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EXPERIMENTAL
ABSTRACT
Background: What is the ideal way of teaching Ayurveda? has been a debated question since long. The present graduate
level curriculum lists out the topics from contemporary medical science and Ayurveda discretely, placing no emphasis
on integration. Most of the textbooks, too, follow the same pattern. This makes learning not only difficult, but also leads
to cognitive dissonance. Objectives: To develop and evaluate the effectiveness of a few integrative teaching methods.
Materials and Methods: We introduced three different interventions in the subject Kriya Sharira with special reference to
cardiovascular physiology. The instructional methods that we evaluated were: 1. Integrative module on cardiovascular
physiology (IMCP), 2. case-stimulated learning (CSL), and 3. classroom small group discussion (CSGD). In the first two
experiments, we subjected the experimental group of graduate students to the integrative instructional methods. The control
group of students received the instructions in a conventional, didactic, teacher-centric way. After the experiments were over,
the learning outcome was assessed and compared on the basis of the test scores. The groups were crossed over thereafter
and the instructional methods were interchanged. Finally, feedback was obtained on different questionnaires. In the third
experiment, only student feedback was taken as we could not have a control group. Results: The test results in the first
experiment showed that the integrative method is comparable with the conventional method. In the second experiment,
the test results showed that the integrative method is better than the conventional method. The student feedback showed
that all the three methods were perceived to be more interesting than the conventional one. Conclusion: The study shows
that the development of testable integrative teaching methods is possible in the context of Ayurveda education. It also
shows that students find integrative approaches more interesting than the conventional method.
Key words: Ayurveda education, case-stimulated learning, classroom small group discussion, Kriya Sharira, instructional
methods, integrative module
INTRODUCTION
The quality of Ayurveda education in post-independence
India has been a matter of concern since long and has
Address for correspondence:
Dr. Kishor Patwardhan, Department of Kriya Sharir, Faculty
of Ayurveda, Banaras Hindu University, Varanasi - 221 005,
Uttar Pradesh, India.
E-mail: patwardhan.kishor@gmail.com
Received: 16-May-2013
Revised: 24-Jun-2013
Accepted: 09-Jul-2013
Access this article online
Quick Response Code:
Website:
www.jaim.in
DOI:
10.4103/0975-9476.118683
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The first author of this report was the instructor for all the
three experiments. All the experiments were conducted in
the presence and direct supervision of the senior author.
IMCP
First stage: Discrete and Integrative teaching
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Box 1: Contd...
Box 2
Box 3
Summary of the method in which the content under
Case-Stimulated Learning was delivered
The imaginary case scenario presented was as follows: A patient
aged 75 years comes to you complaining of sudden feeling of
tightness in the chest that he developed after climbing 20-25 stairs.
The location of this pain is just behind the sternum and radiates
towards left jaw, shoulder, and arm. Laboratory investigation shows
elevated levels of serum cholesterol (350 mg/dl). What might be
the reason for such manifestation? Afterwards, the lecture was
delivered explaining the normal physiology of coronary circulation
and the pathology caused due to abnormalities. At the end of the
lecture, the students were asked to solve the case on the basis of the
knowledge that they acquired during the lecture.
The integrative explanation oered was:
Adequate perfusion to heart tissue is required for the mechanical,
electrochemical, and biochemical functions of the myocardium.
For this, an intact coronary circulation is required. In conditions
where myocardial oxygen demands are markedly increased and
when coronary blood flow is not adequate to fulfill this requirement,
angina precipitates. In the case that is being discussed, a high level of
cholesterol forms atheroma and reduces the diameter and elasticity
of the coronary vessels, thus leading to the manifestation of angina.
According to the principles of Ayurveda, proper functioning of
Rasa is essential for the maintenance of tissue perfusion along with
normally functioning Vayu that keeps the vascular lumen patent.
A condition similar to angina has been documented in Sushruta
Samhita, namely, Hrit-shula. In this condition, Vayu gives rise to
pain in the chest and produces diculty in breathing. This is called
Hritshula, produced by Rasa and Vayu. Another description found in
Charak Samhita in the context of Rasa Kshaya is the development of
pain in the chest which is precipitated after minimal exertion.
Summary of the method in which the subject content was delivered
under conventional teaching.
A regular lecture on coronary circulation was given introducing the
students to basic concepts such as physiological anatomy and factors
influencing the coronary blood flow, along with the applied aspects of
ischemic heart disease and the symptoms. Integrative explanations
as explained above were oered to this group also. However, the
clinical case scenario was not presented in this method.
