Foundations Syllabus

The Canadian College of Naturopathic Medicine COURSE OUTLINE 2006-2007 Term II

Course:

Foundations of Naturopathic Medicine

Course Code:

FNM 200

Times:

Fridays 2:30-4:30pm

Instructor:

Dr. Melanie Facca B.Sc., N.D.

Phone:

(416) 996-9935

E-mail:

[email protected]

Office Hours:

By appointment

Office Location:

Rm 2110

Teaching Assistants:

Dr. Stephanie Rubino: [email protected] Dr. Dana Lerman: [email protected] Dr. Allison Creech: [email protected] Dr. Glenys Brydges: [email protected] Dr. Cinzia Genuardi: [email protected] Dr. Shehab El’hashemy: [email protected] Dr. Mubina Jiwa: [email protected] Dr. Douglas Andrews: [email protected] Dr. Jason Loken: [email protected] Dr. Jill Shainhouse: [email protected]

Evaluation:

PERCENT

DUE DATE

Case Write up #1

35%

March 16, 2007

Case Write up #2

35%

April 13, 2007

Oral Presentation/Panel

10%

TBA

Active Participation

10%

Mandatory

Naturopathic Principles Illustration

10%

March 30, 2007

COURSE DESCRIPTION Foundations of Naturopathic Medicine serves as an introduction to the art of synthesizing a wide array of information about a patient into a complete picture, making an analysis, and deciding upon a therapeutic approach. While a variety of courses discuss diagnostic sciences or the individual naturopathic modalities, no other course integrates this information into a common thread. This task is of importance for the naturopathic student, because the entire curriculum of the ND program is relevant to the task of understanding the state of a patient, what factors led to their state of health or illness, and what to do about it. FNM 200W was created on the premise that naturopathic medicine can be approached as a coherent discipline, and is not merely a collection of therapies with certain elements in common. At its core, naturopathic medicine involves an understanding of the Vis Medicatrix Naturae and the intelligent use of therapeutics to assist, unblock and augment the Vis. While the philosophical implications of this were discussed in Naturopathic History, Philosophy and Principles, FNM 200W takes these to the next point of action. The Vis can only be properly understood by the examination of specific cases, and the personalities, processes and events that one finds in actual clinical situations. The therapeutic approach that results from this close observation of the patient is ordered and purposeful. Therefore, it is the intention as much as the actual therapy that makes a treatment “naturopathic”. The tutorial style of the course allows students to interact as medical colleagues, who will begin elaborating a school of thought that will eventually be applied to patients in practice. The student will learn how to approach a patient with an understanding of naturopathic principles. Through discussion and debate with instructors and fellow students, the student will develop insight into each of our modalities. Eventually, the student will be able to apply these modalities effectively in a clinical setting while at the same time adhering to our naturopathic principles.

LEARNING OUTCOMES This course assumes that diagnostic skills and therapeutic knowledge will be acquired in other classes. The goal of this course is to integrate this information and learn how to apply it to patients while adhering to our naturopathic principles. The conceptual information about what constitutes a thorough treatment, as well as a more detailed examination of the concepts of disease and healing are summarized in the following learning outcomes: To synthesize detailed information about a patient, conceptualize the disease process in that particular person, plan and make provisions for a process of healing, and choose a therapeutic regimen based on clearly defined naturopathic principles. To recognize key determinants of health and what their impact is on the patient’s health To acquire and implement into practice relevant clinical information required to assess and manage healthcare concerns within a clinical setting (i.e., etiology, epidemiology, pathogenesis and clinical information) To understand the naturopathic principles and how to apply them in a clinical setting To gain knowledge in the theory and practice/application of core naturopathic modalities in order to effectively assess and treat patient health concerns To understand how to identify, analyze and clinically manage safe and effectively patient care within the practice of naturopathic medicine To be able to critically appraise and integrate new medical research into clinical practice To learn how to promote patient empowerment and health through personalized education and support To engage in ethical decision making, through an adherence to honesty, integrity and respect for all persons in the context of naturopathic philosophy

ATTENDANCE & MISSED CLASSES Attendance to all lectures is expected and will be monitored. Attendance is mandatory in small groups and will be taken each week by your teaching assistant. Due to the nature of the course, there is no make-up for any missed class. As all practicals are mandatory, any practical session missed by the student without medical documentation will result in a 10% deduction off their final grade FOR EACH PRACTICAL SESSION MISSED. If the student is absent for more than 2 small group sessions for ANY reason, it will result in failure of the course (this includes absence due to medical reasons, even if the student has medical documentation). REQUIRED TEXTBOOKS At least 2 textbooks from the recommended textbook list must be brought by each student to every small group session or else participation marks will be deducted.

