Homeopathy in Medical Schools: Trajectory of the Universidade Federal Fluminense

ABSTRACT Homeopathic medicine was recognized by the Federal Council of Medicine as a medical specialty in 1980, and since then its teaching as part of medical training has grown in Brazil. Homeopathic medicine was first taight in Brazil in 1994 in the undergraduate medicine program of the Universidade Federal Fluminense (UFF). The history of teaching Homeopathy in the UFF medical course was analyzed in a qualitative-approach case study using documental analysis, direct observation, individual interviews with coordinators and students, and focus groups with alumni from five disciplines that address Homeopathy. The path identified involved resistance and progress, triggered by the curricular reform process in context of the implementation of the Brazilian Unified Health System (SUS) and the expansion of primary care. The teaching of Homeopathy in the UFF medical course was supported by the collaboration of external professionals. The major challenges included consolidating the discipline on the compulsory curriculum, acheiving integration with other clinics, hiring qualified teachers and recreating an outpatient Homeopathy school environment for supervised practice. From the perspective of integration and complementarity of the biomedical approach, humanized medical practice and comprehensive care were the most mentioned contributions. In the compulsory subjects it is argued that students can develop skills and abilities to: (a) guide and refer patients to Homeopathy whenever they might benefit from this medical practice; and (b) hold dialogues with homeopathy colleagues concerning the monitoring of common patients. The optional subjects are important for students who want to broaden their theoretical and practical training in Homeopathy, aimed at offering a professional practice that includes this specialty and permits the integration of the vitalist and biomedical paradigms in health care. The teaching of Homeopathy in the UFF undergraduate medical program is supported by its academic community's commitment to a plural health education that enables future professionals to use different paradigms for dealing with the disease process, the body and people in a contemporary society. This, in turn, contributes to improving relationships with patients, promotes autonomy, reduces invasive and insensitive approaches and expands comprehensive health care and resolute health work. This critical study of the trajectory of Homeopathy education in the UFF undergraduate medical course adds support to reflections on its teaching in other medical schools, including schools that already contemplate Homeopathy in their schedule or schools that are planning to include it in their curriculum in response to student and teacher demand.

摘要 顺势疗法医学（Homeopathic medicine）于1980年被联邦医学委员会认定为医学专科，自此之后，其作为医学培训组成部分的教学工作在巴西得到发展。1994年，顺势疗法医学首次在巴西弗鲁米嫩塞联邦大学（Universidade Federal Fluminense, UFF）的本科医学课程中开设。本研究采用质性案例研究方法，通过文献分析、实地观察、对课程协调员与学生开展个人访谈，以及针对五门涉及顺势疗法的学科的校友组织焦点小组讨论，对UFF医学课程中顺势疗法教学的发展历史进行了分析。研究识别出的发展路径兼具阻力与进步，这一进程由巴西统一医疗体系（Sistema Único de Saúde, SUS）实施背景下的课程改革进程，以及初级医疗服务的扩张所触发。UFF医学课程中的顺势疗法教学得到了外部专业人士的协作支持。主要挑战包括：巩固必修课程中的顺势疗法学科模块、实现与其他临床学科的融合、聘用合格教师，以及重建可供学生开展带督导实践的顺势疗法门诊教学环境。从生物医学模式的整合与互补视角来看，人文医疗实践与全人照护是被提及最多的教学贡献。在必修课程框架下，学生可借此培养两项技能与能力：(a) 当患者可从顺势疗法医疗实践中获益时，为其提供指导并完成转诊；(b) 与顺势疗法同行就常见患者的监护工作开展沟通协作。对于希望拓展顺势疗法理论与实践培训的学生而言，选修课程至关重要，其目标是打造涵盖该专科的专业执业模式，并允许在医疗照护中整合生机论与生物医学两种范式。UFF本科医学课程中的顺势疗法教学，得益于其学术共同体对多元化健康教育的承诺——这一理念可使未来的医疗从业者在当代社会中，能够运用不同范式应对疾病进程、身体状况与个体人群。这反过来有助于改善医患关系、提升诊疗自主性、减少侵入性与冷漠的诊疗手段，并拓展全人健康照护与坚定务实的健康服务工作。本项针对UFF本科医学课程顺势疗法教育发展轨迹的批判性研究，可为其他医学院校的顺势疗法教学反思提供支撑，包括那些已将顺势疗法纳入课程大纲的院校，以及那些应学生与教师需求，计划将其纳入课程体系的院校。