Abstract: This article is intended to encourage medical professionalism, emphasizing new approaches to teach homoeopathy with an innovative method of teaching, which might revolutionize the outmoded teaching methods. It is also focused to make us think:
1. What exactly is wrong with our system of education.
2. Where have all the good teachers gone.
3. Is there a fall in educational standards
4. How to tap the potentials of the students
Education has been undergoing a “creative revolution” during the past and teaching methods have changed and so has the teacher-pupil relationship. It is true that strengthening of Homeopathic medical education is the urgent need.
Neglect of quality in homeopathic medical education will have adverse consequences on health care delivery. Quality of education is more important than mere quantitative expansion. Educational administration at all levels, as suggested by numerous commissions and committees on education should be the exclusive prerogative and domain of experts, educators and encourage active involvement of high professionals and motivated professors.
At one side the CCH & the Union Health & Family Welfare Ministry are regulating the functioning of Homeopathic colleges in the country and standardizing Homoeopathic education. Whereas on other side it is sheer shame to note that there is a growing demand for allowing homoeopaths to practice allopathic system of medicine. We need to think seriously about the imbalance between the input and output.
What is more distressing is the fact that students with no confidence unable to know where to knock at after graduating, the graduates with degrees tucked in their arms; they wander aimlessly applying for all sorts of jobs and out of sheer frustration, finally stick to any kind of job although they can have good private practice. Even the full fledged post graduation itself has not gained that recognition what it supposes to have.
In the article “As our people are so our institutions” a renowned stalwart says that the lack of quality of Homeopathy practioners is responsible for the decline in the quality of homeopathic health care delivery and is preventing Homeopathic system from playing an active role in the national health programmes. Over a period of time the homeopathic education has become directionless and so become cult based, rather than scientific.
The steps taken up by the CCH to improve the quality of education are implementing the minimum standards of education requirement (MSER), accreditation for homeopathic colleges are going to be compulsory, the qualification of the teaching staff had been upgraded to post graduation for teaching the undergraduate courses, few more specialties are going to be included in post graduation. Inspite of many measures taken up still there are some kind of stigma remains and diluting the standards of homeopathy. The funding by the government for Homeopathy has remained tardy. For this situation to change, multidisciplinary approach shall be incorporated, creating wide job opportunities at Government sector and many competitive role model government colleges has to be opened.
If the decline in standards is to be halted the quality of homeopathic medical education has to be toned up. The quest to learn and teach began with the insight for both the teacher and the learner by understanding their role respectively; to make teaching-learning process meaningful. There by mutual respect, moral values, standards, learning new aspects, technique adoption follows. I feel teaching should not be just focused only on the subject and assessment, should be more of motivating not threatening and after all at the end he should be a good human being, efficiently practicing Homeopathy, beneficial for himself and for the society in whole.
In general, medical student needs to be specially & carefully trained as they deal with the patient, a life. For this it can be attained only when we have skillful educator com physician. Students require well planned learning – they need to be trained to attain deep and vast subject knowledge in both theoretical & practical aspect, develop skills in the area of perception, intelligent guessing, problem solving, sequential analysis, holding good memory, understand the kernels, ability to convert one form of learning into another, motor skills, passive exposure during studentship and slowly getting them into active involvement. As they become a CRRI and post graduate they should posses the ability to individualize the patient, understanding the peculiar characteristics of the person, apply the holistic Homeopathic principles and improve the attitude, professional values & social values. Only then full fledged professional Homoeopathic physician can be brought out. This idealism or perfection is a goal of any medical profession. How we adopt the techniques, to implement all the above said, makes the difference and take us nearer to the goal. Ability of the educator to educator and the student to student varies. So both needs to be trained at their levels to bring equilibrium otherwise distance to reach the goal will be far.
The entire world is progressing at a terrific speed in the field of medicine – education. Every teacher of this profession need fire of thought that the students passing out should take the pride for becoming a Homeopathic physician.
