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Incorporating and Teaching Spirituality into Medical Education: An Overview of the Field and Possible Educational Strategies

  • Giancarlo Lucchetti
  • Lidia Maria Gonçalves
  • Alberto Gorayeb de Carvalho Ferreira
  • Jorge Cecilio DaherJr
  • Alessandra Lamas Granero Lucchetti
Chapter
Part of the Religion, Spirituality and Health: A Social Scientific Approach book series (RELSPHE, volume 4)

Abstract

Resulting from the increasing scientific evidence on the correlations between spirituality and health (S/H), important institutions such as the World Health Organization, American College of Physicians and Association of American Medical Colleges have already formally recommended the approach of spirituality in clinical practice. In addition, most US and UK medical schools have already included S/H contents in their curriculum, students and medical teachers believe this issue is important to clinical practice and there are several studies showing promising results on the incorporation of S/H courses or strategies to medical students. This chapter will provide a brief panorama on the S/H field, aiming to bring an update overview of the development of the field, the current scientific evidence, the most common educational strategies and initiatives used, the S/H curriculum goals, objectives and general competences. Future challenges of this field are to create an international consensus including the minimum required competences that a medical student should learn concerning S/H, to increase the number of S/H content worldwide and to provide high-quality and continuing training for teachers and students.

Keywords

Spirituality Medical education Religion and health Educational models Medical students 

