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Evolving an integrated curriculum in post-graduate homoeopathic education: Advanced teachings in fundamentals of homoeopathy
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Received: ,
Accepted: ,
How to cite this article: Parekh BR, Dhawale KM, Jain BS. Evolving an integrated curriculum in post-graduate homoeopathic education: Advanced teachings in fundamentals of homoeopathy. J Intgr Stand Homoeopathy 2022;5:43-7.
Abstract
Homoeopathic practice is a challenge as it demands the integration of Homoeopathic Philosophy with clinical medicine, Repertory and Homoeopathic Materia Medica. The compartmentalised division of the Bachelor of Homoeopathic Medicine and Surgery syllabus into 12 distinct subjects strikes at the heart of integration. The introduction of the subject of Advanced Teachings in Fundamentals of Homoeopathy at the PG level in MD Part 1 attempts to address this lacuna and aims to foster the development of various competencies necessary for effective practice. However, we need a method by which we can deliver integration in the classroom. Dr. M. L. Dhawale’s seminal papers on homoeopathic education which were conceived, applied and refined through application at the then Bombay Homoeopathic Medical College (1968–70) and Father Muller’s Homoeopathic Medical College (1985–86) form the backdrop of this paper. The method essentially brings homoeopathic practice into the classroom so that learning becomes experiential. This paper attempts to describe the method of conceptualising and planning an integrated curriculum in the classroom, thereby addressing the gap between theory and practice in the training to evolve competent homoeopathic physicians. A further paper will describe the method of implementation and the results of putting integration in practice.
Keywords
Integrated education
Case-based learning
Competency-based education
Homoeopathic practice
INTRODUCTION
Dr. Hahnemann, the founder of homoeopathy, clearly highlights in aphorism 3 of the Organon of Medicine, the knowledge needed by the physician.[1] The effective homoeopathic practitioner must be not only clinically sound, but also competent in various homoeopathic concepts, as well as possess a basic knowledge of the socio-cultural background of patients’ communities. They should be able to understand the principles of Homoeopathic Philosophy propounded by our founder and their application through Repertory and Materia Medica. Post-Hahnemann contributions by stalwarts such as Boenninghausen, Kent, Boger, Close, Roberts, Farrington, Sarkar and Dhawale enriched the science and art of homoeopathy, which also needs to be understood. This demands the integration of clinical medicine and homoeopathic concepts. The 12 subjects in the Bachelor of Homoeopathic Medicine and Surgery (BHMS) course are introduced in a sequential and compartmentalised manner. Knowledge is scattered across 4½ years of training. The year-long internship is expected to weave these different strands together through application at the bedside. However, this proves to be a daunting task, as multiple ways of approaching the totality leave students confused. We need to evolve methods and techniques to transfer the intricacies of homoeopathic practice to the students.
Per the Central Council of Homoeopathy Amendment of 2015 and the gazette notification dated 29 January 2016, the subject of Advanced Teaching of Fundamentals of Homoeopathy was included in the MD (Hom) Part I syllabus; it comprises the integration of knowledge (learned at degree level course) in respect of subjects, namely Organon of Medicine and Homoeopathic Philosophy, Homoeopathic Materia Medica and Repertory. However, the notification does not mention any guidelines as to how this should be done.
Hence, the first task was to evolve a syllabus for the subject of Advanced Teachings in Fundamentals of Homoeopathy. This has been done by Dhawale KM, through the identification of the various competencies required and broken down into 10 themes as listed below.[2]
Theme 1: Hahnemannian Concept of Man, Vital Force, Health and Disease
Theme 2: Concept of Dynamism, Recovery and Cure and Obstacles to Cure
Theme 3: Concept of Artificial Disease and Portrait of Disease
Theme 4: Concept of Unprejudiced Observation and Case taking
Theme 5: Concept of Symptomatology
Theme 6: Concept of Susceptibility and Acute and Chronic Disease
Theme 7: Concept of Suppression and Miasms
Theme 8: Concept of Totality
Theme 9: Concept of Similar and Similimum
Theme 10: Concept of Therapeutic Management.
This work enabled the Maharashtra University of Health Sciences, Nashik, to accept this as a unique syllabus. The themes, when perused carefully, cover the essential aspects of Homoeopathic Philosophy, which when extended to concepts of Repertory and Materia Medica, have significant relevance in practice. The challenge now is to translate this syllabus into a comprehensive curriculum which will help in planning an effective educational programme to deliver the competencies in a way that can be easily understood by the student. This paper will elaborate on an attempt by us to devise a curriculum of Advanced Teachings in Fundamentals of Homoeopathy.
