Curriculum integration can also be accomplished in smaller steps.
Many schools are undergoing major curriculum revisions to accomplish curricular integration. In some cases this involves dissolving departments, eliminating course directors, and amalgamating the courses into an integrated system. While the jury is out to see if these wholesale changes improve student learning and performance, the utility of integrating material is indisputable and was in fact already promoted by Flexner in his original report.
To accomplish partial integration in the second year of school at the University of Louisville School of Medicine, contact time (not hours) has been extended by giving the major courses, pathology, pharmacology and microbiology one extra teaching block. This modification promotes integration by overlapping all three courses for two teaching blocks. In addition, Islands of Integration have been inserted by bringing in select lectures into the curriculum of all courses. Examples include: when microbiology lectures on hypersensitivity, pharmacology presents antiasthmatic drugs; when microbiology lectures on AIDS, pathology talks about pathological changes with AIDS; when pharmacology lectures on antibiotics, microbiology talks about strategy with specific microorganisms.
By making relatively small changes to the curriculum, yet providing students with increased integration, the integrity of departmental courses is maintained and there is little danger that these changes will adversely affect the success that is currently enjoyed by our students on Step 1 of USMLE. This may provide a model for other schools contemplating curriculum integration/change.