Dr. Eswardas points out: Education & training in Homoeopathy should be directed in enhancing the ability of a student to master the art of individualization as well as the science medicine as conceived in its philosophical concepts to desire its merits.
The general goals and objectives are framed for the course, what a graduate has to acquire at the end of course as well as keeping in mind the current health need, the challenges and future need of the community. Then each department has to have their objectives as per their subject context and at last for each topic it is set forth.
Further, learning objectives are set, so that the teacher can focus & assess whether
a) the students are able to understand the subject, remember the information communicated, relate & apply when needed, could analyse & evaluate and finally he should be able to integrate and internalize the concept.
b) Students are able to imitate, practice under guidance and perform with proficiency. Teacher has to categorize what he must know; should know and better to know.
The students need a breeding ground to sharpen their existing skills, acquire new skills, conceive and experiment with new ideas, enhance their curiosity levels, and perfect their independent pursuit of knowledge. It is very obvious that those who have insight into the topics are the ones who do well later in real life inspite of relatively lower marks and it is not the toppers. That’s why how one succeeds in their jobs is totally unconnected with the marks they have in their academic report cards. “True education must show him “how to think out things for himself” and not place the weight on what to think”.
Essential elements to a medical profession include:
1. Professional values, attitudes, behavior and ethics.
2. Possessing scientific knowledge of medicine and applying the knowledge in solving the medical problems.
3. Communication skills
4. Clinical skills
5. Understanding their role in protecting and promoting the health of the population
6. critically understand the patient to individualize
7. Information analysis and management by understanding the advantage of computing and communication technology.
8. Critical thinking and research
Learner centered / contemporary teaching approaches challenge the traditional view of the teacher as the person who determines what, when, and how learners will learn, with didactic teaching as the predominant method. Creating an environment in which students can learn effectively and efficiently becomes the new prerequisite, demanding. Not only that, teachers are to be experts in their fields and more importantly that they need to understand how people learn.
Above all, there has been a steady deterioration in the value system in society as a whole; therefore value education has to be imparted with a sense of mission.
The quality of education in the college depends to a great extent on ensured good physical environment, safety, goal focused curriculum & syllabus, effective teaching, good clinical set up, infrastructural facilities available including laboratory and library, general atmosphere and the manner in which examinations are conducted. We must build world class facilities and provide stellar opportunities for students to acquire and develop skills, and a conducive environment for them to grow intellectually.
Every individual teacher plays as role model in all aspects and student support system are the most important aspect of healthy educational environment.
The student intrinsic and extrinsic motivation is focused, their feeling of being valued, wanting to learn with desire to achieve and understand the relevance of the learning to their future also plays a role in keeping up motivated environment.
Need for faculty development in education:
In general, it is important to note that the National Policy on Education (1986) places complete trust in the teaching community. Medical field in specific a substantial up-gradation in the quality of teaching are emphasized because those who enter into teaching profession are trained to be doctors basically, not as teachers.
Faculty development is term used to describe all activities taken up by the faculty in an institution targeting their all round development, personally or professionally, they have to be prepared in such a way that they are effective in their work, take satisfaction and pride in the activity they pursue, manifest cheer in the performance of their duties and considerate of their pupils and their co-workers and finally implying the growth of the institution.
The faculty needs training in educational sciences and technology to improve the quality of teaching and update their knowledge in current scenario. Thus at the level of Ayush and cch they are conducting faculty training programmes at various colleges and at the level of college – faculty development programmes and CME’s are conducted. Additional curricular activities like, publication of articles/books, undertaking research, participation in seminars/conference workshop etc., become inevitable for a teacher.
Teachers need to be trained in framing objectives, selecting appropriate teaching learning methods and media, proper evaluation methodologies, presentation skills, communication skills, reinforcement, questioning, making to learn the relevance of the topic, the way he carry himself throughout the session, and responding to the constructive feedback. The teachers should also be trained in educational sciences and technology. Educating the educators would ultimately develop the faculty.
