Awardees for Curriculum Development for Primary Care Residency Training Programs
This award is given to outstanding primary care residency training programs that address spirituality and mental health. Click on school names for descriptions of their programs.
2006
- Somerset Medical Center, Family Medicine Residency Program
- University of Arizona, College of Medicine, Family & Community Medicine
- University of California at San Diego, Department of Family and Preventive Medicine
- University of Wisconsin, Madison Residency Program, Family Medicine
2005
- Drexel University, College of Medicine, Department of Family, Community & Preventive Medicine
- Lenox Hill Hospital, NYU Medical Center, Department of Medicine
- University of Michigan School of Medicine, Department of Pediatrics and Communicable Diseases
- University of Nevada, Reno, School of Medicine, Department of Family and Community Medicine
2003
- Albany Medical College, Department of Family and Community Medicine Residency Training Program
- Glendale Adventist Medical Center, Family Practice Residency Program, Glendale, CA
- Providence St. Peter Hospital, Family Medicine Residency Program, Olympia, WA
- University of Michigan, Pediatric Residency
2002
- Dartmouth Medical School, Maine-Dartmouth Family Practice Residency
- St. Vincent Hospitals and Health Services, Indianapolis, IN
- Shenandoah Valley Family Practice Residency
- Southern Illinois University, School of Medicine
- University of Kentucky Chandler Medical Center, Lexington, Department of Family Practice
- University of Texas Medical Branch at Galveston, Department of Family Medicine
2000
- Boston Medical Center, Boston University School of Medicine
- Brown University School of Medicine, Memorial Hospital of Rhode Island
- Case Western Reserve University Family Practice Residency of University Hospitals of Cleveland
- Kettering Medical Center Network, Grandview and Kettering Medical Centers
- Loma Linda University, School of Medicine
- Oregon Health Sciences University, School of Medicine
- Orlando Regional Healthcare System
- St. Vincent Family Medicine Residency Program, Indianapolis
- University of Colorado Health Sciences Center
- University of Pennsylvania Health System, University of Pennsylvania School of Medicine
Program Descriptions
Somerset Medical Center, Family Medicine Residency Program
Course Director: Laura Micek-Galinat, MD, MPH
Course Design:
- Development of integrated HEALERS curriculum for residency (21 residents over 3 years):
- Health promotion and wellness
- Ethnosensitivity and culturally appropriate healthcare
- Alternative and complementary medicine, including nutrition
- Listening and the doctor-patient relationship
- Evidence-based and reflective practices
- Spirituality
- Distinction between "healing" and "curing"
- Ethnosensitivity workshops such as the Aging Game and BARNGA experiential simulation game for intercultural learning
- Seminar cinema: Crash, The Constant Gardener, and Bill Moyer's On Our Own Terms
- Use of Planetree's "Putting Patients First" based on creating a patient- and family-friendly environment
- Guided learning experiences
- The Healer's Art: a curriculum for medical students
- Use of poetry and literature to convey spiritual and existential themes
- Book club discussion
- Role-playing with standardized patients
- Video monitoring and tape review with residents
- Reflective practice including journal writing
- Holistic hospital rounds with physicians, nurses, chaplains, social workers, and pastoral care
- Gift package given to faculty and residents: The Lost Art of Healing: Practicing Compassion in Medicine, Prayers for Healing, 365 Blessings, Poems, and Meditations, Tuesdays with Morrie, Kitchen Table Wisdom, Final Wisdom: What the Dying can teach us about Living, Wounded Healers, and Minding the Body, Mending the Mind
For Institutional Change
- Residents, faculty, oncologists, geriatricians, social workers, pastoral care, office administration, and patients will acts as panel members for Grand Rounds during the didactic presentations of the HEALERS curriculum
- Visiting Professor series to which entire hospital community is invited
Research
- "Will the implementation of a HEALERS curriculum demonstrate an increase in personal work satisfaction for residents and faculty and will it improve patient satisfaction at the Family Medicine Center?"
- Annual patient and physician satisfaction surveys with collation of data while implementation of curriculum is ongoing
Drexel University, College of Medicine, Department of Family, Community and Preventive Medicine
Course Directors: Margaret K. Stockwell, M.D.; Florence Gelo, D.Min.; Rosemary Harris, M.D.
Course: Spiritual Care in the Healing Arts
Course Design:
- "Spiritual Care in the Healing Arts" course to include (12 residents over 3 years):
- Definition of spirituality
- Examination of common religious traditions such as Islam, Chrisitianity, Judaism, Hinduism, Buddhism, Jehovah's Witness
- Use of the HOPE and FICA spiritual history tools
- Participants write a personal spiritual history and construct a family and personal spiritual genogram
- Development of an environment of compassionate care
- Examination of ethical principles as applied to spiritual care
- Improvement of knowledge of diversity of religious beliefs
- Improvement of communications between healthcare providers and patients and families
- Continue End-of Life curriculum
- One hour per month of All Day Conference dedicated to Spiritual Care
- Resident retreat at location away from hospital solely for spirituality learning
- Presentation of prayer as a power for healing and issues surrounding physician-patient prayer
- Presentation of caring for the patient who has no apparent spiritual base
- Care of the Caregiver and burnout
- Use of web-based, and packet or workbook venue for specific components of the curriculum
- Team building and mediation based on spirituality
For Institutional Change:
- Faculty trained to model behaviors expected of residents
- Faculty training in small groups
- Spiritual assessment prompts such as the HOPE and FICA tools available in patient exam rooms
- Institutional change evaluated by patient satisfaction questionnaires
Research:
- Curriculum's impact on resident knowledge, attitudes, behaviors and their self-perceived level of comfort in exploring the medical spiritual interface. Previous graduates will serve as control group.
