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Review Article (Pages: 125-133)
Application of Spiral Programming Model in Medical Education:
A Review
Khatereh Shariati1, Sahar Peikani2, Hossein Karimi Monghi3, *Masoumeh Ghazanfarpour41
1MSc Student in Medical Education, Department of Medical Education, Mashhad University of Medical
Sciences, Mashhad, Iran.
2 MSc of Epidemiology, Network Development Expert of Mashhad Health Center, Mashhad University of
Medical Sciences, Mashhad, Iran.
3 Professor, Department of Medical Education, Faculty of Medicine, Mashhad University of Medical Sciences,
Mashhad, Iran.
4Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran.
Abstract
Background
The spiral approach is a technique often used in education where the initial focus of instruction is the
basic facts of a subject, with further details being introduced during learning progresses. In the present
study, the findings and results of various research studies are reviewed in a proper structure and the
components of the concept of spiral curriculum, its features, advantages, and disadvantages are
extracted and reported.
Materials and Methods: For conducting this review, online databases, including Medline, Scopus,
ProQuest, Web of Science, SID, CIVILICA, and Google Scholar were systematically searched with
no time limit from inception up to December, 2020. Based on the searches, 14 papers that
concentrated on the spiral educational design model were identified. Of these, spiral educational
design model was applied for educational planning of students in nine studies. These papers were
extracted by the research team under close examination and their results.
Results: In various steps of repetition that increase the depth of contents at every stage, the results and
consequences of applying the model in the spiral curriculum of the subjects from easy to hard are
mentioned. Applying this significant approach, the spiral curriculum leads to a deep understanding of
knowledge, proficiency in performance, building confidence, strengthening long-term memory and
thinking skills, problem solving, and decision-making in the learner. This type of curriculum includes
several characteristics and advantages.
Conclusion: The spiral curriculum reinforces learning by linking new knowledge to learners' prior
cognitive construction. Spiral curriculum model could be applied at various levels of university
education (general and specialized).
Key Words: Application, Curriculum Planning, Design, Medical Education, Spiral Model.
*Please cite this article as: Shariati Kh, Peikani S, Karimi Monghi H, Ghazanfarpour M. Application of Spiral
Programming Model in Medical Education: A Review. Med Edu Bull 2021; 2(1): 125-33. DOI:
10.22034/MEB.2021.293383.1007
*Corresponding Author:
Masumeh Ghazanfarpour, Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran.
Email: masumeh.ghazanfarpour@yahoo.com
Received date: Dec. 14, 2020; Accepted date: Mar.22, 2021
Med Edu Bull, Vol.2, N.1, Serial No.3, Mar. 2021 125
Spiral Model and Learning
1- INTRODUCTION each topic or course at the end of every
Efficient learning is required for year. There is little emphasis on how these
achieving learning objectives. knowledge or skills will be applied in
Experimentally tested educational theories subsequent courses and subjects. Thus, the
in the 20th century and mentioned in students just enter each course with the
articles indicate that efficient adult objective of passing the exams. Therefore,
learning takes place when there is a cycle there is a growing tendency to remove the
of experience, feedback, thinking, and boundaries between courses and subjects
planning. When deep learning is put to the and have a more comprehensive look at
test rather than superficial learning, the special purposes and overall goals of
efficient learning could be achieved. the curriculum. A spiral curriculum
Moreover, when the students' past learning concept finds a special relevance here (3-
is combined by novel learning materials, 6). Basic sciences, applied preclinical
an efficient learning is observed (1). sciences, and clinical sciences are isolated
in traditional layered method. In the
As one of the subsets of education, conventional method, the students finds
educational design is placed alongside little connection between what they learn
producing educational materials and and what they are supposed to perform in
implementation, management, and clinical settings. The limited clinical
assessment of educational programs and is experience leads the student to be
one of the most significant aspects of each challenged by serious limitations in
curriculum. Medical education is no knowledge, attitude, clinical reasoning and
exception; in reality, it can be skills, and decision making after
demonstrated that a beneficial and graduation (5).
effective educational design is a significant The spiral curriculum has emerged in
contributor to successful education in a response to the issue that most learnings
way that some believe that educational are static in subject-oriented patterns and
design is the heart of every educational these patterns are not suitable for students
attempt (2). in a constantly changing world.
