ARCHETYPE OR FOR THE ARCHIVE? ARE CASE HISTORIES SUITABLE FOR ASSESSING INTEGRATED  LEARNING?

Integration is fundamental to medical practice. Yet as we engaged with this project, we were  surprised to realise that it is not fundamental to medical education. Traditionally, medicine was  taught and assessed as a series of distinct disciplines, each with its own department, e.g. anatomy,  physiology, medicine, surgery etc. Each department had its own preferred teaching methods and modes of assessment. Furthermore, the emphasis in such curricula was on the accumulation and  demonstration of knowledge. It was assumed that graduates would demonstrate a professional  manner and that core skills would be learnt (rapidly) 'on the job'. The initial year after graduation was  'a baptism of fire'; many colleagues vividly recall their emotional and physical experiences from this formative year.    That such training was serving neither public nor professional purposes has been recognised and  medical education has been revolutionised in the past decade (General Medical Council, 2003, 2009; Accreditation Council for Graduate Medical Education).    New teaching methods, new assessment formats and indeed a new paradigm has emerged in medical  training. Increasingly cognitive knowledge and the single correct answer are insufficient to ensure graduation; students must demonstrate a range of abilities, explain how the answer is derived and  actively consider alternatives, which recognise patient autonomy and the contextual variation of care.  Medical education today aims to marry the skills and sensitivities of the applied  scientist to the reflective capabilities of the medical humanist (Hurwitz and Vass, 2000, p. 668).  In 2007, University College Cork (UCC) introduced a new curriculum which fosters horizontal and  vertical integration of learning (Diagram 1). Within this model, basic science teaching is integrated  (e.g. anatomy, physiology and biochemistry are now taught as a united subject) and students are  given exposure to patient care early in the course. Specific resources are dedicated to skills training  (e.g. communication skills, procedural skills) and the promotion of personal and professional  development. These changes are implemented through both curriculum content and content delivery.  For example, although lectures remain, their preponderance is reduced and instead students are expected to work in small groups as they wrestle to resolve clinical problems.    The focus of this study is the third year module in clinical practice. Clinical practice starts in  first year but assumes increasing importance as students progress through the course (vertical  integration). Of a class size of 110, approx 10% are from Canada and the US, 20% from Asia, 10% from the Middle East and the majority of the remainder are Irish, with a few Europeans joining in.    Clinical practice is by definition, itself an integrated subject: the module amalgamates previously  distinct clinical specialties e.g. within medicine, surgery and primary care. Five years ago, this term  would have been meaningless in medical universities; we have emerged from isolated discipline  based teaching. The module is delivered at clinical sites, across a range of primary, secondary and  tertiary care services in geographically diverse centres e.g. one week a student may be studying  plastic surgery in a large 500 hundred bed hospital, the following week they could be doing a      house call in an isolated rural town. Students are immersed in full-time clinical placements  - the curriculum is delivered across these sites by a group of tutors (of varying specialties)  by means of 'integrated case studies'. The use of 'case-based, problem based learning' is  promoted on the basis that it promotes authentic, person-centred learning. Such methods also promote problem-solving skills . Four key elements form the basis of the module: core  knowledge; problem solving; clinical skills; and communication skills. To do well students must demonstrate their ability to make connections between all four dimensions.    As we describe this module, we realise how 'integrated' this module is; integrated subjects  (e.g. clinical practice), integrated assessment (e.g. from Objective Clinical Skills Examinations  (OSCE) to reflective journal) and the integration of teaching methods by a team of multidisciplinary teachers are all tangible outputs of the new curriculum.  How has this integration impacted in terms of student learning? One way to determine this  is to critically examine our assessment. If our teaching is promoting integrated learning, the principle aim of the new curriculum, surely this should be a demonstrable output.    In keeping with good practice, the new curriculum has seen the introduction of a diverse  range of assessment tools. Traditional assessment methods, such as essay type questions and  oral examinations, have been criticised for lack of standardisation and for failing to assess a breadth of knowledge key for clinical practice . In keeping with this, the new curriculum  has embraced new assessment methods such as OSCEs (Objective Structured Clinical Exams), mini-CEX (Mini-Clinical Exams) and EMQs (Extended Matching Questions). These assessment  methods appear to be more valid and reliable . There is also now more focus on continuous and formative assessment.    