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Clinical training

Every healthcare profession in the United States requires clinical training: hours and hours in which the medical doctor, chiropractor, psychotherapist or acupuncturist-to-be treats live patients first-hand, under the supervision of a full-fledged professional. For every healthcare profession in the U.S., clinical training—and plenty of it—is a step towards licensure that absolutely cannot be missed. The reason for this imperative is that clinical training, with its direct supervision and the constant evaluation, correction and re-visioning that a mentor provides, is the most effective way to master the art of healing. 

     Clinical supervision requires the student to take knowledge gained in the classroom and put it into practice. It provides a safe, structured environment, while nurturing students' independence. It provides feedback for students to actively refine their skills. It's the one setting where academic competency can be polished into professional competency.

     The bad news is that homeopathic students in the U.S. rarely if ever receive clinical supervision. Until recently, there were no schools in the U.S. providing any clinical supervision. Currently, there are just a handful, and for some baffling reason, these schools at times have difficulty maintaining enrollments. It could be that the homeopathic community fails to support these institutions, and, as a result, students never get the message that clinical training should become a priority in their homeopathic education. 

     Certifying organizations require that applicants submit casework—but they don't explicitly require clinically supervised cases. A certifying organization can require applicants to submit ten cases ... or it can require applicants to be supervised in ten cases and then submit them. There's a big difference.

     The typical path for American homeopathy students is to spend two, three, maybe four years in classroom training in a program that advertises itself as a "clinical program." More often than not, however, the clinical aspects of these programs are limited. Initially the clinical activity is observation of a well-trained practitioner. I agree that watching video cases or live cases taken by the homeopath/teacher is an invaluable introduction to clinical training. Some programs even allow the students to question the patients directly. The class discusses the case and then prescribes. The benefits of such initial clinical training is all the greater if the teacher or mentor can articulate his or her process clearly, so that students can "model" it in their own practice. This method is also effective for learning case management. The down side is the lack of follow-up that often plagues live classroom events, diminishing the entire process because of the inability to accurately judge the outcome. Too much conjecture leads to a lively discussion—but no clear outcome. Some programs favor video cases because they can be screened to present interviews with clear outcomes.

     A more mature clinical teaching environment may begin similarly, with clinical modeling, but it promptly segues to clinical supervision in which the student takes the case, with a supervisor watching. The supervisor gives the student direct feedback about the case in progress. The supervisor maintains the treatment protocols of the patient and supports the student case analysis. As the student becomes more comfortable, the supervisor spends less time directly in the process, allowing the student more control of his/her own practice. The student eventually does it all: takes the case, completes the analysis, and brings the results to the supervisor for assessment and evaluation. The supervisor provides feedback, with the student having increasingly greater amounts of responsibility. Clinical supervision continues to the point where the student achieves competency and mastery of homeopathic technique. Students who achieve clinical competency find board examinations relatively easy to pass, and they start professional development with a strong sense of confidence and skill.

     For supervision to be productive, homeopathy schools must have clearly defined clinical competencies for students to master. If the school does not have stated clinical objectives, the information is available in the Accreditation Handbook of the Council on Homeopathic Education, which has developed clear goals for clinical competencies. 

     As president of the Council on Homeopathic Education and a close observer of homeopathic education in the U.S., I've sometimes wondered if the American homeopathic community has failed to develop a sound process for educating homeopaths. At the average seminar or conference, there might be 50 to 150 people present. We presume that most participants are practitioners, but what if the truth is that a large portion of the participants have not succeeded in becoming practitioners? They're people who sense the insufficiency in their training and fill those seats in the hope that one more seminar will be just what they need. But they're fooling themselves. Because after looking at schools and programs in 1998, the Council on Homeopathic Education found that many schools are simply lecture classes with no meaningful assessment and no clinical supervision. On the other hand, the few schools that do provide one-on-one clinical supervision for one to two years can barely keep twenty students enrolled, and are often forced to postpone new classes. 

     The Council on Homeopathic Education has defined the clinical competencies required of a classical homeopath. Homeopathic schools must have the determination to develop programs that achieve these objectives. A number of schools are well into the process. It is time for the entire homeopathic community to support these schools and demand that these standards be met by everyone.

     Before 1976, there was no profession of acupuncture in the United States. Twenty years later, there are 47 schools recognized by the U.S. Department of Education, and student loans are available. Insurance companies pay for acupuncture services provided by professionals whose licensure bespeaks rigorous training. The opportunity for the homeopathic community looms large. If we are to take our rightful place as a viable healthcare profession in the 21st century, we will have to place all our emphasis on training competent practitioners. This will center on healthy homeopathic colleges that rely on time-honored systems of professional development. We must demand the highest standards and accept nothing less of ourselves, our colleagues, and our colleges.

     The current list of homeopathic schools that offer clinical supervision in live patient clinics (excluding naturopathic colleges):

Colorado Institute of Classical Homeopathy
Institute of Natural Health Sciences
Northwestern School of Homeopathy
Pacific Academy of Homeopathy
Teleosis School of Homeopathy
The Homeopathic College
The School of Homeopathy, New York

In Canada:
Homeopathic College of Canada
Toronto School of Homeopathic Medicine
Vancouver Homeopathic Academy

The Council on Homeopathic Education can be reached at:
3 Main St.
Chatham, NY 12037
(518) 392-7975

About the author:

Joel Kreisberg, DC, CCH, is president of the Council on Homeopathic Education and director of Teleosis School of Homeopathy.