Current scenario:
Current homeopathic education has followed the method of teaching followed in allopathic medical colleges, which is fragmented and traditional. This unfortunately does not allow a homeopathic student to develop the skills to investigate, analyze and prepare to perceive the patient as a whole as demanded by homoeopathic practice. Integrated thinking offers the capacity to individualize, and hence we needed to develop a method of teaching that encouraged this concept.
Demand of homoeopathic practice: concept and philosophy
It is a well known fact that homeopathic medical practice is based on individualization. We need to understand every individual and his reaction at all levels, i.e. spiritual, mental and physical. As homeopaths, we investigate the individual in all areas of action primarily the family, work and society, which is an evolutionary study of man from predisposition-disposition-diatheses and disease along with the environment and its causes.
Dr. ML Dhawale was convinced that the homeopathic student needed to attain a mastery of the first six aphorisms of the Organon. In turn, true teachers had to evolve a methodology that made these aphorisms operational.
Education and training, hence, should train the student to practice integration in his clinical work which would enable individualization. All this seemed possible through action learning, where there is an early exposure to the patient with subsequent direct learning through this exposure. Experience of patients in the clinic and in the community helps formulate clinical problems which exposes the student to problem based medical education. This training empowers them to deal with clinical situations right at the outset. Student centered teaching encourages them to find solutions by themselves with appropriate guidance. Case presentations by students followed by discussions, help them to develop the analytical skill and the capacity of synthesis.
To achieve this, deeper insights into the syllabus helped us to develop a very finely tuned curriculum along with a well trained staff and cooperation of all the departments involved.
Operation: Our background and experience
Smt. Malini Kishor Sanghvi Homoeopathic Medical College (MKSHC) is the undergraduate wing of Dr. M. L. Dhawale Memorial Homeopathic Institute. It is situated at Sumeru, Karjan taluka, 40 km from Vadodara in Gujarat. Clinical services were started here five years back. It has a fully functional OPD and IPD, rendering services to the local community. It also has a mobile clinic and a community health programme giving services to the interior villages. The college commenced only after all these services were fully functional so that students had easy access to the patient from day one.
The clinical services offered, support the PG programme in the Rural Hospital, Palghar, Maharashtra where we are already established as a PG medical college for the last seven years.
Methodology we adopted:
The thrust of all our educational programmes is based on the principle of deriving learning from the clinical work done in the community, OPD and the IPD. As outlined earlier, lectures, tutorials and bed side clinics are conducted keeping problem based learning at the centre. Students are encouraged to find the answers themselves through a guided programme.
The teaching also involves a group discussion method aiming to integrate the teaching, so that the whole is delivered and the concept of individualization is gradually made experiential. All these concepts and the guidelines were provided over 20 years ago by the late Dr. M. L. Dhawale. He was a great visionary and a progressive educationist, who understood the depths of Hahnemannian concepts and evolved a methodology to standardize and make operational a high quality of teaching. As we can see, he propagated the concept of integrated teaching almost three decades ago, when it was just being mentioned in the western medical world.
Successful Implementation and feedback:
At MKSHMC, the integrated medical education curriculum evolves an integrated homoeopathic physician; an integration of preclinical subjects along with understanding the functional and structural component of man at the level of both mind and body. We also integrated a dynamic concept of pharmacy and teaching of Materia Medica and drug proving. Exposing students to the OPD and the community creates the practical relevance of what they are taught in class. Every remedy is studied after it is experienced in the clinic, either as main remedy or in comparison to the prescription. This is dynamic learning that also provides clinical confidence.
Teaching is case centered where the clinical cases help formulate directives for learning. This encourages students to refer to the relevant and related subjects in the syllabus. Integration is achieved through exposition and discussion of these experiences with reference to different related subjects in the curriculum.
Both students and teachers have found this method an enjoyable experience. The feedback from both has been encouraging as it removes the boring academic emphasis on rote learning. Evaluation is also practiced through the periodic written feedback, meetings and exams which helps improvement and appropriate modifications at all levels.
Structured syllabus and curriculum:
The syllabus designed needs to be structured in a way that at each level the student is able to experience an integration of the subjects to be studied. The curriculum is designed so that different subjects complement each other in understanding the whole. In each subsequent year, basic subjects (like anatomy and physiology) and its application to homoeopathic subjects and vice versa are developed by gradually exposing the student to the complexity of clinical experience – the pathology and clinical medicine.
As the student progresses we integrate the concepts of pathogenesis and forensic medicine along with the Hahnemannian concepts of health-disposition-diathesis and disease. To complete the wholistic understanding, the functional and structural changes along with movement of individual susceptibility from health to disease are emphasized along with genetic, hereditary, exciting and various maintaining causes. The subject of Materia Medica is integrated from the general as well as specific pathogenesis of disease development, traveling from predisposition to disposition to diathesis and disease both in the mind and body. Through ingraining of these homeopathic concepts with medical knowledge we can produce mature clinicians. It requires a continuous exposure to the patient with appropriate application in the subjects being taught. We integrate clinical subjects and community medicine along with homoeopathic subjects including repertory while teaching to demonstrate and experience the concept of man as Dr. Dhawale expounded in his writings.
Planning:
Our experience has shown that vital to success, is planning and coordination between different departments so that the whole system runs in rhythm and integration is achieved at all the levels.
All this requires regular training and evaluation of the teachers as well, with coordination between them. Supervising all this is a convener with an in-depth knowledge of integrated teaching and an insight into all medical and homeopathic subjects being taught. In addition, the convener has to develop managerial skills to make this operational.
This is what we have achieved so far at our organization. We share our experience to encourage others seeking to achieve similar goals of integrated homeopathic education.
References:
Dhawale, ML (1982): a) Continued homeopathic Medical Education: The ICR approach
b) Concept of Man and Homeopathic Medical Education
c) Integrated Homeopathic Practice
d) Philosophy and practice of Porfessional competence: the ICR way
e) Professional Education and Training: ICR Fellowship programme Mumbai
Dhawale ML ed (2003); ICR Symposium Volumes, 3rd Edition, Mumbai ICR Symposium Council
Dhawale ML (2000); Perceiving 1; 2nd Ed; Mumbai: institute of Clinical research
Dhawale ML ed (1984); ICR Conference on Education- Action Learning Mumbai; ICR Mumbai Symposium Council.
Dhawale ML (2003); ICR Opertional Manual; 2nd Ed; ML Dhawale Trust, Mumbai
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Dr. Bipin S. Jain
Director, Academic Services,
Dr. M. L. Dhawale Memorial Organizations