References

  1. AAMC (1999). Contemporary issues in medicine: Communication in medicine. Washington, D.C: Association of American Medical Colleges.Google Scholar
  2. Anandarajah, G., & Mitchell, M. (2007). A spirituality and medicine elective for senior medical students: 4 years’ experience, evaluation, and expansion to the family medicine residency. Family Medicine, 39, 313–315.Google Scholar
  3. Anandarajah, G., Roseman, J., Lee, D., & Dhandhania, N. (2016). A 10-year longitudinal study of effects of a multifaceted residency spiritual care curriculum: Clinical ability, professional formation, end of life, and culture. Journal of Pain and Symptom Management, 52, 859–872.  https://doi.org/10.1016/j.jpainsymman.2016.06.006. e851.PubMedCrossRefGoogle Scholar
  4. Balboni, M. J., et al. (2015). Religion, spirituality, and the hidden curriculum: Medical student and faculty reflections. Journal of Pain and Symptom Management, 50, 507–515.  https://doi.org/10.1016/j.jpainsymman.2015.04.020.PubMedPubMedCentralCrossRefGoogle Scholar
  5. Banin, L. B., Suzart, N. B., Banin, V. B., Guimaraes, F. G., Mariotti, L. L., & Lucchetti, G. (2013). Spirituality: Do teachers and students hold the same opinion? The Clinical Teacher, 10, 3–8.  https://doi.org/10.1111/j.1743-498X.2012.00576.x.CrossRefGoogle Scholar
  6. Barnett, K. G., & Fortin, A. H. (2006). Spirituality and medicine. A workshop for medical students and residents. Journal of General Internal Medicine, 21, 481–485.  https://doi.org/10.1111/j.1525-1497.2006.00431.x.PubMedPubMedCentralCrossRefGoogle Scholar
  7. Bell, D., Harbinson, M., Toman, G., Crawford, V., & Cunningham, H. (2010). Wholeness of healing: An innovative student-selected component introducing United Kingdom medical students to the spiritual dimension in healthcare. Southern Medical Journal, 103, 1204–1209.  https://doi.org/10.1097/SMJ.0b013e3181f968ce.PubMedCrossRefGoogle Scholar
  8. Best, M., Butow, P., & Olver, I. (2015). Do patients want doctors to talk about spirituality? A systematic literature review. Patient Education and Counseling, 98, 1320–1328.  https://doi.org/10.1016/j.pec.2015.04.017.PubMedPubMedCentralCrossRefGoogle Scholar
  9. Best, M., Butow, P., & Olver, I. (2016). Doctors discussing religion and spirituality: A systematic literature review. Palliative Medicine, 30, 327–337.  https://doi.org/10.1177/0269216315600912.CrossRefGoogle Scholar
  10. Calman, K. (2008). Spirituality and medical education. Medical Education, 42, 123–125.PubMedCrossRefGoogle Scholar
  11. Culliford, L. (2009). Teaching spirituality and health care to third-year medical students. The Clinical Teacher, 6, 22–27.CrossRefGoogle Scholar
  12. Curlin, F. A., Lawrence, R. E., Odell, S., Chin, M. H., Lantos, J. D., Koenig, H. G., & Meador, K. G. (2007). Religion, spirituality, and medicine: Psychiatrists’ and other physicians’ differing observations, interpretations, and clinical approaches. American Journal of Psychiatry, 164, 1825–1831.PubMedCrossRefGoogle Scholar
  13. de Carvalho Ferreira, A. G., de Oliveira, J. A. C., & Jordán, A. P. W. (2016). Educação em saúde e espiritualidade: uma proposta de transversalidade na perspectiva do estudante. IJHE-Interdisciplinary Journal of Health Education, 1, 3–12.CrossRefGoogle Scholar
  14. Ehman, J. W., Ott, B. B., Short, T. H., Ciampa, R. C., & Hansen-Flaschen, J. (1999). Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill? Archives of Internal Medicine, 159, 1803–1806.CrossRefGoogle Scholar
  15. Ellman, M. S., Schulman-Green, D., Blatt, L., Asher, S., Viveiros, D., Clark, J., & Bia, M. (2012). Using online learning and interactive simulation to teach spiritual and cultural aspects of palliative care to interprofessional students. Journal of Palliative Medicine, 15, 1240–1247.  https://doi.org/10.1089/jpm.2012.0038.PubMedCrossRefGoogle Scholar
  16. Frazier, M., Schnell, K., Baillie, S., & Stuber, M. L. (2015). Chaplain rounds: A chance for medical students to reflect on spirituality in patient-centered care. Academic Psychiatry: The Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 39, 320–323.  https://doi.org/10.1007/s40596-015-0292-2.CrossRefGoogle Scholar
  17. Gonçalves, L. M., Osório, I. H. S., Oliveira, L. L., Simonetti, L. R., dos Reis, E., & Lucchetti, G. (2016). Learning from listening: Helping healthcare students to understand spiritual assessment in clinical practice. Journal of Religion and Health, 55, 986–999.  https://doi.org/10.1007/s10943-015-0146-y.PubMedCrossRefGoogle Scholar
  18. Graves, D. L., Shue, C. K., & Arnold, L. (2002). The role of spirituality in patient care: Incorporating spirituality training into medical school curriculum. Academic Medicine: Journal of the Association of American Medical Colleges, 77, 1167.CrossRefGoogle Scholar
  19. Group, W. S. (2006). A cross-cultural study of spirituality, religion, and personal beliefs as components of quality of life. Social Science & Medicine, 62, 1486–1497.CrossRefGoogle Scholar
  20. Guck, T. P., & Kavan, M. G. (2006). Medical student beliefs: Spirituality’s relationship to health and place in the medical school curriculum. Medical Teacher, 28, 702–707.  https://doi.org/10.1080/01421590601047680.PubMedCrossRefGoogle Scholar