Recommended Textbooks Below are some general textbook recommendations, but any textbook you prefer or find useful is acceptable. Typically each group member will volunteer to always bring the same 2 books each week. This method ensures all topics are covered and students do not have to bring in a multitude of books. Each small group should have at least one reference book on the following subjects: Botanical Medicine (Therapeutic Herbalism, Phytochemistry and Pharmacy for Practitioners of Botanical Medicine, Herb Contraindications & Drug Interactions, Toxicology of Botanical medicine, The Energies of Western Herbs Volume I & II) TCM (The Foundations of Chinese Medicine, Clinical handbook of Internal Medicine vol. 1 & 2, Healing with Whole Foods, The Practice of Chinese Medicine, Obstetrics and Gynecology in Chinese Medicine, Chinese Acupuncture and Moxibustion) Homeopathy (Synthesis Repertorium Homeopathicum 8.1, Concordant Materia Medica 2nd ed.) Clinical Nutrition (Textbook of natural medicine, Drug-induced Nutrient Depletion Handbook, PDR for Nutritional Supplements, Modern Nutrition in Health and Disease, Clinical Nutrition: a functional approach) Physical Diagnosis (Physical Examination and Health Assessment, A Guide to Physical Examination & History taking, 8th ed., Handbook of Signs & Symptoms, Pocket Companion: Physical Examination) Differential Diagnosis (Ferri’s Clinical Advisor, Merck Manual, Problem Solving in Clinical Medicine, Harrison's Principles of Internal Medicine, McQue 18th Ed., Clinical Guidelines in Family Practice, Essentials of Family Medicine) Lab Diagnosis (Mosby’s Manual of Diagnostic and Laboratory Tests, Laboratory Tests and Diagnostic Procedures, Common Laboratory and Diagnostic Tests) Physical Therapies (Naturopathic Hydrotherapy, Orthopedic Physical examination, Massage for Orthopedic Conditions, Evidence-Based Guide to Therapeutic Physical Agents, Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods, Therapeutic Exercise: Foundations & Techniques) Other recommendations (Philosophy of Natural Therapeutics, Naturopathic Gastroenterology, Professional’s Handbook of Complementary & Alternative Medicines, Mosby’s Medical, Nursing & Allied Health Dictionary, Stedman’s Concise Medical Dictionary for the Health Professions, Medical Terminology An Illustrated Guide, Staying Well with Guided Imagery, Mind Body Medicine, Healing Intention and Energy Medicine, Complimentary and Alternative Medicine An evidence-based Approach, Mind Body Health, The Effect of Attitudes, Emotions, and Relationships, Health Psychology, Patient-Centered Interviewing: An EvidenceBased Method)

SPECIFIC EVALUATION CRITERIA i)

Active Participation (10%): 1% will be allocated for each of the 10 small group sessions for a total of 10%. Full marks will be given to students who bring the required reference material, interact with the patient, make regular contributions to the group and offer opinions and insight into the case.

ii)

Case Write-Ups (70%): Each case write up is worth 35%. For Case Write Up #1, you may write up either case 1 or 2. For Case Write Up #2, you may write up either case 3 or 4. Each case write up is out of 100 marks. The template for case write ups is provided.

Case write-ups are to be typed, with reasonably sized font. The marking scheme for the case write-ups follows. Marks will be deducted for exceeding length. Point form is acceptable. There will be a 10% deduction for each day an assignment is handed in late. iii)

Oral Presentation/Panel (10%): Students will do either an oral presentation in their small groups or participate in the panel debate in week 4.

ORAL PRESENTATION During the 10 small group sessions, the first half hour will be devoted to a student presentation. Each week a modality will be presented by a student. The presentation should be 10-15 minutes. No handouts need to be provided. The purpose of the presentation is to take a deeper look into one of our modalities, analyze it, question it and think about it in ways we may not have before. You may arrive at more questions than answers, but these are just as important. After the presentation, time is allotted for questions and debate amongst the group. Some questions you may want to think about when preparing your presentation (but you are encouraged to also use your own inspirations and ideas): How is this modality used by naturopathic doctors? Is this modality effective? Does/Can this modality affect the vital force? How? How does this modality restore health to the individual (vis medicatrix naturae)? How can this modality be used naturopathically? Allopathically? Are there times this modality should not be used? Can this modality be used to palliate symptoms? How? What are my own personal feelings/beliefs regarding this modality? Certainly some modalities will lend themselves better to certain questions. It is not a formal presentation, and no formal references are required, although you are free to use any materials you wish. Marking scheme is as follows for each presentation:

Originality of thoughts

(10 marks)

Insight into topic

(10 marks)

Presentation skills

(10 marks)

(Presentation skills include: flow, organization, clarity of voice, articulation of thoughts and ideas, understanding of the material, response to questions, ability to initiate questions and provoke thought and debate) PANEL DEBATE In week 3, 8 students will participate in a debate on 4 issues related to our naturopathic principles and the practice of naturopathic medicine. The student should be prepared to make an argument for the topic to which they are assigned. The student should also be prepared to engage in discussion and answer questions from the rest of the class. Each student should be prepared to present for approximately 10 minutes. Marking scheme is as follows for each panel member: Insight into the topic Ability to answer questions/rebuttals Presentation skills

(10 marks) (10 marks) (10 marks)

(Presentation skills include: flow, organization, clarity of voice, articulation of thoughts and ideas, understanding of the material, ability to initiate questions and provoke thought and debate). Students participating in the panel discussion are not required to do a presentation in the small groups.

iv)

Illustration of Naturopathic Principles (10%): Design a 1 page illustration of the Foundations of Naturopathic Medicine. You may design it free-hand or with a computer. It should symbolize the Foundations in such a way that it would make them clear and understandable to a patient. You may utilize any/all aspects of Naturopathic Foundations (therapeutic order, naturopathic principles, our modalities or any part thereof). It will serve as a useful tool for you when you are in practice. Example: a six-legged table with each leg having one of our six principles on it “holding up” our naturopathic foundation (the table top). Let yourself be limited only by your imagination.

Each assignment is to include a 1 paragraph explanation of the illustration. Marking scheme is as follows for the illustration:

Originality

(5 marks)

Comprehensibility of Concept Presentation

(10 marks) (10 marks)

Description (1 paragraph)

(5 marks)

(Presentation includes: flow, organization and understanding of material, neatness, aesthetic appeal, and legibility) There will be a 10% deduction for each day an assignment is handed in late. Format for Case Write-Up 1) Naturopathic Evaluation (/10) What is the etiology/root cause of patient’s illness/symptoms (list all spiritual, mental, emotional and physical factors that contribute)? List 5 concerns in total. 2) Medications/Supplementation (/12) List the patient’s past and current medications/supplements (maximum 6). Include the class, indications, side effects, drug/nutrient interactions and nutrient depletions for each. 3) Determinants of Health (/10) Include the determinants of health that apply to the patient. i) ii)

Inborn (genetics, family history physical & emotional intrauterine influences, age, sex)

iii)

Disturbances (past illnesses and medical interventions, physical and emotional traumas, stresses, exposures)

iv)

Lifestyle factors (nutrition, patterns of exercise and rest, emotional health, social factors, socioeconomic status, living situation, beliefs)

4) Patient Strengths/Weaknesses (/6) List 3 strengths/resiliency traits the patient possesses. Conversely, list 3 weaknesses/risk factors the patient possesses. 5) Patient/Clinician Goals (/6) List 3 goals of the patient and 3 goals of the clinician (yourself). 6) Obstacles to cure (/6) List the obstacles to cure which can be of a mental, physical, genetic, emotional, financial, social or spiritual nature. (minimum 3) 7) Vital Force Rating (/3) Assign the patient’s vital force rating /10. Support your answer and give rationale. 8) Prognosis (/2) Support and give rationale for the prognosis you assign the patient (excellent, good, fair or poor).

9) Personal Reflection (/5) Identify any personal triggers, associations, biases, or counter-transference that may be activated for you in working with this patient. 10) Laboratory Tests/Imaging Studies (/4) List any tests or imaging studies you would order for this patient and why (maximum 4). If you would not order either, give rationale for your decision. 11) Naturopathic Treatment (/21) Asian Medicine i) minimum 4 acupuncture points with rationale ii) 1 Asian patent formula and rationale for the prescription Botanical Medicine i) list a minimum of 3 botanicals with rationale ii) prescribe a botanical formulation using those botanicals including ratios and dosage Homeopathy i) minimum of 3 rubrics ii) minimum 3 remedies for consideration (with rationale) Hydrotherapy In-office or at home hydrotherapy prescription (clear and specific instructions for patient) Nutrition & Supplementation i) 3 specific dietary changes with appropriate examples where necessary ii) 3 nutritional supplements including rationale, brand and dosage Physical Medicine A physical medicine prescription done yourself or one which you would refer the patient for, include rational (any manual therapy). Counselling 3 areas to delve deeper with patient, including why they are important and what approaches would be used 12) References (/5) List a minimum of 5 references used for the case write up. 13) Patient Treatment Plan (/10) A 1 page treatment plan that is to be created by you, to be presented to the patient on the next visit. Include a list of chief concerns, short and long term treatment goals and specific instructions for any treatments/prescriptions (frequency, brand names, dosage etc.). The design and any other additional information are left up to the student. There will be a 10% deduction for each day an assignment is handed in late.