The teachers’ participation in general administration, maintaining discipline, students guidance & counseling and shouldering responsibilities in some capacity for the social cause like health awareness camps, medical camps, environmental hygiene and sanitation and many more is desirable.
A teacher is not only a faithful source of knowledge but an efficient philosopher, experienced guide – an affectionate friend com mentor. Professional thinking, behavior and attitudes are modeled by teachers. A teacher should accept the responsibility of being a model to students and make themselves aware that they are the moulders of future Homeopaths.
Major blocks among the educators is mainly because of lack of motivation and lack of recognition or rewards for work done. There is no dearth of opportunities for people who have the skill and the will to pursue it. This is one of the reason why efficient homoeopathic doctors coming forward for teaching are drastically coming down. Until unless this urgent need is recognized we may not get efficient homoeopathic teachers in future. Inversely good practioners are well recognized and respected whereas passion for teaching earns nothing.
The challenges of the forthcoming century will be enormous and exorbitant. The curriculum does not mean only the academic subject traditionally taught, it should touch the life of the students at all points and help, in attaining a balanced personality relating to development of creativity factors, analytical power, problem solving ability etc.
The curriculum development process includes the design, development, implementing, monitoring, evaluating and reviewing the curricula which are relevant. Core committees are from expert in teaching profession. Keeping this in view CCH frames curriculum and syllabus for Homeopathy and that is to be followed by all universities. Time and time again, we have shown that with proper training and skills, we can be as good as anybody else in the world in every discipline.
Are we ready for a change? Do we have the will, patience, and the vision to make meaningful and effective changes in the education system that will produce the best and the brightest in the galaxy of stars who can contribute to Homoeopathic system of medicine? Changing a curriculum and keeping it going are unlikely to be effective if teachers are not able to take on new roles in understanding how people learn, so such development needs to take place at all levels from the institutional to the individual.
Preclinical and non-clinical subjects are there to facilitate to understand the clinical subject. Incorporating homoeopathy into clinical subjects was easy because a thorough study of disease, diagnosis and investigation are same like modern system of medicine (every physician must know) and along with which homoeopathic approach is implemented. That has lot of meaning in it and individuality of homoeopathy was uncompromised. Thus the weightage of those subjects into clinical practice had wide spectrum. But in the midst we get lost somewhere, first thing is may be because there are many subjects that students has to study, secondly we take students for admission having secured average mark. Homoeopathy is for the intelligent, to the intelligent and by the intelligent.
We need to verify, are we tempted to include topic X in a syllabus because it is there. Is it relevant? Does it serve a goal? Is it there in current applications? Will it help them to become a stanch Homoeopathic physician? The curriculum are framed unbiased without loosing the credibility of Homeopathy & its holistic principle and at the same time none the less it should be par with today’s medical technology. New educational technology of current scenario needs to be adopted to reach the goal – “by any means make a student as an efficient homeopath”.
Teachers should know what the syllabus is and relay it to students at the beginning of every course, including a schedule of tests, evaluation criteria and grading policy. Students must be encouraged to pursue various resources other than teachers and prescribed texts for information.
Different type of teaching methods can be adopted according to what & how we want to teach, whether for large or small group or individual. As well, it depends on whether it is theory, clinical subject or non clinical subject, bedside or demonstration, with the patient or without the patient, various skills, attitude teaching and teaching of values – professional, ethical, social and moral.
Teaching methods are described below:
A) Large group teaching:
1. Lectures – are to deliver the factual information and explain concepts to a big group. Various task and teaching media like giving handouts, audiovisual clips, power points etc., are adopted. The most appropriate media will differ depending on the venue, class size and the topic. “Tell me, and I forget. Show me, and I remember. Involve me, and I understand”- proverb.
2. Symposium- a series of prepared talks given by a few experts on many aspects of a topic under a chair person.
3. The panel: Groups of four or more persons sit with a moderator in front of an audience, each of them give opening remark before exchanging their particular view about the topic.
4. Team teaching: Here objective is to improve the quality of teaching by utilizing better talents and skills of a team of teachers.
