Optimizing Curriculum Integration: Development and Validation of the Tool of Integration Practices (TIP) in Health Professions Education - A Mixed Methods Study
Aug 2026· Pakistan Journal of Medical Sciences· Vol 42, pp. 2381-2392· 0 citations· 18 references
TL;DR
The Tool of Integration Practices (TIP) demonstrated adequate validity and reliability and provides a practical, psychometrically sound framework for assessing and comparing curriculum integration practices based on faculty perceptions at the course and program levels in health professions education.
Abstract
Objective: Curriculum integration is increasingly used in medical and dental education, yet validated tools to objectively measure integration are limited. Existing frameworks, such as Harden’s ladder, are mostly descriptive and difficult to implement for systematic evaluation. Therefore, this study aimed to develop a valid and reliable tool to assess the level of integration in medical and dental curricula.
Methodology: A multiphase mixed-method approach was employed for instrument development. Eight domains representing the integrated curriculum were initially identified through a literature review, each structured on a 5-point scale based on Harden’s integration ladder. Content validity was established via expert review (n = 17), followed by cognitive interviews with faculty (n = 6), and pilot testing with medical and dental faculty (n = 150). Reliability was assessed using Cronbach’s alpha.
Results: Content validity resulted in seven domains with a mean content validity index of 0.89 and an average content clarity score of 3.46. Cognitive interviews led to minor adjustments in four items. The final tool demonstrated good reliability (Cronbach's alpha = 0.88). EFA supported a one-factor model, confirmed by CFA (GFI = 0.96, RMSEA = 0.052, normed χ² = 1.4), indicating a good model fit.
Conclusion: The Tool of Integration Practices (TIP) demonstrated adequate validity and reliability. It provides a practical, psychometrically sound framework for assessing and comparing curriculum integration practices based on faculty perceptions at the course and program levels in health professions education.
The purpose of this paper is to examine how the Sustainable Development Goals (SDGs) are integrated into a nursing education program at the Universidad Técnica del Norte (UTN), Ecuador and to identify the institutional, curricular and pedagogical factors associated with their explicit incorporation. The study aims to clarify the gap between SDGs awareness and formal curricular enactment in higher education for the health sciences.
The study adopts a sequential mixed-methods design combining qualitative, quantitative and documentary approaches. Data were collected through a faculty focus group, surveys administered to instructors (n = 35) and undergraduate nursing students (n = 498) and a microcurricular review of official course syllabi (n = 45) within the UTN nursing program. Quantitative analyses included nonparametric tests, correlation analyses, clustering techniques and logistic regression, while qualitative and documentary data were integrated through methodological triangulation.
Although faculty awareness of the SDGs is relatively high, their translation into explicit curricular practice remains uneven, with fewer than two thirds of instructors reporting formal integration. Faculty engagement is concentrated primarily on SDGs 3 (Good Health and Well-Being) and SDGs 4 (Quality Education), reflecting disciplinary proximity, while broader socio-ecological goals receive limited attention. Logistic regression analysis showed moderate explanatory capacity (McFadden’s pseudo-R2 = 0.429), indicating that structural and curricular factors play a stronger role in explicit SDGs integration than pedagogical activity alone. Among students, exposure to the SDGs is widespread, but levels of deep understanding are modest, and knowledge is only weakly associated with perceived importance. The micro-curricular analysis reveals that explicit SDGs references are largely absent from foundational courses and become more prevalent in professionalizing and practice-based stages, particularly during the Rota.
The study is limited by its single-institution design and the small faculty sample size, which may restrict statistical power and generalizability. Future research should adopt multi-institutional and longitudinal designs and incorporate direct measures of sustainability competence development.
The findings provide actionable guidance for curriculum governance and faculty development in nursing education. They support the need to institutionalize SDGs integration from early curricular stages, align active pedagogies with explicit learning outcomes and assessment criteria and strengthen program-level mechanisms to ensure coherent and traceable Education for Sustainable Development (ESD).
