Message from the President
By Alexander P. Cortina – Boucher Institute of Naturopathic Medicine (BINM)
The Future of Naturopathic Medical Education
Naturopathic medical education and practice are constantly immersed in debates that push for the need to move beyond the establishment and challenge the status quo or support the need to organize or structure a formal standing that strengthens and justifies the profession. For the purposes of this article please allow me to refer to the previous role as that of an artist/explorer and the other as reflecting the nature of a scientist/legislator accordingly. Please note I am not referring to science as a model of seeking validity/reproducibility, but rather to a scientist mind frame that seeks to determine a particular static reality, even momentarily. The need for balance and sometimes further influence by one aspect over the other has been clearly validated and seen in naturopathic medical history many times in the past according to the circumstances experienced by the profession. Generally, it has been the role of the institutions (schools, licensing bodies, associations, etc.) to work to secure validation and structure. It has been the role of individual practitioners, particular interest groups and corporations, to question the established agreements as to what is naturopathic medicine and how it should look in the future. It is also apparent that these roles or functions sometimes seem conflicted in the eyes of certain individuals. For example, a student in naturopathic medical school feels trapped by the system and unable to explore or move further in his/her learning because of curriculum limitations. A hard working and dedicated naturopathic physician has selflessly offered countless hours serving in organizations which have succeeded in validating naturopathic medicine within governments, accreditation bodies as well as industry, and feels frustrated by other individuals pursuing a less productive agenda. Not only naturopathic medical education, but medical education in general, has relied on the legislator/scientist role to guide what is considered to be the appropriate role of schools: to offer the basic foundation on which practitioners can build their own expressions of medical practice. Some students may argue that this role is unnecessary and generates considerable waste of time; while some faculty members may argue that this is the only role that can actually provide the broad experience needed for any (naturopathic) medical practitioner to flourish and be of benefit to others. Considering that the legislator/scientist approach has been generally seen at the center of medical education in North America, I was highly impressed by a particular study funded by Health Canada and prepared by the Association of Faculties of Medicine of Canada (AFMC) titled: The Future of Medical Education in Canada: A Collective Vision for MD Education (www.afmc.ca/fmec). The main question was to look at “how the education programs leading to the medical doctor (MD) degree in Canada can best respond to society’s evolving needs given the “enormous challenges health care in general faces in the near future.” In a bold and, in my view, very effective approach, the AFMC offers 10 formal recommendations to all traditional medical schools in Canada for consideration and implementation. These are: • Address Individual and Community Needs • Enhance Admissions Processes • Build on the Scientific Basis of Medicine • Promote Prevention and Public Health • Address the Hidden Curriculum • Diversify Learning Contexts • Value Generalism • Advance Inter- and Intra- Professional Practice • Adopt a Competency-Based and Flexible Approach • Foster Medical Leadership As I read this list and the supporting documentation, I am surprised to notice that the great majority of these suggestions would make a strong case to support the artistic/ exploratory nature of medical education and practice rather than the scientific/legislative one. Many of these suggestions actually appear to me as if they might have been previously developed or considered in a CAM educational setting. The need for connection, humanization, leadership, diversification, flexibility, community, and prevention as well as the need to address “hidden” or stereotypical curriculum/practices, is clearly noted and brought into the center of the dialogue for Canadian MD schools. As many educational scholars have noted, for any form of education to be relevant, it must stay true to the needs of society as well as that of graduates and practitioners. It is clear by the accounts of the AFMC that the health care needs of the future in Canada, and some may argue in North America, will demand medical practitioners become: more human, more artistic, more flexible, more connected, more diverse and better leaders; instead of: more rigid, more structured, more disconnected, more specialized and more compliant. The concept of ‘relevance-based education’ always brings into question what is to be understood as relevant. Canadian and American governments are both facing the same pressures, regardless of the structural differences of both systems: the demographic curve representing the majority of the population is now above 50 years of age, underscoring the need to do everything possible to support this reality. This is clearly important. This is clearly relevant. It is heart-warming and very positive for me to see these suggestions coming from the medical school establishment as the key to address this reality. As naturopathic medical leaders, students, faculty and practitioners, why not consider looking into our curriculum and teaching methodologies; our standards of practice and code of ethics; and our regulations, bylaws and legislation. Let’s see how these AFMC suggestions may be either already a part of what we do, or if not, in what ways can we introduce or enhance them. Furthermore, and I believe more importantly, it would be even more interesting to challenge all involved in naturopathic medicine by asking: “If mainstream medical schools are currently taking this direction, should we understand this as a call to action for naturopathic medical schools and other naturopathic medical institutions to embrace the artistic/explorer aspect of our profession more, and strive to go even further?” How would this look? What would this entail? Certainly naturopathic food for thought…
Alexander Cortina, MEd is president at the Boucher Institute of Naturopathic Medicine (BINM) in British Columbia, Canada. He graduated with a masters in educational administration and leadership from the University of British Columbia, and is currently finishing a doctoral program in the same field based at the University of Calgary. He additionally holds two bachelors degrees, one in philosophy and ethics and the other in higher education. Cortina has 15 years of senior educational management experience, five of which were devoted to serving as dean of student affairs at BINM. He currently serves as AANMC board treasurer. E-mail: [email protected].