While planning an integrated curriculum, we referred to the masterpiece, Principles and Practice of Homoeopathy by Dr. M. L. Dhawale, where the logically deductive presentation is neatly laid out.[3] It elucidates the various concepts used in homoeopathic practice and connects them to the relevant facts through powerful case illustrations. However, practice is neither as clean nor does it have such clear demarcations. It is complex and demands integration of various knowledge of Homoeopathic Philosophy with clinical medicine, Repertory and Materia Medica. Dr. M. L. Dhawale has enlisted eight objectives for homoeopathic education and training highlighted in [Figure 1].[4] In this figure, Dr. M. L. Dhawale emphasises that the patient becomes the centre for education and training. The patient presents to the physician with his problem, which the physician defines, records and subsequently analyses and synthesises in the form of the totality and looks for a similar remedy in the Homoeopathic Materia Medica to resolve the patient’s problem. In this process, the physician integrates various knowledge as highlighted in aphorism 3. This knowledge forms the basis of teaching and education to students and budding practitioners.
- Aim and objectives of homoeopathic education and training based on principles evolved at the institute of clinical research.
Thus, through case-based teaching, integration can be presented to the student, who can reflect on the process undertaken, thereby internalising the same. Case-based learning (CBL) is a long-established pedagogical method associated with learning in real-life situations. A review of 104 papers on CBL by Thistlethwaite et al. concluded that both teachers and students enjoy CBL as it engages and is perceived to motivate students. They define CBL ‘as an inquiry structured learning experiences utilising live or simulated patient cases to solve or examine a clinical problem, with the guidance of a teacher and started learning objectives’.[5] Another review of worldwide literature on CBL was done of 70 articles by Mclean concluded that CBL helps in connecting theory to practice with gains ranging from simple knowledge gains to changing patient care outcomes.[6]
A pilot study on ‘Case-based learning method to enable rational decision-making in posology in the students’ by Bhalinge et al. on 14 students of the 1st year MD (Hom) found statistically significant improvement in the performance of students to assess susceptibility on standard parameters of planning and programming through the application of CBL in three cases.[7]
The paper, ‘Going holistic the whole way: A case for reform in homoeopathic medical education’ by Jain et al. advocated integrated teaching by keeping patients in the centre to prepare competent homoeopathic physicians and second paper in the series they reported the findings of implementation of holistic integrated education in first BHMS at Smt. Malini Kishor Sanghvi Homoeopathic Medical College, Karjan, wherein students showed a favourable response to the program assessed on multiple qualitative and quantitative parameters.[8,9]
Thus, a case study/case report itself has the potential to bring out the various complexities that practice demands and the same can be discussed and learned in the classroom to deliver an integrated learning experience. We will see this through an example.
METHODS
The gist of a case found suitable for use in the teaching programme is presented in facets and the relationship to the themes of the syllabus is presented alongside with suitable explanation as well as the integration of Homoeopathic Philosophy, with clinical medicine, Repertory and Homoeopathic Materia Medica in [Table 1].
| S. No. | Data from the case | Extensions | Themes covered |
|---|---|---|---|
| 1. | A 27-year-old male patient, a carpenter by occupation, presented with the complaint of burning micturition with pricking pain in the urethra and intermittent flow of urine for 30 days. There was one episode of haematuria. Associated complaints: Blackish hard, painless warts on both palms for 4–5 months | The physician will have to understand what they are treating, and how to confirm the diagnosis. Once the diagnosis is determined, they will have to decide on the scope of homoeopathy and the best possible way to treat the disease (O). | 1, 2 and 5 |
| 2. | The investigations supported the diagnosis of lower urinary tract infection with the right renal 5 mm mid-pole calculi | We can demonstrate the concept of clinical diagnosis[10]and clinicopathological correlations which will get reflected further in the miasmatic understanding,[11,12]of the Hahnemannian classification of disease. This will help us have an insight into the concept of health and disease in homoeopathy – mainly the concept of vital force (O). The integrated understanding of these will provide insight into the management of the case (O and HMM). | 1, 7 and 10 |
| 3. | The case should be received and represented to have a complete symptom in the LSMC format | One of the various ways we can understand symptomatology is through classifying them in the format of LSMC. One can then demonstrate the concept of a complete symptom-as advocated by Boenninghausen and the extension into the concept of repertorisation through the Therapeutic Pocket Book, according to Roberts[13](R). Simultaneously, through symptomatic classification, we can find the location, the side, the tissue affected, the evolution of disease, the pathological generals as well as the pathological changes occurring in the patient. This would help us demonstrate the concept of pathogenesis and pathological generals (O), Boger’s concept of totality and integrate it with the conceptual arrangement of Boger’s repertory (R) and Boger’s synoptic key (HMM) | 4, 5 and 8 |
