Harden's Ladder of Integration #medicaleducation #integration #alignment #cbme #education
Channel: SPM & Research with Dr Rock Britto
Date: 2023-11-08

The integration continuum
Discussions about integration have been polarised, with some teachers arguing in
favour and others against integrated teaching. In the SPICES model for educational
strategies, integration is presented as a continuum with full integration at one end
and discipline-based teaching at the other (Harden 2000). A position between the
two extremes may be adopted as described on the integration ladder 
This has been found to be a useful tool to explore integration in a curriculum and
to identify the most appropriate level to suit a particular curriculum.
Step 1 – Isolation
Departments or subject specialists, represented by squares, organise their teaching
in isolation with no consideration of other subjects or disciplines.
Step 2 – Awareness
The teaching is subject-based, as in Step 1, but some mechanisms are in place whereby
a teacher in one subject is made aware of what is covered in other subjects in the
curriculum.
 
Step 3 – Harmonisation
In harmonisation, teachers responsible for different courses consult with each other
and communicate about their course.
Step 4 – Nesting
In this integrated approach the teacher includes, within a subject-based course,
knowledge and skills relating to other subjects.
Step 5 – Temporal coordination
The timetable is adjusted so that related topics within subjects are scheduled at the
same time, with similar topics being taught on the same day or week.
Step 6 – Sharing
Some teaching is shared between two departments or disciplines implementing the
teaching programme.

Step 7 – Correlation
In addition to the subject-based teaching, an integrated teaching session is introduced that brings together areas of common interest in each of the subjects.
Step 8 – Complementary
There is both subject-based and integrated teaching but with integrated sessions
representing a major feature of the curriculum.
Step 9 – Multi-disciplinary
A number of subjects are brought together in a single course with an integrated
theme, but with the subjects clearly identified.
Step 10 – Inter-disciplinary
Subjects lose their identity in a new integrated programme.
Step 11 – Trans-disciplinary
The integration is built around the field of knowledge as exemplified in the real
world rather than a theme or topic selected for the purpose.
References:
ESSENTIAL SKILLS
FOR A MEDICAL
TEACHER
An Introduction to Teaching and Learning
in Medicine
Second Edition
Ronald M. Harden 
https://jmsh.ac.in/articles/an-attempt-to-understand-the-different-levels-of-hardens-ladder
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.nmc.org.in/wp-content/uploads/2020/08/Alignment-and-Integration_03.10.2019.pdf