THE ARTS IN EDUCATION AS AN INTEGRATIVE LEARNING APPROACH  Marian McCarthy UCC  CONTEXT  A number of contexts have a bearing on my focus in this Integrative Learning Project. The  first is that, as programme co-ordinator of the Certificated Courses in Teaching and Learning  in Higher Education, I am conscious of how I can find some common ground for lecturers across the disciplines, so that we can begin to talk about teaching and learning and how  these are interdependent. The second context relates to my interest in the pedagogy of  Teaching for Understanding (TfU) (Wiske, 1998) which speaks to lecturers as disciplinarians as  well as teachers and provides them with a framework to critique and develop their teaching  and advance student learning. I have written elsewhere about the implications of this  model for higher education (McCarthy, 2008a) but will focus here only on one aspect of the  framework: the performance view of understanding (Perkins, 1998). The latter is grounded in  an active learning approach and contrasts with the more traditional, representational view of understanding which predicates a more passive, teacher-focused view of understanding.  In the context of the three programmes that I teach at University College Cork (UCC) -  the Certificate, Diploma and Masters in Teaching and Learning in Higher Education - I am  constantly challenged by the Teaching for Understanding (TfU) approach, always asking myself the question: How can I engage my colleagues in their learning? How can I find performances of understanding for them that will help demonstrate their knowledge of teaching and learning and advance it? This brings me to the third context of this work, that of the role of the Arts in  Education as a catalyst for learning. My interest in the Arts is an intrinsic part of my life, and  has shaped my teaching, which was influenced by lessons learned in the artistic disciplines of drama, speech, mime and dance. Through the Arts, I found a voice and a way of viewing  the world and synthesising my perceptions of it and those of my fellow actors, speakers, and dancers. This transferred into my career as a second - level teacher of English and Drama and  of Civic, Social and Political Education, where I used the Arts as an educative tool, as an entry-  point to learning in these subject areas (O'Connell/McCarthy, 1994). So when I came to the  Project Zero literature (Veenema et al, 1998) and the TfU approach, as a third - level teacher, I was not surprised to find a focus on the idea of creative performance and, indeed, of being actively involved in responding to the arts, as intrinsic to learning.    The final context that speaks to my involvement in this Integrative Learning Project, is that  of the scholarship of teaching and learning and its focus on documenting and researching  teaching and learning. I have attempted to provide an overview of this literature elsewhere  (McCarthy and Higgs, 2005; McCarthy, 2008b), but will focus here on its practical application in my own classroom. Daily, I am challenged as to how to involve teachers, with full lecture  schedules and research profiles and deadlines in their own disciplines, in researching their  teaching and their students' learning. Though the Scholarship of Teaching and Leanring (SoTL)  does not offer a panacea, it acknowledges that teaching and learning belongs to all in the university, and not only to education departments. It also honours the contribution of the  disciplines in framing research questions in teaching and learning (Shulman and Hutchings,  1998) and so gives third-level teachers a way forward that parallels their research in their  disciplinary fields. My challenge is to open up my third-level colleagues to the world of SoTL and the concept that the 'problem' in teaching is not one from the deficit model of  remediation, something that can be 'fixed', but an investigative problem, like any other in the research world (Bass, 1999). Boyer's (1990) paradigm of the four scholarships has profoundly  changed our focus in higher education and given the scholarship of teaching and learning  its due place as research. It has also put the spotlight on the Scholarship of Integration, as one of the four scholarships, putting up front the challenge of working on the margins of several  disciplines, of crossing boundaries and integrating various disciplines- indeed, the daily experience of most lecturers. It is to this challenge, in the context of promoting a SoTL approach that this chapter speaks.   ASSESSING THE ROLE OF INTEGRATED LEARNING IN THE BSC INTERNATIONAL FIELD GEOSCIENCES  (IFG) AT UNIVERSITY COLLEGE CORK, IRELAND  Pat Meere UCC   CONTEXT  The Department of Geology at University College Cork (UCC) launched a new BSc in International Field  Geosciences (IFG) in autumn 2008. In this programme, superb natural field geoscience laboratories,  available in Europe and the western United States, are utilised as learning environments, forming  the basis for a joint Bachelor of Science undergraduate degree. The programme focuses on the  documentation, interpretation, and synthesis of critical geological issues in the field. It rests upon  a backbone of existing modules that are the foundation of current geology curricula at three partner  institutions (University College Cork, Ireland, The University of Potsdam [UP], Germany, and The  University of Montana [UM] USA), complemented by an emphasis on the development of field-based learning in an intercultural setting. The core curriculum is identical to that required for the existing  BSc Geology at UCC except that the third year (sixty credits) is spent abroad at UM while twenty credits are taken at UP at the start the fourth year. The mobility component of the programme is  funded as part of a joint EU/US ATLANTIS project, with the aim of supporting international curriculum development.    Geoscience - the science of the Earth - directly involves the study of natural geological processes  and environmental phenomena that shape the Earth through space and time. These global processes  cross all socio-economic borders and directly affect all of Earth's inhabitants. As the current  generation of students will face enormous future environmental challenges, that are inherently global in scope, modern geoscience undergraduate education ideally requires an international perspective.  The motivation for the new programme was primarily driven by the growing international demand for geoscientists with integrated field skills.    