- The Brody School of Medicine, East Carolina University
- University of Colorado at Denver, Health Sciences Center
- University of Texas Medical Branch at Galveston
- University of Vermont, College of Medicine
Course Director: David W. Musick, PhD
Course: A New Spirituality and Medicine Curriculum
Brody School of Medicine, Greenville, N.C., is a relatively young medical school with a strong primary care orientation. The school has a three-fold mission that serves as a framework for our educational efforts: 1) to increase the supply of primary care physicians to serve the state, with emphasis on the eastern North Carolina region; 2) to improve the health status of citizens in eastern North Carolina via a strong orientation to community-oriented primary care services; and 3) to enhance the access of minority and disadvantaged students to a medical education. Our academic health care center serves a 28 county region of eastern North Carolina, a large geographic area with an approximate population of 1.4 million. The primary vocation in much of eastern North Carolina is agriculture, resulting in a diverse workforce. In response to the growing need for better integration of holistic care for our patients, the Brody School of Medicine has launched a new curriculum development project in spirituality and medicine.
The overall goal of our new Spirituality in Medicine Curriculum is to ensure that our students demonstrate knowledge and competence in providing spiritually sensitive care to diverse patient populations, particularly in the primary care setting, resulting in graduates that provide more compassionate, holistic patient care. To accomplish this overall goal, we have developed a set of fifteen educational objectives that will be addressed across all four years of the medical school curriculum. These objectives were developed in collaboration with our curriculum committees and the course directors of eleven distinct courses/clerkships that all medical students (72 per class) will take. The objectives have been categorized in congruence with the "six general competencies" for ACGME-accredited residency training. Students will work through all objectives by proceeding through the four year curriculum of the medical school; will encounter material in a variety of settings (e.g., classroom, small groups, inpatient and outpatient clinical care facilities); and will be taught using a variety of methods.
One of the most important and concrete learning opportunities for health care professionals concerns the ability to appropriately take a spiritual history from a patient. We will place heavy emphasis on this task in our project, focusing on opportunities to learn this skill set during years one and two; and then promoting opportunities to practice this task during the clinical years. We will focus students' attention on the theory behind the spiritual assessment; the task itself; and how the task can and should be incorporated into holistic practice. Appropriate assessment measures will be used to demonstrate student learning and the effectiveness of this instructional technique. Our project will also feature targeted faculty development activities that are designed to increase the knowledge and teaching skills of attending faculty and resident physicians who teach our medical students. Faculty development will feature such activities as clinical grand rounds sessions; workshops; interactive seminars with chief residents; and panel discussions designed to appeal to a wide audience of health professions educators.
Our project research efforts will focus on "Spiritual Identity Development in Medical Students & Its Relationship to Care". Our research interest is targeted at the level of the individual medical student who is a future practitioner. Our research examines the ability of a physician to respect spiritual and/or cultural traditions different from his/her own. Our research hypothesis is that there is a positive relationship between the spiritual/cultural identity formation of the individual practitioner and his/her willingness to provide holistic care. We base our research project on the work of Josepha Campinha-Bacote, and her "Culturally Competent Model of Care" for health professionals. Dr. Campinha-Bacote's model theorizes that the ability to provide culturally-sensitive care is based on a combination of cultural awareness, cultural knowledge and cultural skills; these, in turn, play an important role in the "cultural encounter," whether it takes place in the health care setting or in everyday life.
Course Directors: Jacqueline J. Glover, PhD, and Julie Swaney, M.Div.
- Small group session on "Diversity and Labeling" during orientation to medical school (Reading: Charon R. Narrative Medicine. JAMA. 2001;286:15 :1897-1902)
- Spiritual dimension of "The Cadaver as your First Patient?" discussed in anatomy class (Readings: Grassi MA. The Gift. JAMA. Vol 276 (11), Sept. 1996, p. 854 and Clements PT et al. Cultural Perspectives of Death, Grief and Bereavement. Journal of Psychosocial Nursing. Vol. 41, No. 7, July 2003)
- Two week Problem Based Learning case examining cultural and religious aspects of genetic diseases such as Tay Sachs
- Panel discussion of Spirituality and Sickle Cell Disease with prerequisite (Reading: Cooper-Effa M, et al. Role of spirituality in patients with sickle cell disease. J Am Board Fam Pract. 2001;14:116-122)
- Panel discussion on cancer survival in health care professionals who were also cancer survivors (Reading: Swaney J. The Shaking of the Foundations: Spirituality, Religion and the Experience of Cancer. Ilios (online curricula))
- Six week Healer's Art Elective based on Rachel Remen's curriculum
- Panel Discussion using Audience Response System to look at "Perspectives in the Terry Schiavo Case" (Q&A format)
- Attendance at Alcoholics Anonymous meetings
- Palliative care (Readings: Morrison RS, Meier DE. Palliative Care N Engl J Med 2004;350:2582-90; Abrams F. The Old Man's Best Friend from Doctors on the Edge, 2006; Parish JA. An Unquiet Death. JAMA 2006;296(21):2531-2532; Steinhauser KE et al. In Search of a Good Death: Observations of Patients, Families, and Providers. Ann Intern Med 2000; 132(10):825-32)
- Discussion of Mindfulness and how to stay engaged when patients are dying (Reading: Meier D et al. The Inner Life of Physicians and Care of the Seriously Ill. JAMA 2001;286(23):2007-3014)
- 2 hour class on Alzheimer's Disease and spirituality, including end of life decision making
- 2 hour class on end of life ethics in case of a dying Orthodox Muslim patient where religion played a significant role in treatment and process of dying (Reading: Sierpina V. Spirituality and Health in Integrative Medicine: Principles for Practice. Kigler B and Lee R, eds. McGraw Hill. 2004; Swaney J and Kerwin J. Spirituality and Healthcare. Ilios. (on line curricula))
For Institutional Change:
- 13-item belief scale which indicated barriers medical students perceived when addressing spirituality
- Does a spirituality and medicine curriculum impact student attitudes, beliefs and practices regarding spirituality and medicine? Data for medical student years 1,2,and 3.