By strengthening the integration of the SDGs in nursing education, higher education institutions can better prepare future nurses to address health inequities, promote preventive and community-based care and contribute to sustainable health systems. Such integration also enhances graduate employability by developing competencies increasingly valued in the global health sector, including sustainability awareness, equity-oriented practice, community engagement and responsible use of health resources. In the Ecuadorian context, and more broadly in the Global South, such curricular alignment has the potential to enhance social justice, public health outcomes and community well-being through professionally trained agents of sustainable development.
To the best of the authors’ knowledge, this study provides one of the first empirical, multilevel analyses of SDGs integration in nursing education in Ecuador. By combining faculty and student perspectives with micro-curricular evidence from UTN, it offers an evidence-informed framework for strengthening ESD in health sciences programs, particularly in Global South contexts.
Katty Elizabeth Cabascango Cabascango, Patricia Marlene Aguirre Mejía, Freddy Hernán Villota González et al.· International Journal of Sus...· 0 citations
Overall, the CTBLQ demonstrated satisfactory psychometric properties and provides a standardized diagnostic instrument for identifying barriers to Team-Based Learning implementation and may support evidence-informed curriculum evaluation, educational planning, and future research in nursing education while contributing to the advancement of health workforce education through improved implementation of collaborative learning.
P. Kien, Leslie F. Lazaro· International Journal of Nur...· 0 citations
Purpose Mind mapping supports clinical reasoning and knowledge organization in health professions education, but its use as a standardized formative assessment tool remains limited. This study aimed to design and validate a comprehensive checklist to evaluate mind maps as a formative assessment tool among bachelor of anesthesia technology students, addressing structural, scientific, and creative dimensions. Study Sample and Methods This cross-sectional study was conducted in 2023 at Iran University of Medical Sciences among 50 bachelor of anesthesia technology students selected via convenience sampling. The checklist was developed through a literature review and refined using a two-round Delphi process with medical and anesthesia education experts. Validity evidence was collected based on Kane’s framework, evaluating scoring (face/content validity), generalization (intra-/inter-rater reliability), extrapolation (correlation with written tests), and implications. Data were analyzed using SPSS version 22. Results The final checklist comprised 10 core items, achieving a high scale-level content validity index (S-CVI/Ave = 0.90). Reliability analyses demonstrated excellent intra-rater (0.88–0.99) and inter-rater agreement (0.90–0.93). Convergent validity was supported by a very strong correlation between mind map scores and written examination scores among a subsample of 24 students (ρ = 0.939, ρ < 0.001). These findings indicate that the checklist provides reliable and valid scores for clinical education. Conclusion The developed checklist demonstrated strong validity and reliability for formative assessment in anesthesia technology education. By integrating structural features with scientific accuracy, the tool provides meaningful and consistent evaluation of mind maps as indicators of student learning and knowledge organization. The strong reliability indices and high correlation with written assessments support its use as a standardized tool for providing targeted feedback in clinical education.
A. S. Sajadi, Alireza Babajani, Raheleh Charmchi et al.· Advances in Medical Educatio...· 0 citations
Background Clinical teaching is essential in high-risk disciplines such as anesthesia. MSc students in Anesthesia Education require validated tools to assess their instructional performance during clinical internships. This study aimed to design and validate a clinical teaching performance checklist for MSc students in Anesthesia Education using Kane’s argument-based validation framework. Methods This descriptive-analytical, cross-sectional, single-center study was conducted at Iran University of Medical Sciences (2023–2025) with 11 fourth-semester MSc students. The checklist was developed using curriculum objectives, Entrustable Professional Activities (EPAs), focus groups, and a two-round Delphi process with 10 experts. Face and content validity (Impact Score, CVR, CVI), reliability (Cronbach’s alpha, ICC across two settings), and extrapolation evidence (Spearman correlation with global ratings) were evaluated. Results Seven EPAs yielded a 20-item checklist. Content validity was acceptable (CVI≥0.79 for most items; two retained via expert consensus). The instrument showed high internal consistency (Cronbach’s α=0.88) and excellent inter-rater reliability (ICC≥0.98). Extrapolation inference was supported by a strong correlation with faculty global ratings (rs=0.81). Faculty and students reported high satisfaction with the tool. Conclusion This study offers promising preliminary evidence supporting the feasibility, validity, and reliability of the EPA-based checklist for clinical teaching assessment. Integrating Kane’s framework with EPAs provides a structured approach for formative evaluation; however, broader confirmation through larger, multicenter studies is required prior to widespread implementation.
