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Vertical integration is believed to increase motivation by providing context for the learning. In this quasi-experimental study, cohort I took two horizontally integrated modules: structure and function of head, neck, and special senses in the second year, and pathophysiology and clinical sciences in the third year. Cohort II took a combined, vertically integrated module in the second year. Data from the questionnaire and examination scores were compared. Response rate was 80.1% (125/156) for cohort I and 57.6% (98/170) for cohort II. Response to the statement that vertical integration provides context to basic sciences was mixed with a higher agreement in cohort II (51.5 vs. 37.2%; P 0.04). Cohort II was least satisfied with the appropriateness of self-study time (52.0 vs. 34.7%; P 0.01). However, cohort II felt that the basic sciences lectures (90.8 vs. 69.4%; P 0.01) and the clinical skills sessions (85.7 vs. 62.1%; P 0.01) were more effective. Cohort II was less satisfied with clinical lectures (80.6 vs. 56.1%; P 0.01) and was less confident in achieving clinical learning objectives (72.8 vs. 40.8%; P 0.01). Mean multiple-choice questions and problem-based learning scores were similar. However, the short-answer question score was higher for cohort I [82.48 (SD 14.9) vs. 70.74 (SD 17.9); P 0.01]. Overall, the idea of early vertical integration had a mixed response. It improved the effectiveness of basic sciences lectures and clinical skills sessions. Achievement of clinical learning outcomes was compromised. A disparity in the module's duration and curricular content, and students' ability to grasp clinical concepts and faculty's expectations are the possible reasons. Increased duration and better communication with clinical faculty may improve early introduction of vertical integration.

This study aimed to assess knowledge and skills in a respiratory physiology course in traditional versus problem-based learning (PBL) groups in two different medical schools. Two different undergraduate medical schools were selected for this study. The first medical school followed the traditional [lecture-based learning (LBL)] curriculum, and the second medical school followed the PBL curriculum. Sixty first-year male medical students (30 students from each medical school) volunteered; they were apparently healthy and of the same age, sex, nationality, and regional and cultural background. Students were taught respiratory physiology according to their curriculum for a period of 2 wk. At the completion of the study period, knowledge was measured based on a single best multiple-choice question examination, and skill was measured based on the objective structured practical examination in the lung function laboratory (respiratory physiology). A Student's "t"-test was applied for the analysis of the data, and the level of significance was set at "P" less than 0.05. Students belonging to the PBL curriculum obtained a higher score in the multiple-choice question examination ("P" = 0.001) and objective structured practical examination ("P" = 0.0001) compared with traditional (LBL) students. Students in the PBL group obtained significantly higher knowledge and skill scores in the respiratory physiology course compared with students in the traditional (LBL) style of medical schools.