  21. Harbinson, M. T., & Bell, D. (2015). How should teaching on whole person medicine, including spiritual issues, be delivered in the undergraduate medical curriculum in the United Kingdom? BMC Medical Education, 15, 96.  https://doi.org/10.1186/s12909-015-0378-2.PubMedPubMedCentralCrossRefGoogle Scholar
  22. Kaufman, Y., Anaki, D., Binns, M., & Freedman, M. (2007). Cognitive decline in Alzheimer disease impact of spirituality, religiosity, and QOL. Neurology, 68, 1509–1514.PubMedCrossRefGoogle Scholar
  23. King, D. E., Arch, G., Mainous, I., Steyer, T. E., & Pearson, W. (2001). The relationship between attendance at religious services and cardiovascular inflammatory markers. The International Journal of Psychiatry in Medicine, 31, 415–425.  https://doi.org/10.2190/F4MP-KLYE-VED4-3LDD.PubMedCrossRefGoogle Scholar
  24. King, D. E., Blue, A., Mallin, R., & Thiedke, C. (2004). Implementation and assessment of a spiritual history taking curriculum in the first year of medical school. Teaching and Learning in Medicine, 16, 64–68.  https://doi.org/10.1207/s15328015tlm1601_13.PubMedCrossRefGoogle Scholar
  25. Koenig, H. G. (1998). Religious attitudes and practices of hospitalized medically ill older adults. International Journal of Geriatric Psychiatry, 13, 213–224.PubMedCrossRefGoogle Scholar
  26. Koenig, H. G. (2012). Religion, spirituality, and health: The research and clinical implications. ISRN Psychiatry, 2012, 278730.  https://doi.org/10.5402/2012/278730.PubMedPubMedCentralCrossRefGoogle Scholar
  27. Koenig, H. G., Hooten, E. G., Lindsay-Calkins, E., & Meador, K. G. (2010). Spirituality in medical school curricula: Findings from a national survey. International Journal of Psychiatry in Medicine, 40, 391–398.  https://doi.org/10.2190/PM.40.4.c.PubMedCrossRefGoogle Scholar
  28. Ledford, C. J., Seehusen, D. A., Canzona, M. R., & Cafferty, L. A. (2014). Using a teaching OSCE to prompt learners to engage with patients who talk about religion and/or spirituality. Academic Medicine: Journal of the Association of American Medical Colleges, 89, 60–65.  https://doi.org/10.1097/acm.0000000000000062.CrossRefGoogle Scholar
  29. Lennon-Dearing, R., Florence, J. A., Halvorson, H., & Pollard, J. T. (2012). An interprofessional educational approach to teaching spiritual assessment. Journal of Health Care Chaplaincy, 18, 121–132.  https://doi.org/10.1080/08854726.2012.720546.PubMedCrossRefGoogle Scholar
  30. Lucchetti, G., & Lucchetti, A. L. (2014). Spirituality, religion, and health: Over the last 15 years of field research (1999–2013). International Journal of Psychiatry in Medicine, 48, 199–215.  https://doi.org/10.2190/PM.48.3.e.PubMedPubMedCentralCrossRefGoogle Scholar
  31. Lucchetti, G., Lucchetti, A. L., & Koenig, H. G. (2011a). Impact of spirituality/religiosity on mortality: Comparison with other health interventions. Explore: The Journal of Science and Healing, 7, 234–238.CrossRefGoogle Scholar
  32. Lucchetti, G., Lucchetti, A. L. G., & Avezum, Á., Jr. (2011b). Religiosidade, espiritualidade e doenças cardiovasculares. Rev Bras Cardiol, 24, 55–57.Google Scholar
  33. Lucchetti, G., Lucchetti, A. L., & Puchalski, C. M. (2012a). Spirituality in medical education: Global reality? Journal of Religion and Health, 51, 3–19.  https://doi.org/10.1007/s10943-011-9557-6.CrossRefGoogle Scholar
  34. Lucchetti, G., Lucchetti, A. L. G., Espinha, D. C. M., de Oliveira, L. R., Leite, J. R., & Koenig, H. G. (2012b). Spirituality and health in the curricula of medical schools in Brazil. BMC Medical Education, 12, 78.PubMedPubMedCentralCrossRefGoogle Scholar
  35. Lucchetti, G., de Oliveira, L. R., Koenig, H. G., Leite, J. R., & Lucchetti, A. L. (2013). Medical students, spirituality and religiosity – results from the multicenter study SBRAME. BMC Medical Education, 13, 162.  https://doi.org/10.1186/1472-6920-13-162.PubMedPubMedCentralCrossRefGoogle Scholar
  36. Mariotti, L. G., Lucchetti, G., Dantas, M. F., Banin, V. B., Fumelli, F., & Padula, N. A. (2011). Spirituality and medicine: Views and opinions of teachers in a Brazilian medical school. Medical Teacher, 33, 339–340.PubMedGoogle Scholar
  37. Mccauley, J., Jenckes, M. W., Tarpley, M. J., Koenig, H. G., Yanek, L. R., & Becker, D. M. (2005). Spiritual beliefs and barriers among managed care practitioners. Journal of Religion and Health, 44, 137–146.PubMedCrossRefGoogle Scholar
  38. McEvoy, M., Schlair, S., Sidlo, Z., Burton, W., & Milan, F. (2014). Assessing third-year medical students’ ability to address a patient’s spiritual distress using an OSCE case. Academic Medicine: Journal of the Association of American Medical Colleges, 89, 66–70.  https://doi.org/10.1097/acm.0000000000000061.CrossRefGoogle Scholar
  39. Michaelsen, L. K., & Sweet, M. (2011). Team-based learning. New Directions for Teaching and Learning, 2011, 41–51.CrossRefGoogle Scholar
  40. Moreira-Almeida, A., Koenig, H. G., & Lucchetti, G. (2014). Clinical implications of spirituality to mental health: Review of evidence and practical guidelines. Revista Brasileira de Psiquiatria, 36, 176–182.CrossRefGoogle Scholar
