A vital aspect of Homoeopathy is the standard of education today and the possibilities in the future. Homoeopathy is gaining a stronger and deeper foothold in society. We need to evolve an education system which will enable us to match the demand being thrown up by all sections of society and which will pass on the existing knowledge base to the next generation for further development.
The social and legal status of Homoeopathy varies around the world. The educational status, which depends on the social and legal status, would of course vary too! Several countries like India, the U.K., some states in the U.S.A., Greece, France, etc have provisions for Homoeopathic education. The educational status of Homoeopathy is currently at its best in the Indian subcontinent and in the U.K.
We see Dr. Hahnemann speaking of an integrated approach to Homoeopathic education in aphorisms 4 and 5. Standardizing education at the undergraduate level and preparing the students for a tough and demanding post-graduate course is one of the biggest challenges that Homoeopathic educators face. The Homoeopathic education scenario in India has all these factors and much more. We need to relook at some of the fundamental tenets which the Master so passionately wrote about.
Dr. R. D. Lele, the well-known medical educationist and researcher, in his thought-provoking work Clinical Science and Clinical Research has explained the term ‘Clinical Science’ thus: “It is concerned with the understanding of Health and Disease in relation to Totality of Human behaviour, physiology and pathology, the understanding of life processes of normal cells, organs and the whole human organism, the variability of these processes and their abnormalities that lead to dysfunction and disease. Mastery of any clinical science involves the intellectual discipline of conceptualising the normal and abnormal processes of the body and the mind, the skills of clinical observation and extending these through the use of appropriate tools and the ability to integrate these to come to a diagnostic formulation and evolve and put into effect a therapeutic plan to produce a cure / palliation.” A Homoeopath could not have put up the demand in a more effective way!
The demands of designing the course of the ‘Practice of Homoeopathic Medicine’ have led to dividing the curriculum into different subjects of Homoeopathic Philosophy, Materia Medica and Repertory and Medicine. Perhaps the impact of Allopathic medical education is clearly discernible in this. We end up teaching the different aspects of Homoeopathy separately as independent subjects thus harming the holistic nature of the science. Organon, Materia Medica, and Repertory become discrete subjects and sometimes it really feels as if there is no link between them!! That this is a Holistic Integrated Healing discipline based on the study of the Individual in great depth has been all but forgotten. The clinical base remains distant, many a Homoeopathic student passes out of the Homoeopathic College without much interaction with a patient or seeing one at the bedside.
Unique Demands of Homoeopathy on the Homoeopath
Homoeopathic education today has been divided into fragments although not intentionally. Our holistic principle needs to be applied to education too.
During his education, the Homoeopath studies a variety of pre-clinical, para-clinical and clinical subjects. He learns about anatomy, physiology, pathology, forensics, preventive and social medicine, internal medicine, surgery, gynaecology and obstetrics, along with the Homoeopathic subjects of Materia Medica, Philosophy and Repertory. Teaching of these subjects is mostly done in a discrete and often disconnected manner. In practice, however, a physician faces a clinical problem and is supposed to solve it by integrating several of the discrete pieces of information he has learnt in the past. This process of integration can pose a major problem if a physician is not used to doing this from day one. The Allopathic medical teaching in some of the better centres in our country and certainly in several centres abroad is veering around to the integrated teaching model – something which was at the heart of Homoeopathic practice since the time of Dr. Hahnemann.
You cannot teach someone in fragments and then expect them to produce an integrated coherent whole on demand. Holistic thinking is a cognitive exercise that requires a lot of practice. It is a learnt response and such responses become second nature only after long practice.
Homoeopathic education has to provide the student with a firm conceptual base of the trinity of Homoeopathy – Organon, Materia Medica and Repertory – as well as with the knowledge of applying the basic concepts to various branches of medicine like Surgery, Paediatrics, Medicine, etc. This is an extremely arduous process, requiring a large investment in terms of time and effort.
Post-graduate specialised work is done to understand the various concepts and their application and in-depth exploration so that new avenues are open for its development and fine-tuning. A lot of our literature and work is lying unused due to failure of formulating a proper perspective in our post-graduate programmes. In that sense the post-graduate programme becomes a mere continuation of the under-graduate one. It is more fact-centred and does not focus on evolving concepts and undertaking further in-depth work of utilising and integrating clinical and literary experiences.
Nothing can replace action learning. The teaching methodology must include the extension of learning from clinic / community to the classroom and from the classroom back to the clinic/community. In the absence of this continual cycle, our teaching programmes – under-graduate, post-graduate or even the PhDs will produce only mechanical workers and pundits!