Lenox Hill Hospital, Department of Medicine
Course Director: Julia Andrieni, MD
Course: S.P.I.R.I.T. of Education Program: Spirituality Practice for Internal medicine residents to develop Relationships and provide Integrated and Total medical care.
Located on Manhattan's Upper East Side, Lenox Hill Hospital is a not-for-profit, 652 bed, acute care teaching hospital. The Hospital not only serves the Upper East Side, but also attracts patients from throughout the United States and around the world. In continuous service since 1857, the Hospital has a national reputation for excellence in general medicine, cardiovascular care, orthopedics, otolaryngology/head and neck surgery, and obstetrics and neonatal care. A major teaching affiliate of NYU Medical Center, Lenox Hill Hospital actively trains new physicians in a wide range of medical and surgical specialties, and conducts research in a variety of disciplines. In addition, the Hospital has a variety of educational programs for the community and is a 911 receiving hospital.
In 2002, the Department of Medicine asked the Pastoral Care and Education Department to develop a required course for interns (first year residents) in Spirituality and Medicine. The course was designed for interns during their ambulatory month, two or three students at time. In September 2004, education in spirituality and medicine was expanded to offer four noontime lectures, one per quarter, in order to educate residents in the areas of cultural and spiritual competency in medicine. The S.P.I.R.I.T. of Education Program will broaden the education of students in spirituality and medicine even further with the addition of the following:
- Introduce ALL medical interns to spirituality and medicine topics during their first two orientation months.
- Sponsor a grand rounds presentation within the first quarter of the academic year on a spirituality and medicine topic.
- Evaluate resident learning in doing spiritual assessment by using an OSCE (Observed Standardized Clinical Examination) in September of the physician's second year of residency training.
- Evaluate the learning of residents who elect to take the spirituality and medicine course by requiring a Verbatim seminar to reflect on a patient visit.
S.P.I.R.I.T will also have a research component. We want to find more effective ways to offer emotional and spiritual support to patients in physical crisis and to their families who are facing a psycho/social/spiritual crisis within 48 hours of admission to a critical care unit. Our proposed intervention is: 1) that medical interns take a spiritual history/assessment as part of the medical history for patients within 48 hours of admission, and make appropriate referrals 2) that when the patient is unable to participate in such an assessment, the intern speak to the primary contact person/ health care proxy listed in the chart and assess patient and family needs, and make appropriate referrals. This research project would extend through a year (July-June) on one critical care unit and would give every intern (36 interns) the opportunity to participate during a monthly rotation.
We expect the following:
- An intentional, visible, and concerted effort to provide holistic, interdisciplinary care at the outset of patient admission to a critical care unit will result in more compassionate care for patients and families.
- An increase in early referrals for psychiatry, social work, palliative care consults, and pastoral care, although only pastoral care referrals will be measured in the first year.
- We can refine this project in the second and third year of the curriculum, with more rigorous controls and measures, as the institution sees the benefits of such early interdisciplinary measurements.
University of Michigan School of Medicine, Departments of Pediatrics and Communicable Diseases
Course Director: Mary Ellen Bozynski, MD, MS
Course: Integrating a Sociocultural Medicine Curriculum in Pediatrics: Part II, Transforming the curriculum into clinical practice
In 2003, the University of Michigan received a John Templeton Spirituality and Medicine Award to integrate a longitudinal and comprehensive sociocultural medicine curriculum into pediatric residency education. The curriculum involved a three-pronged approach targeting the multi-systemic levels of the individual physician, educational infrastructure, and the evolving culture of medical training. Our newly funded course enhances our sociocultural medicine curriculum by intensifying spiritual care-focused training as it relates to end-of-life, medical ethics, and patient-physician communication.
Specific goals include:
- Train faculty to demonstrate and model spiritually/culturally responsive care.
- Identify and monitor opportunities for residents to apply Sociocultural Medicine (SM)-focused knowledge and skills when working with patients/families.
- Increase resident exposure to and participation in interdisciplinary efforts (e.g., pediatric ethics committee, transplant evaluation, psychosocial care).
- Strengthen residents' role and leadership in case-based teaching within the curriculum and in patient care settings.
- Design a portable system to track SM-focused experiences and document the achievement of SM-focused competencies.
The course will utilize the previously developed framework targeting the individual physician, educational structure, and the evolving culture of clinical training. In contract to the previous course, this course will be taught in the context of the daily care of patients and families.
To date, there have been no studies examining the baseline skills and knowledge of residents with regard to spiritual care. Furthermore, no research has critically examined the impact of spiritual care education on the development of residents' clinical skills. Given these gaps in the medical education literature, the purpose of the present study is to investigate factors associated with spiritual care proficiency among pediatric residents. Our research study has three aims:
- to implement a core curriculum on spiritual care in pediatric residency training at the University of Michigan
- to evaluate the impact of the training program on residents' spiritual care skills
- to identify the best predictors of spiritual care proficiency.
