Alternatives in homeopathy education

The purpose of sectoral education is to create avenues for the continuity of that sector. Homeopathy education is no different in this respect. The current system of homeopathy education was modelled after the Medical Council of India’s undergraduate education. This system has maintained status quo for the past many years. However, there is no record of any serious study to assess the impact of this course over the years.

An anecdotal review would reveal the current status of homeopathic practitioners for practicing homeopathic system of medicine. It is accepted fact that a sizeable number of homeopathy graduates gravitate away from homeopathic practice; something that is more notable in certain geographic locations in India. there are many lamentations in the professional circles, but little concrete measures to tackle this trend.

One of the factors that emerges from discussions with newly qualifying graduates is that there is sufficient knowledge of homeopathy and allied medical disciplines, appreciable level of clinical skills, but a rather low confidence to practice homeopathy among the young professionals from the geographic areas referred to earlier.

It is a serious identity crisis for any sector that finds its brand suffering low self esteem among its stakeholders. The solution to this crisis is preparing and implementing a major rebranding strategy. In this exercise, the strengths of the product / service has to be highlighted in the light of its relevance to society and the awareness of its simplicity in application should be created among its practitioners. Further, newer methods of presenting the product / service to its beneficiaries should be evolved.

Considering the above strategy, we need to look at homeopathy in its original form, devoid of the expectations that were heaped on over the centuries. An objective SWOT (Strength, Weakness, Opportunities and Threat) analysis of homeopathic practice would bring out the areas that we need to be focussing on, without being apologetic about anything. The frontier areas of healthcare services where homeopathy has strong and decisive role to play should for the core of training in homeopathic discipline.

We have a firmly established education system at both undergraduate and postgraduate levels. To shake it up drastically might prove disastrous for the continuity of education system. Instead, it is better to experiment with an alternative in controlled environs and mainstream it gradually. I propose two suggestions for the experiment. These can be debated for further refinement.

1.      To start ‘Finishing Schools’, that would cater to honing the skills and attitude of newly qualified homeopathic graduates to provide the much needed confidence to practice homeopathy. The curriculum can build upon the strengths that are already acquired during their BHMS course. The content of this course could include communication skills, marketing skills, improving analytical skills for clinical decision making, etc. This course could be in the duration of three to six months. The participants in this course will have some didactic learning in new areas like business development, social leadership, etc. There could be clinical case discussions – both in the clinic / ward / community and in the discussion room. This can improve the clinical decision making skills. It is also a good idea to run it along with the internship, without affecting the requirements of CCH / University for completion of the internship program.

 2.      This is an elaborate system, which can provide an alternative to the existing PG programs. We can model it after the DNB program in modern medicine. The Centres of Excellence identified by Government of India, Regional Research Institutes of the CCRH, reputed homeopathic hospitals, recognised homeopathic colleges that have superfluous capacity (beyond the minimum required by the statutory bodies) can be the nodes for conducting this program. There need not be a fixed syllabus for teaching, rather a set of clearly defined learning objectives in cognitive, psychomotor and affective domains of educational taxonomy. There could be courses of study in the core homeopathic areas and also in the frontier areas of clinical disciplines (as trandisciplinary stuies)

 Entrance for this course may be through a national entrance test. During the two or three years of rigorous training there shall be continuous monitoring by way of portfolio comprising of case records, group discussions, seminars, symposia, journal clubs, articles in peer reviewed journals, etc. At the end of the course, the participant is evaluated for the attainment of the learning objectives that are listed for the course. There shall be a 360⁰ evaluation – theoretical, clinical, attitudinal – by internal faculty, external board comprising of homeopathic professionals (and other professionals too in case of a transdisciplinary course of study), self evaluation, peer evaluation and evaluation by the stakeholders (i.e., patients).

 Certification for the course may be given in collaboration with the Indira Gandhi National Open University, which is pioneering innovative education. There need not be any stand off with regulatory authorities as these courses in their experimental form are not tipped to vest registration to practice (in fact there is no scope for confrontation, as those enrolling for the course already have their registration).

