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Implementing a Medicine-Spirituality
Curriculum in a Community-Based Internal Medicine Residency Program
Pettus MC. Acad Med. 2002 Jul;77(7):745. University of
Massachusetts School of Medicine
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OBJECTIVE: To promote greater sensitivity to and heightened awareness
of the relevance and therapeutic potential of integrating medicine and
spirituality in the healing process of patients cared for by our medical
residents. Strategies for clear, effective, and empathetic communication
are integrated into the curriculum. DESCRIPTION: With the support of The
University of Massachusetts Medical School Macy Initiative in health
communication, funded by the Josiah Macy, Jr. Foundation, we have fully
implemented a medicine-spirituality curriculum as an integral aspect of
our residency program. Current strategies include (1) new house officers
participate in the workshop "Communicating Bad News," which is based on a
videotaped interaction and experiential role-play about the challenging
"art" of sharing bad and often traumatic news; (2) a monthly lecture
series that looks at various aspects of religious and spiritual practices
and their implications on science and health with topics including the
following: taking a spiritual history, exploring world religious views
from a Judeo-Christian perspective, studying Eastern philosophies such as
Buddhism and Hinduism, and discussing cultural diversity's effect on how
people understand and cope with illness; (3) residents receive a
comprehensive, evidence-based syllabus that encompasses all of the medical
literature relating to spirituality, religion and health; (4) local
hospice professionals give end-of-life care lectures about pain
management, palliation, advanced directives, and ethical implications; (5)
our residents spend one or two days per year with our pastoral care
leaders and one to two days per year with our hospice team; (6) monthly
ward rounds with a faculty member who emphasizes the spiritual dimension
of a particular case and the faith-based resources in our hospital and
community. DISCUSSION: Traditionally, graduate medical education has not
emphasized the importance of spirituality as a "target" for routine
inquiry, understanding, and sharing in the context of patient care. We are
beginning to see that residents need to be aware of the relationship
between spirituality and health, as a consequence of this curriculum.
Because the curriculum is seamlessly integrated into a preexisting
infrastructure (e.g., noon conferences, ambulatory off-site experiences,
walk-rounds, etc.), it has been relatively easy to implement. Focusing on
the literature has also provided a "scientific door" that has made this
more palatable. Over time, we will foster a growing alliance of the
medical and faith communities in our rural area. This has potent
implications for community health initiatives. Two of our residents have
already volunteered to give talks at local congregations. Spirituality and
religion are sensitive and personal areas that can be awkward to embrace
and openly discuss. By remaining sensitive and respectful of all views, we
strive to diminish the obstacles and enable a more provocative,
enlightening residency experience. As a consequence, we are forced to
reconsider what it is to be a "healer" and what it is to be "healed."
Annual verbal and written feedback will allow us to refine our curriculum.
I anticipate this to be a permanent aspect of our residents' training.
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