Our study will follow a prospective, longitudinal, single cohort design over a period of three years recruiting interns entering the pediatric residency program in June 2005. We will collect baseline data on the resident cohort including demographic background, sociocultural-related education history, attitudes towards sociocultural issues and topics (including cultural awareness and spiritual awareness), and cross-cultural communication skills. We will also examine a number of predictor / intervening variables. The attainment of spiritual care focused communication skills will be measured via resident performance on the breaking bad news OSCE. We will also measure resident self-efficacy and patient satisfaction. A successfully designed and implemented curriculum may be used as a model for other training programs, both at University of Michigan and elsewhere, in the future.
University of Nevada-Reno School of Medicine, Department of Family and Community Medicine
Course Director: Denise McKee, M.D.
Course: Enrichment of Family Medicine Resident Education with Spirituality Curricula
Course Design:
- Topics covered: (18 residents over 3 years)
- Defining and describing spirituality
- Differentiating between science and religion
- Evolution of the relationship between spirituality and medicine
- Review of research in spirituality and health
- Role of spirituality as the foundation from compassionate care of patients
- Interdisciplinary spiritual care
- Ethical aspects of spiritual care
- Communication issues around spiritual care
- The physician-patient relationship and its importance in healing
- The spiritual inventory/assessment; taking a spiritual history
- Spirituality and end-of-life care and Advanced Directives
- Treatment preferences and spiritual care
- Medical implications of forgiveness
- "Cultural medicine," Eastern Religions, Naturopathy, Homeopathy, Ayurveda, and other "non-western" forms of spiritual belief and practices
- Use of story, allegory, symbolism in spiritual practice
- Alternative and Complementary Medicine Special Interest Group open to med students years 1-3
- 30 3rd year med students/year and 4th year med students on Family Medicine elective eligible to participate in curriculum
For Institutional Change:
- Four didactic family medicine noon conferences per year devoted to spirituality
- Four Thursday afternoon intern seminars dedicated to topics on spirituality
- One Special Seminar per year focusing on spirituality, inviting all faculty of the University Of Nevada School of Medicine
- Hospital rounds, 2 per month, where advanced clinical pastoral students will attend and provide feedback
Research:
-
Use of questionnaires/pre-tests/post-tests regarding how individual beliefs regarding spirituality and health vary among residents and whether these variations impede or facilitate translation of this curriculum into practice and if they are correlated with quality of patient care/patient satisfaction/patient compliance (6 residents involved)
Albany Medical College, Department of Family and Community Medicine Residency Training Program
Project Director: Mary F. Smith, MSW, Ph.D.
Project: Spirituality: Soulful Living and Dying
Residency Program Description: The Albany Medical College, Department of Family and Community Medicine Residency Training Program is a fully accredited 6-6-6 residency training program as well as an approved Osteopathic Internship site. The residency program, under the direction of Neil C. Mitnick, DO, is housed in a brand new clinical office building. Residents see their continuity patients at this site and provide inpatient care in both the Albany Medical Center Hospital, a regional tertiary care center and at St. Peter's Hospital, a local community hospital less than two miles away.
Curriculum: Spirituality: Soulful Living and Dying is a year-long curriculum for all residents. The curriculum has three main components. The first is the away retreats, one at the beginning of the year and one at the end of the year and 4 follow-up sessions in between. Residents and their significant others will be invited to participate. The second part is 6 two-hour seminars to be presented to all residents during their regularly scheduled teaching sessions. Topics include: What is Spirituality? Is it Different from Religion?; Family Meetings; Spiritual Self-Understanding and Spiritual Assessment; Culture and Spirituality; Now that we are talking about spirituality, what do you do with it?; and Soulful Living and Dying. The third aspect of this project is rotational in nature where residents will participate in a faith based primary care prayer and healing center providing primary care to patients in an atmosphere of prayer and healing. In addition, during their geriatric month, residents will learn how to conduct family meetings often dealing with end of life issues or the diagnosis of chronic or terminal conditions.
Objectives of the Curriculum: Spirituality: Soulful Living and Dying is a creative and new curriculum intended to encourage residents to question their notions of spirituality, understand the difference between spirituality and religion, and develop ways to talk with patients about spirituality. In addition to understanding the distinction between spirituality and religion, the specific, measurable objectives of this grant are to provide the time and place for residents to:
- Explore their own spirituality and how it impacts their patient-physician relationships.
- Learn tools to effectively include spiritual assessment as part of a routine history and to feel comfortable with spiritual and cultural assessment tools as part of routine practice.
- Explore the role of family physicians addressing spiritual needs of patients from diverse cultural and spiritual backgrounds.
- Communicate effectively and compassionately with chronically ill and dying patients and their families.
Evaluation Plan: Three formal assessment tools will be used to generate information regarding the impact of this project. A session evaluation will be collected after each 2-hour seminar. A belief's survey will be given at the beginning of the year as baseline data. Finally, a Spirituality and Medicine pre and post instrument will be given to monitor resident reporting their dialogue with their patients regarding spirituality.
Southern Illinois University, School of Medicine
Program Director: Gary E. Myers, Ph.D., M.Div.
Program: Curriculum in Spiritual and Cultural Competence for Family Medicine
Residency Program Description: The Family Medicine Residency Program of the Southern Illinois University School of Medicine consists of four programs located in Springfield, IL, Decatur, IL, Carbondale, IL, and Quincy, IL. With a total of 78 residents it is one of the largest Family Medicine Residencies in the nation. The Spiritual and Cultural Competency Curriculum will be located at the Springfield location, which has 24 residents and is the largest of the four programs.