There is a scope for ushering in innovation in homeopathic education. But there has to be guarded optimism while planning this. The success of this program will depend on framing of the courses, selection of hubs for training, selection of the internal and external faculty. If guidelines are framed for transparency of actions and if they are implemented impartially and rigorously, there is likelihood of this program succeeding. 

Outline of Workshop to review the newly gazetted curriculum for Homeopathy Postgraduaion

Purpose

• To design a curriculum for the MD (Hom) courses as per the revised ordnance dated 5^th March 2012

Objectives

Organise a workshop, so as to –

• Discuss the amendments that are gazetted
• Brainstorm on the strengths and weaknesses of the proposed syllabus
• Identify areas that need to be clarified for a realistic implementation of the syllabus in the affiliated homeopathic institutions
• Indicate objectives for the teaching – learning of the major and subsidiary subjects
• Develop interdisciplinary objects of learning for the subsidiary subjects under each of the major subject
• Provide parameters for formative evaluation of learners during the course of study
• Suggest scheme of summative evaluation
• Design the curriculum for implementation in the affiliated homeopathic institutions

Program

• Inauguration of the workshop
• Introduction to the purpose of workshop
• Participants getting to know each other
• The NASA Exercise: Lost on the Moon
• Introduction to curriculum designing
• Group work on Curriculum Designing
• Plenary presentation by each group followed by discussion
• Documentation of the Curriculum
• Vote of thanks

Critique on the Revised Curriculum for MD (Homoeopathy)

The Central Council of Homoeopathy, New Delhi has proposed certain amendments to the existing Homoeopathic Postgraduate courses. These are published in the Gazette of India dated 5^th March 2012. These become applicable with immediate effect all over the country. The batch of postgraduate students who take their admission for the year 2012 – 13 will come under its purview.

At the outset, it has to be observed that the regulations in force preceding this were gazetted on 31^st October 2001. In its one decade of existence, this post-graduation course has attracted its share of criticisms. However, there is no documented effort to record its strengths or weakness. The criticism has remained in the realms of anecdotes.

Considering the fact that the newly proposed syllabus makes a significant deviation not only in the subject content, but also the direction of the course, it is only fair that the shift in focus should have been sufficiently explained to the profession. Lack of such a transparency makes one fear a sense of disregard to the customs of globally accepted norms. This also gives an impression of hasty decision imposition by the authorities.

On close scrutiny, the proposed amendments to the MD (Hom) have a new feature in the form of major and subsidiary subjects. As per the directions given in the ordnance of CCH, it is claimed that the syllabus remains the same for both major and subsidiary subjects, i.e., the contents of learning for Materia Medica will be the same whether it is studied as major subject or as a subsidiary subject.

Prima facie, this approach flies in the face of the logical evidence for postgraduate courses in any discipline. As pert the global standards for postgraduate education, the purpose is to nurture a discipline in an environment of research. This is aimed to generate evidences that can be collated to develop concepts and applications to further that discipline. This sets the postgraduate course apart from the undergraduate courses. The outcomes of postgraduation include developing human resources who can be researchers and / or teachers apart from being clinicians in the discipline.  

It can therefore be surmised that the newly gazetted syllabus has been bamboozled upon the profession with little regard to the sensitivity and rationale for the future of homeopathic education. With this in background, we need to examine what is the way forward. It has to be remembered that the gazetted version is mandatory to be applied as it is, so as to obviate any legal hurdles for those who obtain their qualifications under this ordnance.