B) Small group teaching: Limited number of participants are included, this teaching method improve the higher order thinking skills.
1. Group discussion: Here all the learners in the group participate actively. Each ones concept, their understanding about topic becomes clearer. By this their communication skills, team work, ability of problem solving gets improved. Other varieties of group discussions are
a. Controlled discussion – discussion controlled by teacher
b. Free group discussion – teacher acts as an observer
c. Buzz group – students discuss the topic with neighbore for few minutes before they discuss with lecturer or a group
d. Snowball group – pairs join up to form fours, then fours to eights. These groups of eight report back to the whole group – individuals write down their ideas before sharing them
e. Fishbowls – it has inner group discussing an issue or topic while the outer group listen, looking for theme or give feedback; roles are then reversed
f. Circular questioning – one group member formulates a question relevant to the theme and puts it to the person opposite giving time to answer
g. Horseshoe groups – allows you to alternate between the lecture and discussion formats
h. Brain storming – every learners response to a topic is accepted without criticism
i. Synetics – group members are chosen from diverse field to bring out more ideas or solve complex problem and conduct like brain storming
j. Syndicate – class divided into group, work on a problem and contact their teacher now & then
k. Therapeutic group technique or t-group – group members discuss their relationship and their problems in human relations
l. Cross over groups – students are divided into subgroups that are subsequently split upto form new groups in such a way as to maximize the crossing over of information.
2. Seminar: group of persons are engaged in advanced study of a subject who meets under the general direction of an expert staff member.
3. Tutorial are for small group less than 30, here the learners are guided by the teacher to help clear their doubts. It can take the form of mini-lecture or learner can discuss and make presentations. It helps to improve individual thinking and communication skills.
4. Problem based learning: following the group discussion the learner identify what is known and what is not known, simulated clinical scenarios are discussed and tasks will be allocated to the participants. Learners go on to source information from textbooks, journals, electronic databases and from experts. At the next session, new information and knowledge are shared, discussed and applied to solve the clinical problems. It promotes the ability to think critically to analyse problems and improve the learners’ skills in sourcing information.
5. Clinical teaching: learning in the clinical environment is focused on real problems in the context of professional practice. The skills of history taking, physical examination, clinical reasoning, decision making, empathy and professionalism can be taught and learnt as integrated whole. The skills are learnt by simulated patients, videos, manikins; computers and virtual reality technology are increasingly being used to ensure that trainees learn skills in a safe environment, receive feedback, and reach a certain level of competence before they use the skills on patients.
6. Demonstration: teacher performs demonstration while student watch. Here the learner actually experiences the event in turn it stimulate his curiosity.
7. Role play: here the student act out a situation and then discuss.
8. Workshop: it is like a meeting during which experienced persons in responsible positions come together with experts to find solutions to problems that have cropped up in the course of their work.
C) Individual methods:
They are reading, programmed learning, project, individual assignments, conference, counseling and simulation. Self directed learning is the educational strategy most likely to produce doctors prepared for life long learning and able to meet the changing needs of their patients. Problem based learning and guided discovery learning are two instructional strategies that exploit the merits of a learner centered approach.
Microteaching help teachers to improve the content & methods of teaching and develop specific teaching skills such as questioning, the use of examples, simple artifacts to make lessons more interesting, effective reinforcement techniques and introducing & closing lessons effectively. Immediate, focused feedback and encouragement, combined with the opportunity to practice the suggested improvements in the same training session, are the foundations of the microteaching protocol.
Oral communication has been dominant medium for teaching and learning since time immemorial. But if something is seen and heard then the retention in memory is increased.
1. Non projected visual aids
a. chalk board- inexpensive, helps students in note taking
b. display boards, cards and charts – displaying prepared materials to small group
2. Projected visual aids
a. overhead projector – transparency prepared in advance are projected to optimum legibility. This can also be used as chalkboard and project x-rays
b. silde projector – ideal for conferences and formal presentation.
c. episcope and micro projector- with episcope, diagrams and pictures from text books, journals, charts and other available material without any further preparation it can projected directly. Micro projector is used for projecting the images of histopathological section from a microscopic slide.