Curriculum Status: The curriculum is a required component of the Family Medicine Residency Program. All PGY's are required to participate in each component of the curriculum. As an indication of the importance given to this curriculum by the medical faculty, it will be included in the Residency Program's Core Curriculum Conference (CCC). The CCC meets weekly to address issues central to the practice of family medicine. The Spiritual and Cultural Competence in Family and Community Medicine Curriculum will have control of the agenda of the CCC on a monthly basis. The CCC will anchor this curriculum in the mainstream of resident learning.
Overall Goal: Training residents to provide medical care that sensitively and competently takes into account the diverse spiritual and cultural needs of their patients.
Structure: Developing cross-spiritual and cultural competence in the practice of medicine requires three distinct, but related kinds of learning. They are:
- Acquisition of specific knowledge, skills, and attitudes relevant to the spiritual/cultural needs of patients
- Clinical practice of learned skills, such as, spiritual history taking, active listening for spiritual/cultural issues, spiritual assessment, making referrals to chaplains and clergy, and networking with community resources
- Integration and Supervision of acquired knowledge and skill with practice
The learning needs of the residents determine the structure and content of the curriculum, as well as the venues in which the learning activities occur. The anchor of the curriculum is the monthly Core Curriculum Conference (CCC), which consists of didactic seminars, skill-building workshops and integrative case conferences. Residents' acquisition of knowledge, skills and attitudes will primarily occur in the various components of the CCC. Clinical rotations provide supervised opportunities for residents to apply acquired knowledge and practice learned skills will real patients (each PGY is assigned to a different clinical rotation: PGY1--, PGY2--, and PGY3--, and all years are assigned to a Continuity Clinic). Formal integration and supervision occurs in the case conferences that are a component of the CCC. Informal supervision occurs as a part of their regular contact with supervising faculty.
Boston Medical Center, Boston University School of Medicine
Course Director: Samuel M. Putnam, MD, MPH
Program: Curriculum on Religious and Spirituality Practices
The Boston University Primary Care Training Program is one of the oldest and largest Primary Care programs in the country. Its psychosocial curriculum, along with other components of the program, is shared with the traditional internal medicine residency program. Within the psychosocial curriculum, we are implementing a new curriculum on Spirituality and Religious Practices. The learning objectives and goals of this curricular enhancement are:
- To teach residents the importance of a patient's spirituality and religion in maintaining health and coping with illness.
- To provide the residents with the skills necessary to comfortably discuss a patient's spirituality and religion and to identify the appropriate setting for initiating the discussion.
- To provide opportunities for residents to use resources from the religious community that will help them in their care of patients in various stages of life/health. This includes making appropriate referrals to a hospital chaplain and learning to work as a team with the chaplain and community clergy.
These objectives will be incorporated into the objectives of the psychosocial curriculum which are to teach: interviewing skills; the elicitation of cultural beliefs regarding health; diagnosing and managing common psychiatric illnesses; self-awareness of personal biases and styles affecting health care; and the empirical database underlying the effect of interviewing and psychosocial skills on outcomes of care. Through readings, lectures, and seminars, we will acquaint residents with the data on spirituality and religions in health care. In the core training sessions for interviewing skills, we will teach residents to elicit patients' spiritual beliefs about their illnesses. Throughout the psychosocial curriculum we will emphasize that spirituality and religious issues relate to each of the basic objectives of the psychosocial curriculum because:
- Patients' concerns about their illness will inevitably involve spiritual ones if the illness is serious enough.
- Many patients' beliefs about their illnesses involve spiritual beliefs.
- Patients' spirituality and religion will likely stimulate residents' thoughts and feelings about their own spirituality and religion.
- It will be important to consider barriers around spirituality and religious issues that both patients and physicians have if there is to be a free flow of thoughts and feelings on these issues.
A new element in the psychosocial curriculum will be the implementation of a biweekly conference for nurses, social workers, residents, attendings, and fellows working on the Hematology-Oncology Service. One conference will be on the Hematology-Oncology Ward; the other will be in the Hematology-Oncology Clinic. A Hospital Chaplain will attend each of these conferences. At this conference, patients will be presented to determine if there are any ways in which the Chaplains Service or services in the religious community outside the Hospital might be more involved in their care. Since all residents rotate on this service, this will be a good opportunity for them to learn how chaplains and others in the religious community can be of assistance in taking care of patients with spiritual needs.
Since we expect that modeling by faculty preceptors, on the wards and in the clinics, will have the greatest impact on the residents' motivation to learn skills and attitudes necessary to elicit patients' spiritual concerns, we will conduct two faculty development workshops with the help of the Chaplains Service.
The incorporation of the new curriculum on spirituality and religion occurs at the same time that the psychosocial training for medical residents is embracing two other topics: End of Life Issues and Cultural Diversity Awareness. The End of Life curriculum, funded through the Robert Wood Johnson Foundation, includes lectures/seminars and a mandatory rotation for all residents on a hospice service. Cultural Diversity Awareness is being developed by a taskforce that includes residents, faculty, the Dean for Minority Affairs and represents a broad base of cultural and ethnic backgrounds.