It is therefore, proposed to –

• Retain the distribution of subjects as it is given in the said CCH ordnance
• Maintain the scheme of examinations and marks distribution, as per the directions given in the said CCH ordnance
• Pass a resolution to notify the provisions of Homoeopathy (Postgarduate Degree Course MD (Hom) Regulations as amended and gazetted in the 5^th March 2012 gazette of India for the distribution of subjects, marks and examination scheme, so as to ensure that the regulations for admission of students to the MD (Hom) course comply with the CCH directions
• Conduct a workshop with experts drawn from each of the seven postgraduate subjects, so as to evolve specific objectives for the subsidiary subjects under each of the major subjects. This would ensure that the relevance of the subsidiary subject for aligning it to the main subject and developing an interdisciplinary study.
• Add the recommendation of workshop after a process of scrutiny and publish it as annexure to the ordinance that is already published.
• For the long term course correction, there has to be national debate with a fair representation of the stakeholders, so as to make –

o     situation analysis of both undergraduate and postgraduate homeopathy education in India

o     prepare a HR forecast for the homeopathy human resources with state-wise density distribution

o     identify areas of postgraduate specialisation for homeopathy keeping in view the national healthy needs and the demonstrated strengths of homeopathy

o     distinguish the task analysis for both basic and specialist homeopathic clinician, homeopathy-based researcher and teacher

o     design curriculum as per the scientific principles of developing higher education programs

Proto-type of curriculum review for the newly proposed syllabus

As an evidence for the diversity of the same subsidiary subject under different main subjects, an example of Repertory as subsidiary to two different subjects – Homeopathic Philosophy and Homeopathic Materia Medica is provided:

Repertory as Subsidiary for Homoeopathic Philosophy

Purpose

To explore the philosophical dimensions of repertory, so as to align the study of repertory with homeopathic philosophy

Goal

The postgraduate scholar of Homoeopathic Philosophy, having chosen Repertory as subsidiary subject, will –

• Recognise the prescription needs of homeopathic practitioners
• Master most of the competencies related to case taking and case analysis, so as to generate totality of symptoms for repertorisation
• Acquire a spirit of scientific enquiry and gain orientation to the principles of research methodology for developing yardsticks for improving the applicability of repertory

General objectives

• Justify the importance of case analysis and symptom analysis for repertorisation
• Practice repertorisation ethically and in step with principles of homeopathy
• Demonstrate sufficient understanding of competencies associated with case taking and case analysis
• Align unprejudiced methodologies in the practice of repertorisation
• Interpret the rubrics of repertories in the light of symptom analysis
• Develop interdisciplinary approach for homeopathic philosophy  and repertory

Repertory as Subsidiary for Homoeopathic Materia Medica

Purpose

To scrutinise the relevance of repertories in relation to the drug action evidences, so that a comprehensive utility of repertory as a tool for prescription can be measured.

Goal

The postgraduate scholar of Homoeopathic Materia Medica, having chosen Repertory as subsidiary subject, will –

• Demonstrate the prescription needs of homeopathic practitioners
• Master most of the competencies related to case taking and symptom analysis, so as to generate totality of symptoms for repertorisation
• Acquire a spirit of scientific enquiry and gain orientation to the principles of research methodology for developing yardsticks for improving the applicability of repertory

General objectives

• Justify the importance of case taking and symptom analysis to differentiate the similimum\m after repertorisation
• Practice repertorisation with the objective of differentiating similar medicines for a group of symptoms
• Demonstrate sufficient understanding of competencies associated with case taking and symptom analysis
• Interpret rubric information with drug action
• Develop interdisciplinary approach for materia medica and repertory

Challenges for healthcare education in 21st Century and the Role of Health Science Universities

Preamble

Higher education is juxtaposed between the needs to sustain the singularity of knowledge in higher echelons of intellect and a compulsion to provide pragmatic solutions to the issues that matter for a sustainable world. If one factor places intellectual demand on the system, the other factor tweaks at the conscience of the establishment. Such a position demands a delicate balance to strike, so that the scarce resources can be optimised.

Healthcare education is in a much more edgy flux. A significant portion of knowledge in healthcare education is drawn from various components of higher education, which could range from anthropology to zoology. Thus, healthcare education can essentially be termed to be deriving philosophical moorings from higher education and practically responding to the needs of society.