3. Audio aids
a. Public address system: used for large group aiming to reproduce original sound with the help of microphone, amplifier and speakers.
b. Audio tape system – used to provide narration for slide sequences, give commentary of silent films, demonstrate heart sounds, recorded dialogues of subject experts and give instructions for use of equipment.
4. written aids: hand outs
5. Patients and real objects: patients themselves are used as media for teaching. In case of anatomy, pathology and histology the section slides and specimens are used.
6. Three dimensional representations
a. Models- used to demonstrate small structures as well as function.
b. Simulators – to avoid risk, this is used to provide repeated practice experience before one works with expensive equipment or patient. It helps to improve the psychomotor skills.
7. Simulation and role play: simulation means imitating mimicking, e.g., simulated patients used for teaching. Role play is used for bringing about attitudinal changes. It provides safe environment that does not expose patients or trainees to risk.
a. Simple models or manikins – anatomical models, devices to practice first aid, intravenous catheters and basic life support maneuvers etc.
b. Simulated/standardized patients – training and assessment of history taking, physical examination and communication skills.
c. Simulated clinical environment – room equipped with emergency unit with procedure skill rooms
d. Human patient simulators – full sized patient simulator provides virtual simulation of almost every major bodily function attached to monitors displaying vital signs.
8. Audio visual aids
a. Video tape system – it is very powerful and effective media of teaching. Professionally prepared videotapes are available. Simultaneously the topic can be discussed. It improves the psychomotor, communication skills and attitude.
b. Tape slide system and cine film – visual and commentary are used separately.
9. Mass communication media: these provide distance education as well as continued update of the acquired knowledge.
10. Tele medicine: use of internet and telemedicine helps to learn medical subjects extensively. Medical websites are run by medical universities and also by private companies. Jay doc histoweb, journal database, (medline, helinet, online journals, Cochrane collections), cd-rom medline, current contents on diskette facility, virtual eye simulator, online medical courses, problem base learning, audio and video tutorials articles, exam oriented information, subject catalogues, MCQ’s enhances the quality of health education. Web technologies are moving forward at rapid pace, where telemedicine consultation (like e-heath customized application for doctors & hospitals, National rural telemedicine Ayush network of bihar) is blooming up to conquer new horizon in practice of medicine.
11. Computer assisted learning: this mechanism allows exchange of skills, resources, and ideas between institutions, exemplified by the universities. Self study modules are also coming up in medical field. It has become one of important tool for learning eg., functioning of heart valve, 3d image of internal ear etc. Now a days, computer technology is used in diagnostic and therapeutic equipments. And also it helps to assess the learner performance, marks, give immediate feedback of evaluation especially for MCQ type of examination. Some of the useful homoeopathic websites are as follows: www.ihma.in, www.homeopathyhome.com,www.ghmccalicut.org,www.homeobook.com,www.indianmedicine.nic.in,www.cchindia.com/index.htm,www.likecureslike.org,www.tinussmits.com,www.canadahomeopathy.com,www.homeopathy.com,www.classicalhomeopathy.com.,www.abchomeopathy.com,www.wholehealthnow.com,www.homeopathyNHS.com,www.owennaturalhealth.com,www.homeopathy.co.nz.,
12. Virtual reality: it is a computer based 3 dimensional interactive programme. There is VR helmet and electronic glove that has to be worn, which create separate images for the right and left eyes. So that the user can interact with the computer program. Used mostly to learn flying an air craft but these programs are coming up in surgical field.
13. Poster design: used for platform presentations in scientific gatherings.
Assessment can be formative (guiding future learning, providing reassurance, promoting, reflecting and shaping values) or summative (making an overall judgment about competence, fitness to practice, or qualification for advancement to higher levels of responsibility). Therefore it would be nice to have model/sessional examination can be of formative type and prefinal/terminal & university examinations can be summative type. So that, the strength and weakness of the student can be made transparent to the student without putting them in stress.