Brown University School of Medicine, Memorial Hospital of Rhode Island
Course Director: Gowri Anandarajah, MD
Course: Spirituality and Family Medicine: From Self Care to Patient Care
The Spirituality and Family Medicine curriculum is a required longitudinal curriculum that is built seamlessly into the existing overall residency curriculum. It emphasizes the complex and multidimensional nature of health and healing and the role of spirituality in the medical care of the whole person: body, mind and spirit. It also emphasizes the importance of finding balance and harmony in one's own professional and personal life. The curriculum focuses on moving from spiritual self-care and understanding to the spiritual care of patients and families and uses a variety of teaching methods, settings and instructors. It attempts to help residents:
- develop healthy spiritual self-understanding and self-care skills
- understand the ways in which spirituality may affect health, well-being, and health care decisions
- understand the role of a family physician in helping with the spiritual needs and concerns of patients from diverse cultural and spiritual backgrounds
- assess whether spiritual factors are helping or hindering the patient's healing process
- develop skills needed to integrate general spiritual care (eg. compassion, presence) into routine medical encounters and how to sustain these skills
- understand the resources available for the spiritual care of patients and their families
Required Core Curricular Elements
1st Year Residents:
Session 1: 1 hr tutorial during FM rotation: "Introduction to Spirituality and Medicine" (concepts, research, assessment methods etc)
Session 2: 1/2 day conference/retreat on Spirituality and Medicine: "The care of the body, mind and spirit: from self-care and understanding to patient care"
Session 3: 1 hr discussion during OB month: "Spiritual and cultural considerations in bereavement care for families who have experienced poor pregnancy outcomes"
2nd Year Residents:
Session 4: 1/2 day rounds with hospice chaplain during geriatrics/rehab month
Session 5: 1/2 day conference on Spirituality and Medicine: "The care of body, mind, spirit .."
3rd Year Residents:
Session 6: 1/2 day rounds with hospital chaplain during community medicine month
Session 7: 1/2 day conference on Spirituality and Medicine: "The care of body, mind, spirit .."
Session 8: debriefing session in behavior medicine seminar, "personal and professional challenges to incorporating spiritual assessment and spiritual care into medical practice"
Family Medicine Grand Rounds -- "Meditation and the Relaxation Response" and "Spiritual and cultural diversity and the care of the dying patient"
Elective Experience -- Monthly Spirituality and Medicine discussion group
Case Western Reserve University Family Practice Residency of University Hospitals of Cleveland
Course Directors: Antonnette V. Graham, PhD (lead director), Julie Keller, MD
Course: Spirituality and Health
Many patients believe their physical, mental, and spiritual health are interrelated and research suggests that spirituality can play a positive role both in prevention of health problems and in coping and recovery. Primary care patients are interested in the effects upon their health of their spiritual beliefs. However, family physicians often fail to inquire about the importance of spirituality in the lives of their patients. The goals of the Curriculum on Spirituality are to prepare family practice physicians to address spiritual concerns by increasing their knowledge about the importance of spirituality in their patients and in their own lives, by helping them to develop skills to assess and support the spiritual resources of their patients, and by increasing their ability to refer patients to appropriate spiritual care professionals. The curriculum will be presented through a systematic program that integrates lectures, skill building workshops, clinical and community experiences and faculty development. Lectures will focus on:
- Introduction to Spirituality and Health
- The Differences and Similarities in the Major Religions
- Spirituality in the Life Span
- Research in Spirituality and Health
- Spiritual History Taking
- Cultural Sensitivity, Spirituality and Health Care
- The Role of Shame, Forgiveness and Hope
- Recognizing Harmful Spiritual Views
- Referrals for Spiritual Care
- A Team Approach to Spiritual Care
- Spiritual Needs of the Care Givers
- Variations in the Integration of Spirituality and Medical Care: Sufism and Paranormal Healing in the Middle East
Clinical experiences will vary by year of training. First year residents will conduct a community assessment of spiritual resources, such as types and locations of religious institutions, services they provide, and clergy names and telephone numbers in the neighborhood where most of their patients reside. They will have the opportunity to meet local clergy and to develop a referral network. They will compile the information regarding the resources into a Spiritual Resource Manual for patients and providers. Second year residents will accompany chaplains on hospital rounds and attend home visits, medical rounds and team conferences with the medical director and chaplain of a local hospice. Third year residents will attend group meetings at a wellness community for cancer patients and their family members that focus on healing the mind, body and spirit. Residents will be videotaped in their clinical care to encourage and support the incorporation of spiritual care into daily practice. Residents will attend a support group lead by faculty members who will invite the discussion of spiritual issues in their clinical work and in their own lives.
In order to prepare faculty for incorporating spirituality into their clinical work and teaching, they will attend sessions on spirituality and religion, ethical issues related to integrating spiritually into clinical care, cultural aspects of spirituality and assessing spirituality in clinical and professional life. Through this comprehensive training experience, family medicine residents and faculty will develop a clinical style that incorporates spirituality into patient care.
Kettering Medical Center Network, Grandview and Kettering Medical Centers
Course Directors: R. Keith Dobyns, DO, MDiv, S. Elizabeth Kelly, MDiv
Program: PRISM (Program for the Integration of Spirituality in Medicine)
The Program for the Integration of Spirituality and Medicine teaches spiritual observation and encourages spiritual reflection as legitimate components of primary care medicine. The curriculum emphasizes understanding the spirituality and religious traditions of patients, in order to individualize their medical care. It challenges participants to integrate spirituality into medical practice. By learning to recognize and value spiritual integration in its many forms, we hope that physicians will gain a deeper understanding of, and thus take better care of, their patients, their peers and themselves.