Further, healthcare is not a monolithic entity. It is more of a team-based service that includes medical, nursing and allied healthcare professionals. The medical profession encompasses clinicians of western biomedical stream, the dentists, surgeons and the various AYUSH healthcare professionals. Pluralism of healthcare sector is not only an opportunity for the policy makers, but also a challenge to provide inclusive growth.

With this unique position, it would be worthwhile to examine the challenges in the healthcare sector, what are the resources needed to address to these issues and what role should a health university play in moderating the resource generation.

Challenges in the healthcare sector

The century we just left behind has been a remarkable one for human development. Fifty years ago, the majority of the world's population died before the age of 50. Today average life expectancy in developing countries is 64 years and is projected to reach around 70 years by the year 2020.

Health demography is concerned with study of the characteristics of human populations, such as size, growth, density, distribution, and vital statistics. This is a newly emerging discipline that emphasizes the interdisciplinary nature between the population science and health science. Studies conducted in this domain reveal changing landscape of health awareness among populations. This has brought in a paradigm shift in their healthcare priorities.

Moreover, epidemiological trends have undergone a seismic shift in the pattern of morbidities. If a century ago, the major healthcare concern was infectious diseases, today, the need is to tackle non communicable chronic metabolic disorders. Changes in lifestyle and cultural shift have contributed to this change.

A look at the population pyramid of India today and its projections over the next fifty years shows that nearly half of our country’s population will be below 25 years of age. This is a determining force in understanding the nature of morbidity that we can expect on a mass scale.

Increased urbanisation has also given rise to many cross cultural practices. Coupled with this is the phenomenon of democratisation of information with internet as a medium. Such a cultural shift has enabled people to become aware of many health beliefs that were not well known on a larger scale. Many traditional healthcare practices which were confined to select geographical or cultural zones are now in the public domain.

The importance of community based healthcare, rural healthcare, etc, have become influential variables in the healthcare domain. The flagship project of India’s healthcare broadband –National Rural Health Mission, and now proposed National Urban Health Mission have fired public imagination on the multitude of healthcare options. These projects have also challenged the policy makers to rethink and relook on the need for policies that would be sensitive to the needs of people.

Along the way, the corporatisation of healthcare in various forms like swanky hospitals, healthcare insurance, package deals in health check-ups, medical tourism have bred a new wave of practices. These have also had a salutary effect in innovating mass health projects like health insurance for populations Below Poverty Line.

Thus, on the whole, the outlook of healthcare sector presents a dynamic kaleidoscope of opportunities and some unexplored vistas of potential solutions.

Resources needed to address to these challenges

The resources needed to address these challenges could fall into infrastructure development and capacity building of human resources. What is significant for the Universities is to generate resources that are either human in nature or resources that could be utilised by human component of healthcare system.

This effectively means generating knowledge, skills and values that are relevant for the practice of healthcare and capacity building of human resources to optimally utilise these resources.

Thus far, the medical education was an exclusivist and discipline based study, with some amount of informal vertical integration during the clinical postings. This would apply to all disciplines of healthcare education like medical, dental, nursing, pharmacy, AYUSH, allied health sciences, etc. What is remarkable is that all these professions are interdependent on one another at some point in time.

A perusal of human resources available under various categories of health professions as per the official documents, can be listed as below –

• Doctors having medical qualifications under Indian Medical Council Act are around 640,000
• Dental Surgeon registered with Dental Council of India are around 80,000.
• Registered AYUSH Doctors is around 850,000
• Nursing staff is around 1800,000
• Pharmacists are around 700,000

As per the documents of World Health Organisation, the number of physicians per 10,000 populations for the world is 1.5. For India it is 7, which is at par with low income countries. Similarly, number of nurses per 10,000 population in India is 8, while it is 33 for the world and 16 for low income countries.