A. S. Sajadi, N. Hamidi, Shahnam Sedigh-Maroufi et al.· Advances in Medical Educatio...· 0 citations
Background: Workplace-based assessment (WBA) has become a cornerstone of competency-based medical education, shifting evaluation from artificial testing environments to authentic clinical settings. Tools such as Direct Observation of Procedural Skills (DOPS), Mini-Clinical Evaluation Exercise (mini-CEX), and Case-Based Discussion (CbD) are widely used to assess clinical competence in real time, yet a comprehensive synthesis of their validity, reliability, and educational impact is needed. Objectives: This narrative review aims to evaluate the effectiveness of WBA tools in postgraduate medical education, with a focus on their psychometric properties, feasibility, and role in enhancing clinical skills and professional development. Methods: A narrative review methodology was employed, guided by established frameworks for medical education research. Electronic databases, including PubMed, PMC, and Google Scholar, were searched using terms such as “workplace-based assessment,” “DOPS,” “mini-CEX,” and “postgraduate medical education.” Inclusion criteria encompassed peer-reviewed studies, reviews, and guidelines published in English that discussed the design, implementation, or outcomes of WBA tools. Thematic synthesis was used to analyse and integrate findings. Results: Evidence indicates that WBA tools significantly improve procedural and clinical competencies through structured observation and immediate feedback. DOPS demonstrated marked skill progression, with mean scores increasing from 3.91 to 7.25 in suturing (p < 0.001). Reliability improves with aggregation. DOPS achieves a generalisability coefficient of 0.75, reaching 0.80 after six assessments. WBA is feasible, with DOPS taking approximately 24 minutes (11 min observation, 13 min feedback). Trainees report high acceptability, citing enhanced confidence and skill mastery. Conclusions: WBA is a valid, reliable, and educationally valuable approach when implemented longitudinally and supported by rater training and institutional commitment. It plays a critical role in shaping competent, reflective practitioners within modern medical education frameworks. Future efforts should focus on standardisation, digital integration, and faculty development to maximise its impact.
BJME: Vol.-17, Issue-02, July, 2026: 23-36
Md. Rasel Ahmad, Dr Anika Mahfuz, Dr. Kazi Shantono et al.· Bangladesh Journal of Medica...· 0 citations
Background: Multiple choice questions (MCQs) are widely used in medical education for their objectivity and efficiency. However, poorly constructed questions can compromise the validity and reliability of the assessments. Faculty development programs have emerged as a key strategy to improve the quality of MCQs.
Objective: This study aims to evaluate the impact of structured FDPs on the MCQs construction using objective metrics and participants’ feedback.
Methods: This observational study was conducted over three years period (2022 - 2024) at University College of Medicine & Dentistry. Three workshops on MCQs development were organized for the faculty. Feedback was collected through structured forms using 5- point Likert scale. Additionally, MCQs submitted before and after the workshops were analyzed for item flaws, difficulty & discrimination indices. The study also evaluated the impact of training using the Kirkpatrick Model. The data was computed and analyzed using SPSS version 26.0. The Shapiro Wilk test determined the normality of the data. P value <0.05 was considered as significant.
Result: A significant reduction in test-wiseness flaws (logical cues from 12.9% to 1.3%, p<0.001) and irrelevant difficulty (extraneous details from 7.6% to 0.9%, p<0.001) was observed. The proportion of moderately difficult items increased from 56.9% to 62.2%, while the proportion of very good discriminating items increased from 2.2% to 6.7%; however, neither change reached statistical significance (p=0.062 and p=0.098, respectively). Feedback from the participants revealed increasing satisfaction across workshops, with the highest ratings in workshop 3 (2024). Instructor expertise remained consistently rated above 87.5%.
Conclusion: Incorporation of multiple structured faculty development workshops lead to measurable improvements in MCQ quality. These training sessions can enhance the reliability and validity of medical assessments, benefiting both educators and learners.
S. Amjad, Noor Ijaz, Zakia Saleem et al.· Proceedings· 0 citations