A series of six lectures at each participating institution is open to the hospital community, including attending physicians, house staff, nurses, social workers, chaplains and local clergy. Response panels for each talk include health care professionals of multiple faith traditions. Lecture topics include: Introduction to Spirituality; Health Care in the Major Religious Traditions; Participation in Prayer and Religious Ritual; Spiritual vs. Psychiatric Illness; Clinical Hope vs. Existential Hope; and The Means of Medicine vs. the Ends of Faith. Additionally, six teaching sessions will be held in each residency and internship class during the year, in alternating months with the lecture series. These cover topics that require more open discussion than the lecture format will provide: Breaking Bad News: A Skills Workshop; Respecting those of Other Faiths; The Spiritual Challenge of Dementia; Confidentiality and Confession; Medical Rituals; and Spiritual Assessment.
The two course directors and other chaplaincy staff regularly attend morning report at their respective institutions. This provides opportunities to establish relationships with residents, to facilitate pastoral care referrals, and to include spirituality as an integrated component of diagnosis and treatment. Residents and interns from each participating training program are assigned to participate in pastoral care rounds for one-half day in each of their training years. This involves "shadowing" an experienced chaplain during pastoral care visits. We will develop opportunities to explore spiritual assessment, listen to narrative and metaphor, and participate in ritual and prayer as appropriate.
The course directors participate in the training of hospital chaplains through the Kettering Medical Center Internship and Residency in Clinical Pastoral Education. This participation specifically promotes pastoral care to physicians and other health care professionals. Clergy participation in the lecture series has been invited, to give community clergy exposure to particular issues in medical spirituality. This exposure seeks to promote an ongoing dialogue between clergy and physicians, and to promote respect and support for each other's calling.
A year-end interdisciplinary conference on Spirituality & Medicine is planned for physicians and clergy, with waived tuition for participant interns and residents.
Loma Linda University, School of Medicine
Course Directors: John K. Testerman, MD, PhD, Ann M. Ronan, MA
Program: Spirituality in Whole Person Care
Whole person care, which includes addressing the spiritual needs of patients, is central to our institutional mission. The proposed curriculum builds on existing institutional and departmental strengths in spiritual care, pulling previously scattered elements together into a coherent educational program and adding new and integrating material. Although the curriculum is specifically designed for our Family Practice residents, it is hoped that it can serve as a blueprint for other residencies and the teaching of medical students. The overall goal is twofold: First, for resident physicians to learn how to help patients identify their spiritual strengths and recruit their spirituality as a positive factor in healing. Second, for residents to develop their own spiritual strengths as they cope with the stresses of patient care and struggle to achieve balance in their lives. The objectives:
- Effectively include spiritual assessment as part of a routine history.
- Identify beneficial and detrimental religious coping styles and their effects on health and quality of life.
- Communicate effectively and compassionately with chronically ill and dying patients and their families.
- Recognize the effects of culture and religion on health care choices and coping styles.
- Describe and apply recent research findings on the role of spirituality and religion on health.
- Explore their own belief systems and spiritual practices and understand how these might impact care of patients.
- Recognize and develop an action plan to meet their own spiritual needs and cope positively with the stresses of professional training and practice.
PGY I residents will be introduced to an overview and rationale of the curriculum, including its philosophical, historical and scientific bases. They will learn to take a spiritual history. In the hospital inpatient setting, they will participate in bedside "integrative rounds" with spiritual care, behavioral science and clinical ethics professionals followed by group discussion. In the outpatient clinic, they will videotape encounters with patients and review the videotaped sessions with course faculty. Both the integrative rounds and video reviews will continue throughout the three years. Also continuing through the 3 years are resident group support sessions with chaplain personnel.
During the PGY II year, the residents will learn about how religious and cultural beliefs impact on health care decisions and health practices, especially as they relate to the areas of preventive medicine, use of alternative and complementary medicine, pregnancy and childbirth, and end-of-life care. Didactic and role play sessions will teach them to identify and address religious coping styles as researched by Ken Pargament.
The PGY III residents will develop action plans for developing their own spiritual resources as part of learning to bring into balance the various aspects of their lives. Becoming familiar with James Fowler's faith development paradigm, they will understand how faith grows and changes during the stages of the life cycle. They will learn to communicate effectively and compassionately with chronically ill and dying patients and their families. Residents will make home visits with hospice staff and may voluntarily choose to participate in a spiritual formation group.
Oregon Health Sciences University, School of Medicine
Program Directors: Stephen Kliewer, DMin.(Lead Director), Ann Sinclair, MS, MSW, Elizabeth Steiner, MD, Val Krause, MD
Program: Creating a Healing Relationship - Integrating medicine, culture and spirituality
"Creating a Healing Relationship" is a curriculum designed to help Family Medicine residents explore the spiritual dimension of patient care. Through a variety of methodologies residents will be asked to:
- Explore the implications for patient-centered care of religious beliefs by held by patients
- Define the impact of their own personal beliefs upon their lives and upon their ability to interact effectively with patients
- Explain ways in which spiritual and clinical perspectives can both support and conflict with one another
- Identify and utilize appropriately personal, institutional, and community resources for assistance in dealing with the spiritual dimensions of patient care
- Be able to effectively integrate spirituality into the physician - patient relationship and feel comfortable with spiritual and cultural assessment tools as part of routine practice.