University of Texas Medical Branch at Galveston, School of Medicine, School of Nursing, and The Institute of Medical Humanities
Course Directors: M. Kay Sandor, PhD, RN, LPC, AHN; Victor S. Sierpina, MD; Harold Vanderpool, PhD, ThM
Course: Spirituality and Clinical Care
Interdisciplinary Course: The University of Texas Medical Branch in Galveston, Texas, will expand and update its ongoing Spirituality and Clinical Care course, first offered in 1999. This required course will continue offering the following elements to all first and second year medical students, junior and senior nursing students, and entry level allied health sciences students:
- Research findings related to spirituality and health, and the importance of spirituality in the lives of a large majority of patients.
- Tools for assessing the spiritual needs of patients and an opportunity to observe an interdisciplinary team assessing a family.
- Opportunities for reflection on personal spiritual practices as a means of self-discovery and as a way to prevent professional burnout or compassion fatigue.
The expansion of the course will emphasize interdisciplinary collaboration between students using an innovative instructional strategy, Team Learning. Students will be placed in interdisciplinary learning teams and engage in active problem-solving activities. Interdisciplinary Web-based case studies will be developed to incorporate basic science, alternative health practices, cultural competence, and spirituality. A written, online assignment-an individual spiritual assessment with personal reflections about the clients and the students own responses to using a spiritual assessment tool in a practice or community setting-will be required.
Graduate Course: The course directors will also develop an interdisciplinary online class for graduate nurses, residents, and upper level allied health science students entitled Spirituality, Culture, and Suffering: Learning the Language of Healing. This course will emphasize the development of moral character and compassion, cultural competence, and spirituality in the context of community, relationship, and discourse.
Research Project: The basic course will include a research project designed to explore the students' attitudes about team learning, their engagement in the course, and changes in their personal spiritual well-being before and after the course. We will evaluate student responses by using a comparison group of nursing, medical, and allied health sciences students at another university who are not participating in interdisciplinary courses taught using team learning strategies.
Summary: The courses will be evaluated for impact, process, and outcomes. (Impact) The course will be promoted on campus Web sites and electronic bulletin boards, and in press releases to the local community. Electronic sites will be monitored for hits to measure interest in the activities related to the courses. In addition, the number of students and the level of participation in the course will be monitored and tracked electronically. (Process) Curricular, course, and student evaluation tools will be evaluated and changes made during the year and over the four years of the funding cycle to improve the effectiveness of the course. (Outcomes) Student online and face-to-face work will be evaluated. In addition, student engagement will be assessed, student attitudes about teams will be evaluated, and levels of spiritual well-being will be monitored.
Course Director: Robert Macauley, MD
Course: Spirituality in Patient Care
"Spirituality in Patient Care" will be a required longitudinal course incorporated into the Vermont Integrated Curriculum, a significant curricular revision which began at the University of Vermont College of Medicine in 2003. The context of the course will include didactic lectures, small group discussions, standardized patient encounters with individual feedback, and interdisciplinary involvement with other hospital disciplines, such as the Department of Pastoral Care.
Various first year courses will distinguish spirituality from religion, examine the ethical aspects of pastoral care, explore the impact of spirituality on the practice of medicine, train students in taking a spiritual history, and review relevant data regarding the relationship between spirituality and health. Second year courses will build on this foundation by discussing the role of spirituality in childhood and at the end of life, as well as by practically incorporating a greater awareness and appreciation of spirituality into clinical encounters with standardized and actual patients.
Several innovative programs are envisioned for the clinical years. First, there will be increased interaction between medical students and the Department of Pastoral Care (including Clinical Pastoral Education students). Second, the three week-long "Bridges" between clinical blocks will include discussions of end-of-life care, complementary and alternative medicine, and a review of how to take a spiritual history and related ethical concerns. Lastly, spirituality will be incorporated into the nearly thirty Observed Structured Clinical Exams (OSCEs) in which students participate. This will enable the course faculty to modify and improve the curriculum by highlighting specific areas that require greater attention.