Introduction: Medical education increasingly recognizes that cultural competence is an important component of patient care. However, religion is an aspect of culture that still often goes unaddressed in medical education. Spiritual Histories: Putting Religio-Cultural Competence into Practice is a resource for medical school educators designed to address this gap in medical education. Methods: This 90-minute learning module introduces medical students to key tools and strategies for communicating with patients about how their religious beliefs and practices impact their care. The module reviews why taking a spiritual history is important, when and how to ask appropriate questions about a patient’s religious beliefs and practices, and what do with the information once obtained. This module also includes two longer case studies and two role play activities that allow students to develop their skills around taking spiritual histories. The facilitator’s guide provides detailed instructions and helpful strategies for the facilitator on how to effectively convey the information and facilitate the accompanying activities. Results: The Tanenbaum Center for Interreligious Understanding initially developed this learning module for Hofstra North Shore-LIJ School of Medicine. Dr. Judith Brenner, Associate Dean for Curricular Integration noted that the materials were “extremely helpful in planning and idea-generating for their course, Sources of Support, Meaning and Hope.” She added that our curriculum had “molded the session and prompted us to include religion and spirituality as a critical component of our curriculum.” In an evaluation the medical students completed after their course, 60% of students agreed or strongly agreed with the following statement: “Session content enhanced my knowledge and/or skills.” In addition, 70% agreed or strongly agreed that the “session was engaging.” Approximately 2 months following the course, Hofstra faculty also evaluated students’ learning through a standardized patient encounter. The results indicated that the majority of students internalized the information on how to take a spiritual history. Thirty-nine students completed standardized patient encounters. The mean score was 78.46 out of 100. Dr. Judith Brenner summarized the outcome of the standardized patient exercise as follows: “Overall performance was very good. Nearly half of students met all expectations for performance on this station, which included checklist items addressing the following competencies: interpersonal and communication skills, patient care and professionalism. Regarding the specific checklist items relevant to spiritual history content, students performed extremely well, with mean scores of nearly 4 or more [on a scale of 1-5] on 75% of critical questions.” Discussion: The knowledge and skill sets presented in this course provide instruction for pre-service physicians on how to respectfully ask patients about their religious beliefs as it relates to their health care, as well as how to address the topic of religion when it impacts patient care and/or patient decision-making. Addressing the religious beliefs of patients as it relates to their health care is an essential component of patient centered care and improves patient satisfaction.
- Recognize that spiritual histories are an essential piece of patient-doctor interactions.
- Distinguish between spiritual screens, spiritual histories, and spiritual assessments.
This module was reviewed by eight individuals working in the field of religion, cultural competence, and medical education. Reviewers included:
- Judith Jacobson, Dr.PH - Associate Professor of Clinical Epidemiology, Columbia University Mailman School of Public Health
- Ann-Christine Nyquist, MD – Associate Dean of Diversity and Inclusion and Associate Professor of Pediatrics at the University of Colorado School of Medicine; Associate Professor of Community and Behavioral Health, Colorado School of Public Health
- Geri-Ann Galanti, PhD – Department of Anthropology at California State University, Doctoring Curriculum at the David Geffen School of Medicine at UCLA and author of Caring for Patients from Different Cultures, currently in its 4th edition.
- Hilit Surowitz-Israel, PhD – Professor in the Department of Religion at Rutgers University.
- June Jones, PhD – Senior Lecturer in Biomedical Ethics and College Lead on Religious and Cultural Diversity at University of Birmingham, UK.
- Edward Poliandro, PhD – Assistant Clinical Professor of Preventive Medicine, Social Work and Behavioral Science, Assistant Clinical Professor of Medical Education at Icahn School of Medicine at Mount Sinai.
- Rabbi Rafael Goldstein – Director of Spiritual Care and Education, Mount Sinai Hospital
- Dr. Joseph Truglio – Assistant Professor, Departments of Internal Medicine and Pediatrics, The Mount Sinai Medical Center
The materials were sent out with an evaluation form that, in addition to asking for general comments on the strengths and weaknesses of the curriculum, asked reviewers to rate the curriculum and accompanying case studies based on the following criteria:
- The learning module demonstrates why clinicians should address the topic of religion with patients.
- The learning module offers practical strategies for identifying when religion and health care intersect.
- The learning module includes discussion questions that promote reflection and learning.
- The content is comprehensive—does not have any gaps in essential knowledge and/or skill sets.
- The PowerPoints are formatted and organized in a way that is easy for educators to use.
- The facilitator’s guides include clear and comprehensive instructions for implementing the lessons.
- This curriculum could be easily integrated into a medical institution’s existing curriculum.
Edits and additions were made to the learning module based on the reviewer evaluation responses. After materials were edited, Tanenbaum submitted the modules to reviewers and other experts in the field to ask for an endorsement. A sample of endorsements received are as follows:
- “The Tanenbaum Center has produced an excellent and informative educational program that should prove useful in training physicians, residents, medical students, and other health professionals to care for patients from diverse religious and cultural backgrounds. Real world clinical cases and interactive exercises help learners develop the knowledge, skills, and attitudes needed to put 'religio-cultural competence into practice.' This program is highly recommended and relevant for addressing national accreditation requirements and competencies relating to spirituality and health.” - Robert C. Like, MD, MS, Professor and Director, Center for Healthy Families and Cultural Diversity, Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School
- “Designed to support non-clergy educators during the challenging experience of incorporating “soft science” concepts of caregiving into the creation and development of physicians. While developed with medical school curriculum in mind, these volumes provide important curricular content for the education of all health professions.” - Deborah Caputo Rosen, RN, PhD and Amy Wilson-Stronks, MPP, CPHQ
None to report.