Since we believe that the discussion of spirituality is integral to the practice of medicine, our curriculum is required. It is presented throughout residency training, and in a wide range of contexts. It routinely interfaces with other aspects of the curriculum to show the key role of spiritual and cultural care in daily practice.
This curriculum is didactic, experiential and clinical. Some elements are level specific and others are longitudinal. Level specific highlights include such components as an introduction to spirituality and medicine seminar during resident orientation, experiences with a 12 step and a hospice program, chaplain shadowing, and home visits with patients that focus on listening skills, spiritual assessment, and appropriate responses.
There are a variety of longitudinal components. One such activity is an ongoing series of lectures on topics related to medicine and spirituality that is part of the core didactic curriculum. Other elements include videotape reviews of patient encounters involving spiritual issues, and monthly spiritual and cultural assessment and care rounds as part of the inpatient teaching program and resident Balint groups. The Behavioral Medicine Inpatient Rounds provide yet another opportunity for residents to discuss the spiritual needs of patients and their families.
Orlando Regional Healthcare System
Course Directors: Beth Boyer Kollas, MS, MDiv, PhD, CAAP, Chad D. Kollas, MD, FACP, FCLM
Course: Spirituality and the Practice of Medicine
The "Spirituality and the Practice of Medicine" curriculum is designed to train internal medicine residents to care for their patients in a more holistic approach, integrating mind, body, and spirit through the practice of relationship centered care (RCC) and the re-integration of spirituality into medical practice. Our focus on RCC philosophies and skills in teaching the connection between spirituality and medicine coincides with the current trend in medicine toward RCC and further underscores the value of spirituality in the practice of medicine. Similarly, this proposed course design emphasizes scientific research data reported in the literature as foundational for the re-incorporation of spirituality into medicine. It stresses an evidence-based approach to the course construct which will be monitored through an ongoing research study exploring resident physician spirituality and its affect on patient care.
Course topics will be taught using didactic lectures, experiential small groups, journal clubs, spiritual exercises, and clinical rotations with a spiritual care specialist as a part of an internal medicine inpatient team. This multi-dimensional construct in learning will be used to ensure the completion of all learning objectives, and to offer a more comprehensive approach to learning. The lecture series will include:
- Introduction: "Re-Integrating Spirituality into the Practice of Medicine"
- The Link between Spirituality and Medicine
- Relationship-Centered Care (RCC)
- Spirituality Versus Religion
- Religion/Spirituality in Healthcare Issues
- Religion/Spirituality and Medicine in the Research Literature
- Interviewing & Assessing Spiritual Practices, Beliefs and Attitudes
- Spiritual Interventions: The Practical Incorporation of Spirituality in Medicine
- Review: Spirituality and the Practice of Medicine
We will designate a "spiritual care specialist" [SCS] to participate on teaching rounds with one inpatient team each week. The spiritual care specialist will participate in teaching rounds with emphasis on the following:
- To teach residents how to perform an effective spiritual assessment of their inpatients
- To teach residents how to identify patients' spiritual issues in the context of their illnesses
- To assist with patients' treatment plan by helping to identify and form spiritual supports when needed
- To help residents identify and understand their own spirituality and how it affects their development as physicians.
It is the vision of this course construct to provide more than a general knowledge base concerning the major religious traditions, inclusive spirituality, spiritual needs and issues of patients, spiritual interventions and research data; rather, it was designed also to provide resident physicians with an opportunity to gain knowledge of self, skills that promote contemplation and reflection, and the values of self-care, self-awareness, and self-growth in order that they may be more compassionate, more caring physicians as well as healthier individuals.
St. Vincent Family Medicine Residency Program, Indianapolis
Program Director: Paul Bay, DMin
Program: Integration of Spirituality and Culture in Family Medicine
Our curriculum, Integration of Spirituality and Culture in Family Medicine, was developed in response to the needs of our residents and our patients. Prior to residency training, only 8% (2 of 24) of our residents had a course in spirituality in medical school. With the opening of Seton Cove, a spirituality retreat center on our campus, in 1998, we saw an opportunity to address these needs in an ideal setting. We began hosting quarterly meetings in 1999 to discuss issues relating to spirituality and to provide an atmosphere of support for our residents. Through this attempt to incorporate spirituality into the curriculum, we became cognizant of our need to develop a unified, comprehensive and longitudinal curriculum to examine spiritual and cultural issues.
Quarterly sessions at Seton Cove will continue providing a unique venue for notable speakers with additional time for the residents to have private class discussions. Additional noon conferences throughout the year will include lectures, case presentations and analysis of the literature.
Spirituality will be integrated throughout all rotation experiences. Inpatient medicine will go beyond the science to identifying a patient's spiritual needs. The spiritual dimension of end-of-life care will be discussed in geriatrics. Psychiatry, behavioral science, medical ethics and primary care rotations will also join forces to provide this curriculum. Our goal is to weave spirituality and culture into the fabric of our curriculum.
A two-week elective in Spirituality in Medicine will give second and third year residents a more intensive learning experience with significant community outreach. A highlight of the rotation will be the "Day of Discovery": a day for residents to focus on their own spiritual attitudes and needs through guided self-reflection.