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CSGD
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CSL
Table 1: The attendance, teaching hours, and human hours spent during the first experiment
(Integrative module on cardiovascular physiology)
2011-2012
2012-2013
Total
N
27
18
45
Attendance
89
72
161
Control group
Teaching hours
5
5
10
Human hours
445
360
805
N
27
19
46
Attendance
103
73
176
Experimental group
Teaching hours
5
5
10
Human hours
515
365
880
Table 2: The groupwise results of the written test for first experiment (Integrative module on
cardiovascular physiology)
Short description of the area on which the question was
focused
Definition of Srotamsi
Atrioventricular nodal delay#
Seat of peripheral resistance#
Flowing pattern of Rasa#
Rasa Vaha Srotamsi#
Subtypes of Vata involved in Rasa Samvahana#
Functions of Rasa Dhatu#
Functions of circulatory system
Classification of Srotamsi#
Conduction velocity in conductive system of the heart#
Capacitance vessels#
Factors determining the arterial pressure#
Mula of Rasavaha Srotamsi#
Quantity of Rasa Dhatu#
Cardiac functioning in Ayurveda
Ohms law in the context of circulation
Factors determining Rasa Samvahana
Vasomotor center: Location and functions#
Eect of sympathetic stimulation on circulation#
Dhatu vriddhi and Kshaya associated with vomiting and diarrhea#
Total
P value
0.017
0.349
0.165
0.217
0.590
0.429
0.255
0.205
0.276
0.993
0.570
0.541
0.931
0.475
0.337
0.568
0.284
0.125
0.217
0.156
0.093
The P values without # indicate the results of independent samples t-test, whereas, the P-values with # indicate the results of Mann-Whitney test. Mann-Whitney test was
applied wherever the standard deviation (SD) exceeded half of the mean, thus rendering the data unfit for any parametric test to be applied. P<0.05 was considered to be
statistically significant
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Table 3: The groupwise results of the written test for the second experiment CSL
Short description of the area with which the questions
were related
Cross-sectional area of the branches of the coronary artery#
Variations in myocardial O2 demand
High level of circulating cholesterol and its implications#
Autoregulation in relation to coronary circulation#
Blood supply to the subendocardial zone of the myocardium#
Regulation of cardiac activity by Vyana Vayu and Prana Vayu#
Ischemic heart disease, angina pectoris and Hrit Shula#
Interrelationship between the ventricular systole-diastole and
coronary blood flow#
Determinants of myocardial O2 supply#
Collateral circulation#
Role of Rasa in cardiac nutrition#
Sympathetic stimulation and coronary circulation#
Capillary density in myocardium#
Metabolic control of coronary circulation#
Dhamani Praticaya#
Total
P value
0.600.50
0.710.46
0.830.38
0.810.40
0.830.38
0.880.33
0.640.49
12.122.07
0.410.50
0.880.33
0.780.42
0.800.40
0.800.40
0.800.40
0.490.51
10.491.71
0.102
0.066
0.580
0.957
0.738
0.343
0.157
0.000
0.343
0.976
0.654
0.030
0.046
0.009
0.002
0.432
The P values without # indicate the results of independent samples t-test, whereas the P values with # indicate the results of Mann-Whitney test. Mann-Whitney test was
applied wherever the standard deviation (SD) exceeded half of the mean, thus rendering the data unfit for any parametric test to be applied. Therefore, in such cases, the
nonparametric test was applied. P<0.05 was considered to be statistically significant
CSGD
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Further, the instructor for both the groups was the first
author of the present study, and hence, we could not
avoid the possible carry over effect, because of which,
there might have been some amount of mixing up of
the contents during the lecturing sessions. Therefore,
we suggest placing the two groups temporally distant,
in the future studies of this kind.
We could not assess long-term learning outcomes
because of time restrictions.
These integrative methods may not be applicable to
all the topics that appear in the syllabus.
ACKNOWLEDGMENT
The authors thank all the students who participated in these
experiments enthusiastically. The authors also acknowledge the
support and facilities they received from the Department of
Kriya Sharir, Faculty of Ayurveda, Banaras Hindu University,
during the present work. We fondly acknowledge the help of all
the anonymous reviewers of J-AIM who were instrumental in
giving this article the present shape.
REFERENCES
1.
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