The Arnold P. Gold Foundation, The Josiah Macy Jr. Foundation and The Louis and Rachel Rudin Foundation provided funding to support the creation and initial piloting of these materials.
- Boncheck, A. (2004, Winter). Is OCD a Jewish disease Jewish Action, 5765.
- Chen, L-M, Miaskowski, C., Dodd, M., & Pantilat, S. (2008). Concepts within the Chinese culture that influence the cancer pain experience. Cancer Nursing, 31(2), 103-108. http://dx.doi.org/10.1097/01.NCC.0000305702.07035.4d
- Curlin, F., Chin, M., Sellergren, S., Roach, C., & Lantos, J. (2006). The association of physicians’ religious characteristics with their attitudes and self-reported behaviors regarding religion and spirituality in the clinical encounter. Medical Care. 44(5), 446-453. http://dx.doi.org/10.1097/01.mlr.0000207434.12450.ef
- Dhingra, L. (2008, Winter). Pain in ethnic Chinese cancer patients: Role of cultural factors in assessment and treatment. The Pain Practitioner, 28-34.
- Flannelly, K., Handzo, G., Galek, K., Weaver, A., & Overvold, J. (2006). A national survey of hospital directors’ views about the importance of various chaplain roles: Differences among disciplines and types of hospitals. The Journal of Pastoral Care & Counseling. 60(3), 213-225.
- Friedrich, I. & Levy, Y. (2000). Diabetic ketoacidosis during the Ramadan fast. Harefuah, 138(1), 19-21.
- Galanti, G.A. (2008). Caring for patients from different cultures. Philadelphia, PA: University of Pennsylvania Press. http://dx.doi.org/10.9783/9780812203479
- Im, E., Yi, L., Young, K., & Wonshik, C. (2008). Asian American cancer patients' pain experience. Cancer Nursing, 31(3), 17-23. http://dx.doi.org/10.1097/01.NCC.0000305730.95839.83
- Institute for Safe Medication Practices. (2011). Some alternative medicines native to India may cause lead poisoning. ISMP Safe Medicine, 9. Retrieved from http://www.ismp.org/Newsletters/consumer/Issues/20110324.asp
- Koenig, H.G. (2007). Spirituality in Patient Care: Why, how, when, and what. West Conschohocken, PA: Templeton Press.
- Loike, J., Gillick, M., Mayer, S., Prager, K., Simon, J.R., Steinberg, A., et al. (2010). The critical role of religion: Caring for the dying patient from an Orthodox Jewish perspective. Journal of Palliative Medicine, 13, 1267-1271. http://dx.doi.org/10.1089/jpm.2010.0088
- McCord, G., Gilchrist, V.J., Grossman, S.D., King, B.D., McCormick, K.F., Oprandi, A.M.,….Srivastava, M. (2004). Discussing spirituality with patients: A rational and ethical approach. Annals of Family Medicine, 2(4), 356-361. http://dx.doi.org/10.1370/afm.71
- Mi-Ling, E. & Wai-Chi Chan, Sally. (2008). The pain experience and beliefs of Chinese patients who have sustained a traumatic limb fracture. International Emergency Nursing, 16, 80-87. http://dx.doi.org/10.1016/j.ienj.2008.02.002
- Robinson, G. (2000). Essential Judaism: A complete guide to beliefs, customs, and rituals. New York, NY: Simon & Schuster.
- Rundle, A., Carvalho, M., & Robinson, M. (2002). Cultural competence in health care: A practical guide. San Francisco, CA: John Wiley & Sons, Inc.
- Saper, R., et. al. (2008). Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet. JAMA, The Journal of the American Medical Association, 300(8), 915-23. http://dx.doi.org/10.1001/jama.300.8.915
- Smith, M. & Lederman Flamm, A. (2011). Accommodating religious beliefs in the ICU: A narrative account of a disputed death. Narrative Inquiry in Bioethics, 1.1, 55-64. http://dx.doi.org/10.1353/nib.2011.0003
- Smith-Stoner, M. (2003). How Buddhism influences pain control choices. Nursing, 33(4), 17-18. http://dx.doi.org/10.1097/00152193-200304000-00013
- Thakrar, D., Das, R. & Sheikh, A. (2008). Caring for Hindu Patients. Abingdon, UK: Radcliffe Publishing Ltd.
- Thiel, M. & Robinson, M. (1997, Spring). Physicians’ collaboration with chaplains: Difficulties and benefits. The Journal of Clinical Ethics, 94-103.
- University of Maryland Palliative Care Initiative. Basic Cancer Pain Management: Case Studies for Medical Students, Medical Residents, and Hematology/Oncology Fellows [PowerPoint slides]. Retrieved from PowerShow.com website: http://www.powershow.com/view/3b0b10-NWZjO/Basic_Cancer_Pain_Management_Case_Studies_For_Medical_Students_Medical_Residents_and_Hematology_Oncology_Fellows_powerpoint_ppt_presentation
- Williams, J., Meltzer, D., Arora, V., Chung, G., & Curlin, F. (2011). Attention to inpatients’ religious and spiritual concerns: Predictors and association with patient satisfaction. Journal of General Internal Medicine. July, 1. Published Online. http://dx.doi.org/10.1007/s11606-011-1781-y
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