The diverse community of Indianapolis will provide a rich resource of speakers including religious leaders, physicians, and local authorities and celebrities. Other St. Vincent resources such as Hospice, the Institute on Aging, and our Multicultural Coordinator will contribute valuable time.
We anticipate that this curriculum will have a far-reaching impact. Beyond affecting how our residents practice medicine, we will impact our patients' perception of what a physician can do. Community outreach will increase awareness of the services our clinic provides and will encourage more patients to take part. Moreover, our hope is that our residents will identify their personal needs and connect with their calling as healers.
"We are not human beings having a spiritual experience: we are spiritual beings having a human experience." Pierre Teilhard De Chardin
University of Colorado Health Sciences Center
Course Director: David Nowels, MD, MPH
Course: Family Practice Residency Training Program
We will present a curriculum to allow learners at two Family Medicine residency-training programs of the University of Colorado to investigate the intersections of spirituality with health and the delivery of healthcare. The curriculum will consider spirituality as "that which pertains to ultimate meaning and purpose in life". It will allow the residency training programs to accomplish a variety of objectives that focus the attention of the learner on persons with illness rather than on diseases. Overall it will be structured around spirituality as a source of meaning, spirituality as a source and framework of values, and spirituality as a context for appreciating human diversity. To that end we will address issues of suffering, holism, and cultural and spiritual diversity. The program is designed to accomplish the following
- increase learners' awareness of the importance of spirituality and its relationship to health and healthcare delivery
- enhance learners' sensitivity to diverse beliefs and cultures
- provide learners with tools they can use in clinical settings to explore the impact of spiritual and religious beliefs with patients and their families on their health and healthcare
- provide learners with tools they can use in these interactions with patients and families.
The curriculum is competency based, extends across each year of training and is integrated with the complete curriculum. We will use multiple educational methods including lectures, workshops, projects by small groups, journal club, movie nights, and extensive clinical precepting by chaplain interns. Use of chaplain interns provides educational opportunities for several professional groups. The specific objectives of this curriculum are:
- Learners will gain knowledge of the interaction between spirituality and health at the individual patient level, including potential negative impact of religious/spiritual beliefs or practices on health.
- Learners will exhibit an understanding of potential mechanisms for how spiritual beliefs and activities might positively impact health.
- Learners will gain insight into spiritual beliefs and practices of faith traditions other than their own, and identify how these might impact health.
- Learners will assess their own spiritual beliefs and practices.
- Learners will learn, practice, and appropriately apply specific skills in taking spiritual history form patients - including how elements of the history impact health and healthcare.
- Learners will identify some spiritual issues of the organization and delivery of healthcare.
- Learners will understand role of the chaplain/spiritual advisor in health and illness - exhibiting appropriate understanding of when/how to access and refer.
Evaluation consists of formative and summative measures. Competency for each objective will be assessed for all learners. A needs assessment using previously developed survey instruments addressing programmatic and personal spiritual beliefs and activities will be performed at the beginning of the year and aspects of that will be repeated yearly. Evaluative methods will include structured self-report, observer reports, chart review, analysis of log-book of interactions between residents and chaplain interns, and participant evaluations of lecture and activities.
University of Pennsylvania Health System, University of Pennsylvania School of Medicine
Course Director: Kevin M. Fosnocht, MD
Course: Spirituality and Medicine Curriculum
Through a multidisciplinary effort, including the Departments of Medicine and Religious Studies of the University of Pennsylvania and the UPHS Office of Pastoral Care and Education, this yearlong curriculum will provide practical and patient-centered training in spirituality as it pertains to the primary care of patients. The curriculum will be required for all second and third year Primary Care residents, and will be comprised of three concurrent modules:
Workshop/conference series. The curriculum will center around a series of workshops and conferences on topics pertaining to spirituality and medicine. The series will include the following topics and themes:
- Interactive workshop designed to develop working definitions of important concepts that will be used throughout the curriculum. These concepts include: spirituality, transcendence, religion, healing, ritual, symbol, and afterlife.
- A critical review of the literature pertaining to spirituality and medicine. After this session, the weekly journal club will include at least two journal article presentations of recent studies dealing with spirituality and medicine.
- A series of conferences led by a Religious Studies faculty member and a patient from the local community representing selected faith traditions.
- Accessing providers of spiritual care: the practical steps to involve spiritual care providers in the care of the patient. This will involve both chaplaincy and community clergy.
- Talking to patients about spiritual matters. After a preparatory session outlining techniques to open the discussion of spirituality with patients and how to perform a formal spiritual assessment, the residents will, as a group, critically review selected videotapes of residents with their patients as they inquire into spiritual issues. These sessions will be moderated by a psychiatry faculty member and a chaplain from the Office of Pastoral Care and Education.
Field Rotations. The residents will attend three weekly sessions in settings where issues of spirituality meet medicine.
- Faith-based organizations that provide medical care.
- "On call" with the chaplain at either Presbyterian Medical Center or the Hospital of the University of Pennsylvania.
- Chaplaincy residents' case presentation meetings.
- Hospice rotation
- 12-Step Group Meetings
The Doctor and the Patient. All residents will identify a patient in their continuity practice with whom they will delve into spiritual issues, including a formal spiritual assessment. This experience will culminate in a "clinical vignette", a presentation given by the resident which demonstrates how exploring the patient's spirituality affected the doctor-patient relationship and/or how the patient's spirituality played a role in his or her medical care.