However, over the last two decades existing geoscience programmes in Europe and the US have  tended to progressively reduce their field-based learning components. One of the major reasons for  this neglect is the increasing cost associated with physically transporting students into the field and maintaining a safe outdoor working environment. In the last few decades health and safety  considerations in an increasingly litigious society have led to a decrease in choice of suitable field  areas. Lastly, recent technological advances, such as Geographic Information Systems (GIS), and  various forms of remote sensing have led to new ways of analysing geospatial data that, while  certainly useful, divert the attention of the geoscience community away from collecting 'ground truth' data and making direct observations in the field.    This overall trend has not gone unnoticed by employers of geoscienists who, despite the overall  reduction in field-based learning, increasingly place greater store on these experiences in  geoscientist training programs. As a result, industry recruiters seeking to hire students view with favour those whose training has involved significant field-based learning. Field-oriented students  are more 'familiar with the rocks', are better able to make accurate predictions of new and unproven  geologic systems, and are more valuable in the marketplace. Similarly, graduates entering the  environmental industry without substantial time in the field are less well able to, for example, design efficient pollution remediation systems than students whose undergraduate education includes field-  based topics. It is now well established that field training programs equip students with a valuable  suite of transferable skills that critically include the fostering of self reliance, personal initiative and independent thinking. An effective field programme will encourage students to pull together  multiple facets of their prior learning, and challenge them to build a new robust understanding in the discipline. A recent quote from an industry insider (Ian Sharp, the Chief Geology Researcher at  StatoilHydro) in Butler (2009, p. 8) illustrates the growing importance industry is placing on  field based learning:  The industry perspective is clear - the skill to visualise, think and sketch models  in 3D gained from field work is absolutely invaluable - if you don't have this then  it does not matter how good you are at producing nice attribute images from seismic [remotely-sensed] data - if you do not know what you are looking for (i.e. what the geological element/geo-body looks like) you cannot find it.  These worldwide trends have led us to place a very strong emphasis on field-based learning  in the BSc IFG joint degree programme. To undergraduate students of geoscience, field-based  learning is a powerful means of optimising skill-sets involved in the analysis of phenomena  that shape the Earth. We believe that substantial time in the field helps build students'  capacities to be integrative thinkers and learners, because it:  (1) Allows students to make their own conceptual connections and adopt a problem  solving approach that requires them to draw on and integrate various sub-disciplines in the geosciences.  (2) Provides students with direct access to their study subject (the Earth) and so allows  authentic practice.  (3) Provides opportunities for students to acquire 3D visualisation of geological  structures and relationships, a threshold concept in geoscience.  (4) Offers students an opportunity to take ownership and responsibility for their own  learning experience.  (5) Offers greater opportunity for students to show personal learning initiative.  (6) Raises awareness and enhances student appreciation for environmental issues and the  complexity and uncertainty of feedback mechanisms.  (7) Enhances generic scientific investigative skills, and subject-specific research skills.  (8) Enhances personal development, through increased self-reliance, self confidence and  team-building.  (9) Promotes deeper learning through direct experience and complete immersion.   These benefits as outlined above are supported by recent pedagogic research (e.g. Boyle et al,  2007; Butler, 2009) where quantifiable feedback from students clearly underscores the merits  of field-based learning. To add to this, we see the field experience as the place where students  are challenged to bring together their prior knowledge to build a new and more robust understanding, which is greater than the sum of the parts.    The students involved in the IGF will also be exposed to differing educational philosophies  over the course of their three year programme. Students primarily based in Ireland will spend  one year at the University of Montana where they will be exposed to a liberal arts tradition,  a tradition that has at its heart the idea that learning should be greater than the sum of  its parts (Huber and Hutchings, 2004). This programme offers the opportunity to assess the effectiveness of both the European and US traditions in the context of field-based learning. In addition, because of the global scope, professional Geoscientists will have an advantage if their formal education provides a venue for understanding the subtleties of other cultures and peoples from different backgrounds. With exposure to cultural differences and a broader  understanding of global issues, geoscience students are better able to contribute to decisions involving the environment and its evolution at governmental, industry and scientific levels.         THE INQUIRY  The question at the heart of this enquiry is 'focusing on both the cognitive and affective domain,  how can we assess the success of the integrative learning opportunities provided on the IFG  programme?' We will use a variety of means to collect evidence of student integrative learning.