LECTURE SCHEDULE

WEEK

DATE

TOPIC

1

January 12, 2007

Course Introduction, Lecture 1 (M. Facca)

2

January 19, 2007

Lecture 2 (A. Jenab)

3

January 26, 2007

Panel Debate (8 students, M. Facca)

4

February 2, 2007

Case #1 (Part I)

5

February 9, 2007

Case #1 (Part II)

6

February 16, 2007

Case #2 (Part I)

February 23, 2007- No Class

READING WEEK

7

March 2, 2007

Case #2 (Part II)

8

March 9, 2007

Case #3 (Part I)

9

March 16, 2007 Case Write Up #1 Due (Case 1 or 2)

Case #3 (Part II)

10

March 23, 2007

Case #4 (Part I)

11

March 30, 2007 Naturopathic Principles Illustration Due

Case #4 (Part II)

12

April 6, 2007- No Class

GOOD FRIDAY

13

April 13, 2007 Case Write Up #2 Due (Case Case #5 (Part I) 3 or 4)

14

April 20, 2007

Case #5 (Part II)

DETAILED LECTURE OUTLINE Week 1: JANUARY 12, 2007 Lecture: Introduction to Course, The Therapeutic Order & Major Naturopathic Themes, Dr. Melanie Facca, N.D. Topics covered: Description of the course and details of how the course will be executed

Overview of the evaluation criteria Questions from students will be addressed Distribution of 2 articles by Jared Zeff N.D. (to be read for next class) Discussion of the therapeutic order and the principles of naturopathic medicine Understand the integration of naturopathic treatment and the therapeutic order How does naturopathic medicine differ than the application of natural therapies to symptoms? Does the therapeutic order reflect naturopathic principles? Appropriate questioning of the patient How to ask difficult questions of the patient Week 2: JANUARY 19, 2007 Lecture: Naturopathic View on Health and Disease, Dr. Arvin Jenab, N.D. Topics covered: Why do only some get sick? Why does disease begin? How does naturopathic medicine describe/view the disease process? How is the naturopathic view of disease different from allopathic models? What information you need to obtain from a patient Asking questions surrounding the determinants of health (inborn, disturbances, lifestyle factors) Overcoming obstacles to cure (when possible) How do we re-establish the basis for health in patients? How do we stimulate the vital force in the individual? (generally vs. specifically?) Palliation of symptoms vs. cure Week 3: JANUARY 26, 2007 Panel Debate, 2nd year students (8), mediated by: Dr. Melanie Facca, N.D. The panel debate will consist of two teams of 4 students. Students will be given 4 topics to debate with the other team. There will be opportunity for class participation. The goal is to provide in depth discussion on issues being faced by naturopathic doctors and students.

Weeks 4-14: 10 Small Group Sessions

Time

Format

2:30pm to 3:00pm

Modality Presentation (given by student)

3:00pm to 4:30pm

1st week: Patient (TA) intake done as a group. 1 student will serve as a facilitator. 2nd week: Patient assessment and treatment summary done as a group (see attached form).

* Remember that active participation includes bringing at least 2 textbooks to each small group session

1st week: Students will be interviewing the patient (TA). Students will be provided with a case summary of the patient similar to that of an intake form including physical examination findings and laboratory data (if applicable). Students are responsible for obtaining all necessary and pertinent information in the time allotted. Each student is responsible for his/her own note taking. One student will act as a facilitator each week. 2nd week: Students will exchange information and ideas about the case. The TA will serve as the facilitator. Discussion should follow a specific format. Each student is expected to make valuable contributions and share opinions. Disagreement and debate is encouraged and is to be done in a respectful manner. TA’s will also give insight into areas of the case that should have been more deeply delved into or that were missed altogether by the students. Remember that in many situations there is no one correct answer and that there are many routes one can take to achieve their ultimate goal; healing the patient.