There are many questions waiting to be Accordingly, this model was proposed as a
answered before designing a training replacement for other subject-based
program. A large amount of attention has models to teach the subjects more
been paid to purposes, curriculum content, meaningfully and focus on thinking skills
teaching methods, assessments, and more than other curriculum models (7).
educational strategies such as problem- Medical students initially pass basic
based learning and community-based sciences courses involving anatomy,
integration and learning. Hence, the issue physiology, and biochemistry and then
of content organization and the overall enter the clinical science phase in
structure of curriculum remains a traditional methods of medical education.
relatively forgotten area (3); therefore, The problem with this approach is the lack
plans for assessing the curriculum design of connection between the materials taught
must be considered to ensure coordination in the basic sciences courses with the
among students' perceptions, educational medical practices and clinical settings.
purposes, strategies, and other components Besides, after entering the clinical course,
of a curriculum (1). In the traditional the contents taught in the past sessions are
curriculum design, a series of courses and mostly forgotten (6). The spiral curriculum
a range of subjects and lessons are approach is still unfamiliar for teaching in
separately planned and tests are held for separate departments, and does not possess
evaluating the competence of learners in
Med Edu Bull, Vol.2, N.1, Serial No.3, Mar. 2021 126
Shariati et al.
the comprehension and coherency to Defining spiral curriculum model;
provide courses for medical students. Principles and features of spiral
Since the subjects taught to students are curriculum design;
planned and performed by a respective
department, professors feel that teaching The advantages of spiral curriculum
every subject is separately justified (8). To design model;
solve this issue, during the last half Issues and limitations of spiral
century, many modern medical education curriculum model;
institutions have adapted and applied the
"spiral curriculum" concept in medical Results and consequences of applying
education. This spiral is applied in various the model; and
ways in multiple institutions (5, 9). Discussion and conclusions.
2- MATERIALS AND METHODS 3-1. Defining spiral curriculum model:
This research was conducted in 2018 In their study, Wark and Kohen explained
as a comprehensive review of articles by a the spiral as a metaphor, a pattern, and a
systematic search of database and search concept which may involve aspects of
engines, including Medline (via PubMed), human physical and even intellectual and
Scopus, ProQuest, and Web of Science and psychological enhancement (10). Harden
Persian databases, including SID, described the history and emergence of
CIVILICA, Magiran, and also Google this concept in education. The concept of
Scholar without time limit up to December spiral model was introduced by Jerome
2020. To find research articles involving Bruner in 1960. Brunner coined the term
spiral educational design, the following "spiral curriculum," and suggested that for
keywords were searched: "Spiral", effective teaching, the level of complexity
"Instructional design", "Curriculum", of educational concepts and content should
"Training", "Integration", "Medical be gradually increased throughout the
Education", and "Course". curriculum. The important approach in
After completing the first search of papers spiral curriculum is that new teaching
in all databases and search engines, 14 content is prepared on the basis of prior
papers that matched the research criteria knowledge and it is intended to facilitate
were extracted based on title and abstract. the understanding of educational content
Of these, one papers was in Japanese and, for learners (3).
therefore, excluded. The remaining 13 In the spiral curriculum concept, subjects,
papers were included in the research. This principles, and values are frequently
process was carried out independently and reviewed along the way (Figure.1). A
in duplication by two reviewers and any spiral training program is not a mere
disagreement was resolved by a third repetition of the subject being taught, but it
reviewer. requires the understanding of the subject to
3- RESULTS deepen with every successive encounter of
At the end of the search process, 13 a past subject (3, 9). A spiral training
studies were selected. All papers were first program supports the induction principle,
reviewed in a comprehensive and thorough which states that the whole is larger than
manner several times and then all contents the sum of sections. In this approach,
were extracted and categorized. The results students are taught that the way to progress
will be discussed divided in the following is by putting the pieces of a puzzle
sections: together, and without a preview of the
completed image, they will find it difficult
Med Edu Bull, Vol.2, N.1, Serial No.3, Mar. 2021 127
Spiral Model and Learning
to finish the puzzle. Therefore, the indicates how various sections of the
research guide provided to students curriculum are matched (4, 9).
Fig.1: The Spiral Model.
3-2. Principles and features of spiral The level of difficulty increases in
curriculum design: steps. It means the reviewed subjects and
The spiral educational model has special content become harder at successive
principles and features explained below: levels. Every review adds purposes and
proposes new learning situations which
The initial objective, that is, result in achieving the final objectives (3,
providing high-quality learning 6, 8).
experiences to students via an integrated Transparency and full
helix educational program, is understanding of subject at every step is
accomplished by combining learning with required for students to retain intangible
a deep understanding of knowledge not information (1).
only through assessments, but also
continuously (1). A logical arrangement is present in
In this model, students review various steps and phases of spiral
subjects, patterns, and objectives in a few curriculum. It is necessary to pay attention
steps over several periods (3, 6). to both aspects, i.e., the extent and breadth
and the order of the topics. The spiral
Each review can involve new and curriculum can help bring order to the
more enhanced knowledge or skills complex nature of medicine and medical
considering a subject learned via practical education (3).
experience (3). A spiral training program must
New learning is due to past have a spiral form; so, every novel cycle of
learning; novel information and skills are this spiral must expand learning and not
based on past knowledge and skills and are merely repeat past topics (1).
a direct result of learning in past phases of A spiral curriculum must be
spiral. Past learning is a prerequisite for designed so that in the transition between
later learning, as new knowledge and skills courses, the gap in expectations of
are repeated in subsequent lessons (3, 6). consecutive semesters of students must be
Med Edu Bull, Vol.2, N.1, Serial No.3, Mar. 2021 128
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