Integration in medical education is a crucial and complex issue that is considered a fundamental educational strategy. However, like many integrated programs, the level of integration in the IU-ITF UGME program does not reach the higher levels outlined in Harden’s 11-step integration ladder [6]. Integration is at the level of temporal coordination in the first three terms and at the level of awareness in the fourth and fifth terms in IU-ITF UGME program.
There is no single definition for the concept of integrating educational programs. Typically, integration involves combining basic, clinical, and social sciences in one course during preclinical years or weaving interdisciplinary block courses (such as ethics) throughout the program [7, 8]. Integration in medical education has various benefits, such as emphasizing patient problems by linking basic and clinical sciences, enhancing diagnostic skills, being more meaningful and engaging for students, and incorporating socio-humanistic and public health aspects into education through vertical integration. Despite the opposition from some educators, integration plays a key role in delivering an effective educational program [9, 10].
In the transition to an integrated education program, the perceptions of program stakeholders are crucial, yet little attention has been given to this issue. A study conducted by Muller JH and colleagues in a medical school implementing an integrated education program in 2008 focused on the perceptions of students, faculty members, and program coordinators. The results of their study indicated that all stakeholders highlighted the importance of interdisciplinary teaching in an integrated program, the necessity of preparing basic science material for practical application in clinics, and the significance of detailed monitoring of the program by program coordinators [8]. Furthermore, the study highlighted some challenges, such as the ability of different disciplines to collaborate in teaching, faculty members’ reluctance to transition to a new educational model, communication between stakeholders, and maintaining consistency throughout the lessons. Program coordinators expressed their view on integration, stating that it involves gathering members from various departments and disciplines around a table and noting the predominant representation from one or two disciplines, differing from the traditional program’s composition [8]. A workshop conducted with faculty members at Istanbul Faculty of Medicine revealed similar findings. Participants highlighted significant barriers to integration, such as the entrenched departmental structure, resistance from some faculty members, and the influence of institutional culture, which hinders adaptation to the integration process.
An intern survey evaluating the program’s compatibility with UCEP 2020 revealed that while intern doctors had adequate knowledge on clinical symptoms/signs/conditions related to breast health and diseases, they lacked competency in prevention methods. The study unveiled deficiencies in practical medical skills, such as breast and axillary region examinations, and self-breast examination teaching capabilities. These deficiencies may stem from inadequate structured training in breast examination skills and clinical breast examination in the current education program, as well as a lack of skills assessment exams. The program’s shortcomings highlighted by intern doctors reinforce the need to address deficiencies in clinical experiences within the program.
In Türkiye, there is no other study evaluating the alignment of breast health and disease topics in the undergraduate medical education program with UCEP 2020. However, studies from institutions that generally assess medical education programs in terms of alignment with UCEP 2020 have been reviewed. They indicated that the content of the undergraduate medical education program fully and completely covers all clinical symptoms, core diseases, and basic medical skills outlined in UCEP 2020, with a very detailed and comprehensive program. However, there was approximately a 25% deficit in the overall skills expected to be acquired by students as outlined in UCEP [11,12,13]. When considering the results of all these studies together, it is evident that the situation in medical faculties is fairly consistent. In conclusion, students are not adequately prepared for primary healthcare services based on the basic medical skills defined in UCEP 2020.
The strength of this study is that, there is no other study in Türkiye that is as organized and structured as this one evaluating the undergraduate medical education program, and these results actually include important results and details that are known but not documented before. On the other hand, the most significant limitation of this study is the exclusion of faculty members who are resistant to change. They did not come to the workshop even though they were invited. Instead, the study primarily included faculty members who are already actively addressing deficiencies in the program and working on areas that require improvement.
Numerous studies have been conducted on how topics should be addressed in the organization of undergraduate medical education programs. Students have found problem-based learning to be more encouraging, humane, engaging, difficult but beneficial. In a review article published by Nandi PL et al., students mentioned that they find traditional learning to be irrelevant, passive, and boring. Students who use the problem-based learning method demonstrate better interpersonal skills and psychosocial knowledge towards patients, while students who use the traditional model perform better in basic science exams. Generally, educators prefer problem-based learning [14].
Lam AK et al. stated that web-based modules are an important resource that can facilitate pathology teaching and enhance pathology education in medical schools. They also have the potential to be used nationally and internationally in other fields due to their multidisciplinary structure and flexibility of presentation [15]. In their studies, McNulty JA et al. analyzed the use of video lessons in basic science courses for medical students. They found that the individual use of videos was related to the difficulty of the subject, students preferred to use video lessons more for reviewing the course and preparing for exams, and the most viewed videos resulted in lower exam scores due to the more difficult and harder to understand topics [16]. On the other hand, when specially prepared multidisciplinary modules are made available for remote access and the possibility of accessing them at any time, independent learning is encouraged, and students’ participation and success are positively affected, as demonstrated by Lam et al. Another teaching model that has become increasingly popular in recent years is the flipped classroom model [17, 18]. This method differs from traditional classes where students passively receive information from the teacher. The flipped classroom model provides flexibility for students to learn at their own pace, promotes retention of content, and increases students’ interest in learning [19,20,21,22]. In clinical pathology, an ultrasound-guided anatomy lesson and practical applications can be included in the program to demonstrate changes in anatomical structures and increase memorability.
There have been numerous studies conducted on the effectiveness of skill training in breast examination. When examining these studies, it is seen that training with breast models, standardized patients, or in a virtual breast clinic is effective in acquiring breast examination skills [23,24,25,26,27]. In their randomized controlled studies, Campbell et al. showed that training in breast examination using standardized silicone models was more effective in detecting masses in the breast [23]. In the studies by Nassif et al., it was observed that hybrid simulation using standardized patients and breast model jackets to teach clinical breast examination increased sensitivity in skill but did not change specificity. However, it was found to be effective in increasing students’ self-confidence [26]. The results of this study show that hybrid simulation leads to a significant improvement in medical students’ ability to correctly diagnose a lesion and interpret potential malignancy.
It is essential for medical students to feel comfortable and safe when interacting with patients in clinics. Currently, due to the high number of students in many medical faculties, a lack of experienced teaching staff, and insufficient time allocated to education by teaching staff, medical students do not have enough exposure to seeing and examining patients alongside faculty members in clinics before directly interacting with patients. This lack of experience can make them feel tense, insecure, and uncomfortable when meeting patients in the clinic. One solution to this fundamental issue in medical education is to ensure that students have acquired basic breast examination skills before interacting with patients in the clinic. Taking histories from standardized patients, performing physical examinations, and practicing breast examination skills on breast models and simulators are proven teaching methods in medical education. Training sessions with breast models and standardized patients increase students’ self-confidence, while decreasing anxiety and stress levels [24, 27]. Another effective teaching method that can be implemented in university hospitals is peer education or involving residents in student education. Studies in this area show positive changes in residents’ attitudes towards teaching and improvement in their understanding of educational principles. Additionally, the majority of residents (92.5%) believe that their role as educators for medical students, interns, and other residents is highly important [27,28,29,30].
This study primarily identifies the deficiencies and redundancies in the program, highlights areas for improvement, and provides recommendations to address these issues. However, to develop a new program, further investigation is needed to determine specific learning goals and objectives, how they will be integrated into the program, and which teaching and assessment methods should be employed.