Need for Standardization of Homoeopathic Education
This concept has been widely misunderstood and vilified by many. The most commonly misunderstood meaning of standardization of Homoeopathy is transforming Homoeopathy into an Allopathy-like science where a particular illness will be treated with a specific remedy. This will naturally lead to the death of individualization and the death of Homoeopathy!
We should understand that the word standardization does not apply to the remedy aspect of Homoeopathy. It aims at streamlining and bringing about uniformity in the concepts of Homoeopathy – in the way they are defined, interpreted and used by the teachers and practitioners. There should be a consensus about the very philosophical principles on which the remedy selection is based. If the conceptual base is even and consistent, it will not make a difference as to what remedy is selected as the basis for the selection of that remedy will be transparent and hence strong.
What we need is to bring some semblance of order to this chaotic arena. A student needs to know the basic conceptual essentials very well before he is exposed to any newer themes. It is conveniently overlooked that the founders of these newer methods have their basics firmly in place before they venture onto any flights using the new concepts. Students who don’t have their basic concepts right cannot expect to achieve the same results as the pioneers of the new methods. Students also need to be given at least a minimum amount of exposure about the various schools of thought that exist in present times. This will help them to be more aware of the overall scenario.
Graduate Level Education – Introducing the Concepts
Graduate level training in Homoeopathy consists of learning the basic concepts and principles in their entirety and must therefore comprise of teaching as well as practical case exposure. Homoeopathy is a holistic science. A Homoeopath approaches a patient with a holistic perspective. This perspective does not come naturally to any Homoeopath, it is a learnt response achieved through years of practice. We will have to practice applying the holistic principle to education.
Pre-clinical and para-clinical subjects like anatomy, physiology, forensics, pathology etc are currently taught as discrete subjects. While this is necessitated by the demands of the present curriculum, it makes it difficult to adopt a holistic viewpoint regarding a patient.
Studying Materia Medica, Organon and Repertory is also a process that needs to be done carefully. The three obviously cannot be taught by one person or as one subject. However, a careful correlation while teaching will go a long way in establishing firm links between the three in the minds of the student. Learning of these subjects has to create a conceptual framework in the mind of the student that will form the foundation of Homoeopathy in the years to come.
These general principles also need a firm clinical backing. For example, it is one thing to read about Kent’s remedy reactions in a book and a completely different experience watching it happen in a patient. The student also needs to learn case taking and clinical skills. Many times we see that the Homoeopath’s case taking skills are limited to one-dimensional questioning and listening. Addition of skills like interpreting, confrontation, guiding, exploration, role-playing, etc. will help the Homoeopath to obtain complete knowledge of the patient and in turn to select an appropriate remedy.
The syllabus demands integration, the curriculum must perform it. We can make efforts to build bridges and achieve integration by making education patient-oriented from the first year itself. Patient-oriented and problem-oriented teaching is currently not a part of graduate education. For example, we take a case in which a patient has knee joint problems. The same case can be used to teach students from all years. For first-year students, the teacher can concentrate on the anatomy and the physiology of the knee joint. Teaching second-year students will include a discussion of the various pathological processes that affect the parts of the knee joint. Third and fourth year students will integrate medicine along with Miasmatic and Materia Medica correlations. This way, students of every year can benefit from clinical and problem-oriented teaching.
There is also a common misconception that Homoeopaths don’t need to know any diagnostic skills. In fact, good clinical knowledge helps a Homoeopath to distinguish between the common and characteristic symptoms of the disease, a skill which is vital for Homoeopathic prescription. Through clinical and case exposure we also understand the scope and limitations of our healing science.
Knowledge of scope and limitations not only help us to choose cases wisely but also gives us a deeper understanding of the therapeutics of a particular clinical condition through understanding the clinico-pathological correlations. By undertaking a deeper study of these correlations, we can understand why certain groups of remedies are better suited for a particular clinical condition. This does not in any way undermine the use of Homoeopathic concepts while prescribing. Knowing a group of remedies for a clinical condition is but the first step of remedy selection. The physician then needs to identify the remedy for any patient based on the characteristic data available. Acquiring these skills is an essential part of graduate Homoeopathic education.
We see that Homoeopathic education cannot be taken lightly or casually. The emphasis is on the Doing that has to come after the Knowing and the Understanding. Doing can be measured through appropriate evaluation methods. Thus, the student needs to not just understand the first six aphorisms of the Organon of Medicine, but he has to learn to LIVE them through his actions. This kind of training puts the student on a firm footing in Homoeopathy. The same kind of training when applied to the post-graduate or the doctorate level of education will also produce fine teachers grounded in the same concepts. This will ensure the establishment and maintenance of standards of education. The Homoeopath is the quintessential eternal student, the explorer who has to be forever ready to seek out new worlds of knowledge. Can the Homoeopath bring about an evolution in the fundamental aspects of his science through changes in education?