WD, Kroon J. Vertical and horizontal integration of knowledge and skills: a working model. Eur J Dent Educ 2005;9:26-31.

9. School of Dental Medicine, University of Nevada, Las Vegas: vision, mission & goals. At: http://dentalschool.unlv.edu/vision.html. Accessed: May 2007.

10. Hassed CS. Bringing holism into mainstream biomedi-cal education. J Altern Complement Med 2004;10(2): 405-7.

11. Sanders RM, Ferrillo PJ Jr. A new school’s perspective on clinical curriculum. J Dent Educ 2003;67(12):1316-9.

12. Patel VL, Arocha JF, Chaudhari S, Karlin DR, Briedis DJ. Knowledge integration and reasoning as a function of instruction in a hybrid medical curriculum. J Dent Educ 2005;69(11):1186-211.

13. DePaola D, Howell H, Baker CG, Boy-Lefevre ML, Hull P, Holmstrup P, et al. Research and the dental student. Eur J Dent Educ 2002;6(Suppl 3):45-51.

14. Touger-Decker R, Sirois DA, Mobley C. Nutrition andNutrition and oral medicine. Totowa, NJ: Humana PR Inc., 2004.

15. Kingsley K, Sewell J, Ditmyer M, O’Malley S, Galbraith GM. Creating an evidence-based admissions formula for a new dental school: the University of Nevada, Las Vegas, School of Dental Medicine. J Dent Educ 2007;71(4):492-500.

16. Hinkle DE, Wiersma W. Applied statistics for the be-havioral sciences. 5th ed. New York: Houghton Mifflin Company, 2003.

17. Hays WL. Inferences about population means. In: Statis-tics. 5th ed. Orlando, FL: International Thomson Publish-ing, 1994:311-42.

18. SPSS for Windows, Rel. 14.0.2. Chicago: SPSS Inc., 2006.

19. Heiman GW. Basic statistics for the behavioral sciences. 5th ed. New York: Houghton Mifflin Company, 2006.

20. Evans DL. Curriculum integration at Arizona State Uni-versity. At: www.foundationcoalition.org/publications/journalpapers/fie95/4d41.pdf. Accessed: May 2007.

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