Research has been a part of the degree course at Centre for Homeopathic Education (CHE) since 2005. It has become a valued inclusion for those wishing to practice Homeopathy following graduation from the BSc course.
Our students come from varied educational backgrounds and may only have basic research skills on joining. One of our most important tasks initially, is to remind students that they actually do have research skills and use them in their daily lives—for instance, when they search for the best phone plan, compare computer specifications or simply choose a restaurant where they would like to eat.
During their undergraduate years we teach students over two modules. Firstly, Research Methods which is followed during the final year with a challenging Proposition module. Recently we have also introduced ‘the basics’ to the first year, as we feel it is important to build an awareness of Evidence Based Medicine and the ongoing debate surrounding Homeopathy early on.
Initially, some students panic because they feel it’s unrelated to the rest of their homeopathy study. This doesn’t last long! The teaching is a “learning by doing” approach; explaining why we are doing something is quickly followed by how we are going to do it. Then we actually perform the tasks. Students get very involved and indeed seem to enjoy participating.
Once in practice patients will come to a homeopath with lots of their own questions, and we can’t always have the answers in our heads. We have a responsibility to use research skills to find the information required for the patient. Nowadays, provision of health care is centered around evidence-based practice and evidence-based medicine. As homeopaths we need to be prepared when we are asked, “What is the evidence with regard to homeopathy?” As health care professionals, we should be aware of relevant research, not only within homeopathy but also in the current treatment of disease conditions of our patients and the general population.
Due to the nature of the course content we use a mixture of teaching techniques to deliver the varied material. In addition to lectures we hold workshops where small groups of students work together investigating relevant published material. Presentations skills are developed as students present their findings to the class. Self study forms a part of each assessment especially in the final year. Student participation is very much part of our ethos and we encourage students to keep up to date with published studies in homeopathy including both clinical trials and basic research. Time is allocated for sharing ideas and opinions on what has been discovered away from the classroom.
As student homeopaths, they are encouraged to question. When they interpret a case, they need to delve into any diagnosis and, of course, investigate any drugs the patient may be taking. Knowing where to look for such information is something we show students early on, and we encourage them to become familiar with the available tools in workshops. In recent years, much criticism has been levelled at homeopathy, saying that it is “not evidence-based.” Indeed, in the absence of a known mechanism of action, many feel that homeopathy is not plausible. It is important, therefore, that students are aware of the current evidence base and are able to understand the content of the criticisms and respond to it.
The assignments are demanding as they are wide ranging, aimed at encouraging students to explore the relevant literature via sources that often are new to them.They learn how to critically appraise and review as well as become aware of the opinions surrounding this system of medicine. In return, they are given comprehensive feedback from which more learning is achieved, and their research skills evolve, becoming a part of who they are as practitioners.
The first assignments students tackle is centred on exploring the debate surrounding homeopathy, identifying points raised by all sides and presenting a review of the evidence found. It is a wide remit which is extremely challenging, yet once complete, results in a self-driven awareness of the long standing controversy and what depths have to be investigated to gain a balanced perspective, which will lead to better informed future debates.
We cover what constitutes sound methodology and how to identify trials of good quality skills. A literature review of clinical trials using homeopathic Arnica montana is undertaken to assess the strength of the evidence base of the most frequently used remedy.
After spending time discussing methods used in clinical trials within CAM as well as conventional medicine, an assessment is carried out to critique a single trial which helps students identify the finer points and subtleties of good methodology. The work of Robert Mathie and Clare Relton in particular are addressed as important for development of future methods in research in Homeopathy. There is more to research method than the Double Blind Randomised Placebo Controlled trials and it is important to address the future.
The final year sees students writing their own research proposal. This module has self-study as its main focus. After an introductory lecture, one to one tutorials support individuals through the year to final submission. This is a great opportunity to explore a particular therapeutic or disease area in detail, discover what the conventional treatment is, how effective it is and why there is justification to conduct a study assessing a homeopathic approach. A detailed methodology is required too, bringing together all the components learned in the preceding module. It is demanding and challenging yet enjoyed by the majority, some of whom have gone on to perform the proposed trial.
As professionals, let’s also not forget about the value of clinical audits of our own practice. We have a duty to monitor the effectiveness of the treatments we offer. In the student clinics we use MYMOPs (measure yourself medical outcome profile), which is a validated and acknowledged tool that measures patient-perceived changes in symptom severity, well being and ability to undertake a key activity.These measures are combined to provide a ‘profile’ which is quantified before and at one or more interval during a course of treatment. It has been shown to have promise as an outcome measure for primary care and complementary treatment, with the added bonus of improving patient-practitioner communication. By monitoring in the clinic we form good habits which can be carried forward following graduation.
Research at CHE has become an integral part of the course, not isolated modules but relevant to all that our students study and for their future work as practitioners. Remember, Hahnemann was a scientist and clinician. He spent his life exploring and investigating through simple observations, recording them, testing, and learning by experience, which he fed back intohis practice, always learning. We view research and practice as a continuation of Hahnemann’s work.