India has an abysmally low doctor-patient ratio - one doctor for 1,953 people, or a density of 0.5 doctors per 1,000 population. This reflects a serious issue in human resource management is huge gaps in critical health manpower in government institutions, particularly in rural areas, that provide healthcare to the poorer segments of population. These statistics reiterate a need for both long term and short term measures to overcome this serious challenge.

The Indian Government is seized of the gravity of this matter and therefore has asked the health ministry to work towards "strengthening of public health through creation of necessary human resources capacities at all levels." The Planning Commission's high-level expert group recently suggested the setting up of a Public Health Service Cadre that would be responsible for all public health functions starting at the block level, and going up to state and national levels.

We also need to look at the leadership role that India is expected to play in the future, especially in contributing to the mentoring of healthcare and education systems of the underdeveloped countries. Passing over the phenomenon of Brain Drain to the developed western countries, we need to frame a policy of intellectual and social harvest for the unfortunate humanity in countries like Africa and Asia. We need to prepare some fraction of our health human resources with a global outlook.

The challenge for future is certainly a human resource cadre that is responsive to the needs of India’s healthcare needs. Alongside, we also have an obligation towards the international community of underprivileged countries that look at us with hope and expectations to mitigate their sufferings.

Role of health sciences’ universities for resource generation

Health Sciences Universities were envisaged as hubs for the generation, nurturing and dissemination of knowledge, skills and values that are essential for viable and valuable healthcare practices. Various committees appointed by the World Health Organisation have stressed on the need for a inclusive and integrative healthcare education. Such an education is desirable to mirror the realities of healthcare practices.

Healthcare education faces several important challenges. Changes in healthcare scenario have had an enormous impact on the relevance of the current healthcare training. Such a situation calls for strong academic leadership in healthcare sector. We need to be aware of the complexities and challenges that confront the academic leadership of healthcare. There is a need to answer questions like ‘how do we prepare tomorrow’s doctors and nurses and pharmacists and a host of healthcare professionals today?’. Education of health professionals is critical to meeting global and national health challenges.

This throws up the challenge as to how best we could converge the needs of future healthcare and the emerging frontiers of knowledge into the curriculum so as to produce a more complete physician – the one who meets the needs of individuals and communities. We also need to look at the best way to mainstream disciplines as significant as molecular medicine, genetics, palliative care, AYUSH systems, nutrition, medical ethics, information technology, and many more into the existing curriculum. Exclusion of these neglected areas of medical education produces an incomplete physician.

Information and Communication Technology is another area that needs to converge with healthcare practices. There is a trend in healthcare education to absorb the best of all inventions and innovations. This healthy trend has given rise to not only many effective solutions in patient care, but also thrown up many interdisciplinary areas like Healthcare Informatics, Tele Medicine, etc.

Application of technology in healthcare education has also sprouted newer ways of teaching and learning. Blended Learning, which is a judicious mix of face-to-face teaching methods and digital teaching techniques offers new panorama of educational landscape. Considering that the future practitioners of healthcare would use computer technology as a matter of routine for many of their clinical decision making, we need to train our students to be able to survive and flourish in such an environment. We should train our students in such a way that they use the computer technology for their self-directed learning. It is not only a matter of using technology, but also being critical in evaluating the information available through technology.

The success of Open and Distance Learning as a medium in the Higher Education Domain opens up newer avenues of administering healthcare education. It may not be an alternative to the conventional form of undergraduate and postgraduate healthcare education. There is possibility to include certain modules of learning in this medium. However, a significant application of this form of education could be harnessed for Continuing Professional Development. This is because, healthcare education is also is about teaching how to manage change.

We live in a rapidly changing world. As educators, we need to inspire the future health professionals to embark upon a lifelong learning and applying quest. That will be their assurance of being able to provide their future patients with the best quality care they need for many years from now.

Conclusion

The challenges of healthcare in the new millennium are complex and multiple. The solutions for these ought to be appropriate and dynamic. Health Universities have their role cut out, not just to generate relevant human resources who are capable of solving the health related issues, but also instil into them ethical and social responsibility to perform as leaders of healthcare movement.