The integration ladder: a tool for curriculum planning and evaluation

TLDR

Integration is a key educational strategy in medical education, yet discussions about it are often polarized among teachers. This paper aims to present 11 points on a continuum that bridges the polarized extremes of integration. The authors outline an integration ladder comprising 11 stages—Isolation, Awareness, Harmonization, Nesting, Temporal coordination, Sharing, Correlation, Complementary, Multi‑disciplinary, Inter‑disciplinary, and Trans‑disciplinary—where ascending levels reduce discipline emphasis, increase central curriculum demands, organizational structure, and staff participation. The integration ladder proves to be a practical tool for medical teachers, aiding curriculum planning, implementation, and evaluation.

Abstract

Integration has been accepted as an important educational strategy in medical education. Discussions about integration, however, are often polarized with some teachers in favour and others against integrated teaching. This paper describes 11 points on a continuum between the two extremes. * Isolation * Awareness * Harmonization * Nesting * Temporal co-ordination * Sharing * Correlation * Complementary * Multi-disciplinary * Inter-disciplinary * Trans-disciplinary As one moves up the ladder, there is less emphasis on the role of disciplines, an increasing requirement for a central curriculum, organizational structure and a requirement for greater participation by staff in curriculum discussions and planning. The integration ladder is a useful tool for the medical teacher and can be used as an aid in planning, implementing and evaluating the medical curriculum.