| 4. | The patient is a carpenter by profession, shifted to P town 11 years prior in search of livelihood, while his wife and family still stay in the village. Gradually, discord developed between the wife and the mother in which the patient got involved. This was further complicated through alleged neglect of his child by the family members, leading to him losing his temper. The patient was left with a feeling of disappointment and dissatisfaction which could not be expressed openly. The patient was helpful, fastidious, egoistic and intolerant of contradiction, sensitive to being dominated, gets offended easily and squanders money on unnecessary purchases. | The patient’s mind must be understood objectively, as caution given by Dr. Hahnemann in aphorism 6. The difficulties of understanding the mind have been adequately highlighted by Boenninghausen. While receiving the patient, the physician must be aware of his prejudices so that the patient can be understood as they are (O and R). A well-rounded case can be solved through multiple approaches. The qualified aspect of the mind and generals will help to highlight Kent’s concept of totality (O), a reflection of the same in Kent’s Repertory (R) as well as in Kent’s Materia Medica (HMM). In addition, the technique of repertorisation, which includes the concept of RS and PDF,[14]can be also integrated while dealing with the above repertorial approaches. Repertorisation will deliver a group of remedies which will be further narrowed down through PDF (R). The group of remedies can further be differentiated by referencing Materia Medica. The acute, deep-acting and intercurrent remedies can be elucidated by referencing the Materia Medica. |
4, 5 and 8 3, 6 and 9 |
| 5. | The patient was under treatment from 19 April 2019 to 6 March 2020 and was completely relieved. Treatment was commenced with Cantharis 200 frequently for 3 days followed by Lycopodium as deep acting remedy and Thuja as intercurrent. The patient was also advised plenty of fluid intake as ancillary mode. Lycopodium 200 was administered weekly and gradually increased to daily and finally, 1 M weekly was prescribed. Thuja 200 was administered infrequently as an intercurrent, especially when improvement came to standstill. While the urinary complaint of the patient responded promptly, warts took some time to resolve which warranted the gradual increase in the repetition of Lycopodium and use of Thuja as intercurrent. | Once we find the similimum at the portrait level, it is important to prescribe the medicine in the right dose, which is the right potency and repetition. This would only be possible if one understands the patient’s susceptibility in both its qualitative (miasm) and quantitative dimensions (O). Prompt case management can be accelerated using various ancillary measures or removing obstacles to cure which can be advised to the patient. In the case of renal calculi and urinary tract infection, increased intake of water and liquids would help to flush out the infection and prevent the crystals from aggregating. | 2, 6, 7 and 10 |
LSMC: Location, sensation, modalities and concomitants, RS: Repertorial syndrome, PDF: Potential differential field, O: Organon of medicine, R: Repertory and HMM: Homoeopathic Materia Medica
DISCUSSION
Effective homoeopathic practice demands the integration of various knowledge as advised by Dr. Hahnemann in aphorism 5. The homoeopath must go much deeper into the case to understand the various intricacies of understanding not only the clinical dimension but also the person with the disease. CBL effectively brings out these intricacies and creates the scope wherein students can engage better and more importantly, it helps to integrate theory and practice. Thus, a single case experience when analysed in-depth as shown above can illustrate several themes, bring into the classroom various intricacies of practice and develop integrated thinking which can further be applied to practice and refined. The relevance of knowing theory becomes clear and the ease of application is promoted. It also provides a better base to understand the problem of the patient and management strategies which get logically correlated with the philosophy, making practice more scientific. It defines the important role of the clinician-academician who can help bridge homoeopathic theory and practice.
Case-based education for the subject of advanced teachings in fundamentals of homoeopathy promises to integrate theory and practice as what is learned during the classroom can be applied at the bedside and experiences at the bedside can be brought to the classroom to maximise learning. It also helps integrate Homoeopathic Philosophy with clinical medicine, Repertory and Homoeopathic Materia Medica, thereby making learning more experiential.
CONCLUSION
An important step in implementing the process of aligning homoeopathic medical education to a competency-based approach is defining the curriculum elaborately so that it becomes clear to all the stakeholders what is expected to be taught and what is to be learned. The intricacy of homoeopathic practice demands the integration of various knowledge which can only be experienced through a case. The article has attempted to describe one such attempt which promises to deliver integration necessary for homoeopathic practice essential for budding practitioners and would ultimately lead to the advancement of the science. One hopes that the article will provide the essential guidelines to make competency-based education effective and lend uniformity to teaching this particular subject, the outcome being a competent homoeopathic physician.
Acknowledgements
I thank the teachers at the Dr. M. L. Dhawale Memorial Homoeopathic Institute, Palghar, who have been the change agents to facilitate integrated education in the institute.
Declaration of patient consent
Patient’s consent not required as there are no patients in this study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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