Commonly used methods of assessment:
A) Written examination:
a. Multichoice questions in either single best answer or extended matching format. It improves the knowledge and ability to solve the problems.
b. Key feature and script concordance questions improves clinical reasoning, problem solving ability, ability to apply knowledge.
c. Short answer questions improve to interpret diagnostic tests, problem solving ability, clinical reasoning skills.
d. Structured essays improve synthesis of information, interpretation of medical literature.
B) Practical / clinical examinations
a. Global ratings with comments at end of rotation improve the clinical skills, communication, teamwork, presentation skills, organization, work habits.
b. Structured direct observation with checklists for ratings (eg. mini- clinical evaluation exercise or video reviews) improves communication skills and clinical skills.
c. Oral examinations improve the knowledge and clinical reasoning.
d. Objective structured practical examination
C) Clinical simulations
a. Standardized patients and objective structured clinical examinations improve clinical skills, interpersonal behavior and communication skills.
b. Incognito standardized patients improve actual practice habits.
c. High technology simulations improve procedural skills, team work, simulated clinical dilemass.
D) Multisource (360-degree) assessments
a. Peer assessments improve the professional demeanor, work habits, interpersonal behavior and teamwork.
b. Patient assessments improve the ability to gain patients trust, patient satisfaction and communication skills.
c. Self assessments improve the knowledge, skills, attitudes, belief and behaviors.
d. Portfolios assessment: assessing what the student already knows or can already do e.g., artistic gifts (also includes chart notes, referral letters, procedure logs, videotaped consultations, peer assessments, patient surveys, literature searches, projects and any other type of learning material). It improves all aspects of competence, especially appropriate for practice based learning and improvement and systems based practice.
e. Log books
A doctor does not prescribe the same medication to every patient; even if his patients have the same illness. Likewise, not all people can learn and assimilate every subject at the same pace. Some people can do some things faster than others. Therefore the mode of testing the knowledge of students should involve examinations, papers, projects, seminars, practicals, performance in OP & IP and other means of testing to gauge the student’s knowledge.
Feedback refers to information describing trainee’s performance in a given activity that is intended to guide their future performance in that same or in a related activity. It is an important indicator to know how well a given program is fulfilling its charge. A feedback can be to its trainee by the teacher (clinician/skilled observer/teacher) to know when a trainee needs a correction. And the trainee’s reaction to the feedback would also be a valid indicator of the program’s success.
The evaluation of a teacher’s overall performance can be done by administrating suitable questionnaires to students, faculty members, the head of the department and peers if he is willing to participate in the rating. The main objective of the evaluation process is to promote academic excellence and to maintain quality and standard of education. The performance appraisal of teachers has four broad categories – personal, pedagogical, professional and institutional. Where the responses are noted in objective check list with specifications and the options in greater explicitness.
Exchange of ideas will be useful in inculcating better and most effective methods of teaching among the inexperienced and the young teachers. Needless to mention, the teaching method cannot be generalized as it hinges on the mental aptitude of the students and the experience of the teacher. A devoted teacher never refrains from evolving and experimenting different techniques of teaching with the sole objective of delivering the goods to the students in the best way. To know whether the goal is achieved or requires any reform feedback is the one which offers the greatest benefits and opportunity to optimize in the educational situation. It helps to rescue to face the challenging situation.
Whatever the medical system be, being a doctor is a challenging commitment that requires high levels of professional skill and precision. Even a small professional mistake could drastically affect a patient’s life. Therefore teacher should shoulder the Herculean task of accomplishing the goal of facilitating the student to become a competitive homeopath. The educational leaders need to come forward with strategies to overcome the crisis in Homeopathic medical education and initiate reforms at the earliest. Let us commit ourself to the profession and as well utilize the methods & media of teaching as per the need and changing scenario of today’s trend.
“Practice what we learned; upgrade your learning in every step; unlearn to criticize or practice other systems of medicine”.
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