  41. Musick, D. W., Cheever, T. R., Quinlivan, S., & Nora, L. M. (2003). Spirituality in medicine: A comparison of medical students’ attitudes and clinical performance. Academic Psychiatry: The Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 27, 67–73.  https://doi.org/10.1176/appi.ap.27.2.67.CrossRefGoogle Scholar
  42. Neely, D., & Minford, E. J. (2008). Current status of teaching on spirituality in UK medical schools. Medical Education, 42, 176–182.PubMedCrossRefGoogle Scholar
  43. Onyon, C. (2012). Problem-based learning: A review of the educational and psychological theory. The Clinical Teacher, 9, 22–26.  https://doi.org/10.1111/j.1743-498X.2011.00501.x.PubMedCrossRefGoogle Scholar
  44. Osorio, I. H. S., Goncalves, L. M., Pozzobon, P. M., Gaspar Junior, J. J., Miranda, F. M., Lucchetti, A. L. G., & Lucchetti, G. (2017). Effect of an educational intervention in “spirituality and health” on knowledge, attitudes, and skills of students in health-related areas: A controlled randomized trial. Medical Teacher, 1–8.  https://doi.org/10.1080/0142159x.2017.1337878.CrossRefGoogle Scholar
  45. Panzini, R. G., & Bandeira, D. R. (2007). Spiritual/religious coping. Archives of Clinical Psychiatry (São Paulo), 34, 126–135.CrossRefGoogle Scholar
  46. Perechocky, A., DeLisser, H., Ciampa, R., Browning, J., Shea, J. A., & Corcoran, A. M. (2014). Piloting a medical student observational experience with hospital-based trauma chaplains. Journal of Surgical Education, 71, 91–95.  https://doi.org/10.1016/j.jsurg.2013.07.001.PubMedCrossRefGoogle Scholar
  47. Pettus, M. C. (2002). Implementing a medicine-spirituality curriculum in a community-based internal medicine residency program. Academic Medicine: Journal of the Association of American Medical Colleges, 77, 745.CrossRefGoogle Scholar
  48. Prober, C. G., & Heath, C. (2012). Lecture halls without lectures – a proposal for medical education. The New England Journal of Medicine, 366, 1657–1659.  https://doi.org/10.1056/NEJMp1202451.PubMedCrossRefGoogle Scholar
  49. Puchalski, C. M., & Larson, D. B. (1998). Developing curricula in spirituality and medicine. Academic Medicine, 73, 970–974.PubMedCrossRefGoogle Scholar
  50. Puchalski, C., & Romer, A. L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine, 3.  https://doi.org/10.1089/jpm.2000.3.129.CrossRefGoogle Scholar
  51. Puchalski, C., et al. (2009). Improving the quality of spiritual care as a dimension of palliative care: The report of the consensus conference. Journal of Palliative Medicine, 12, 885–904.  https://doi.org/10.1089/jpm.2009.0142.CrossRefGoogle Scholar
  52. Puchalski, C. M., Blatt, B., Kogan, M., & Butler, A. (2014a). Spirituality and health: The development of a field. Academic Medicine: Journal of the Association of American Medical Colleges, 89, 10–16.  https://doi.org/10.1097/acm.0000000000000083.CrossRefGoogle Scholar
  53. Puchalski, C. M., Vitillo, R., Hull, S. K., & Reller, N. (2014b). Improving the spiritual dimension of whole person care: Reaching national and international consensus. Journal of Palliative Medicine, 17, 642–656.  https://doi.org/10.1089/jpm.2014.9427.PubMedPubMedCentralCrossRefGoogle Scholar
  54. Ramakrishnan, P., et al. (2014). Perspectives of Indian traditional and allopathic professionals on religion/spirituality and its role in medicine: Basis for developing an integrative medicine program. Journal of Religion and Health, 53, 1161–1175.  https://doi.org/10.1007/s10943-013-9721-2.PubMedCrossRefGoogle Scholar
  55. Rassoulian, A., Seidman, C., & Loffler-Stastka, H. (2016). Transcendence, religion and spirituality in medicine: Medical students’ point of view. Medicine, 95, e4953.  https://doi.org/10.1097/md.0000000000004953.PubMedPubMedCentralCrossRefGoogle Scholar
  56. Sandor, M. K., Sierpina, V. S., Vanderpool, H. V., & Owen, S. V. (2006). Spirituality and clinical care: Exploring developmental changes in nursing and medical students. Explore (New York, NY), 2, 37–42.  https://doi.org/10.1016/j.explore.2005.10.009.CrossRefGoogle Scholar
  57. Schonfeld, T. L., Schmid, K. K., & Boucher-Payne, D. (2016). Incorporating spirituality into health sciences education. Journal of Religion and Health, 55, 85–96.  https://doi.org/10.1007/s10943-014-9972-6.PubMedCrossRefGoogle Scholar
  58. Talley, J. A., & Magie, R. (2014). The integration of the “spirituality in medicine” curriculum into the osteopathic communication curriculum at Kansas City University of Medicine and Biosciences. Academic Medicine: Journal of the Association of American Medical Colleges, 89, 43–47.  https://doi.org/10.1097/acm.0000000000000078.CrossRefGoogle Scholar
  59. Tomasso, C. S., Beltrame, I. L., & Lucchetti, G. (2011). Knowledge and attitudes of nursing professors and students concerning the interface between spirituality, religiosity and health. Revista Latino-Americana de Enfermagem, 19, 1205–1213.CrossRefGoogle Scholar
  60. Tosteson, D. C. (1990). New pathways in general medical education. The New England Journal of Medicine, 322, 234–238.  https://doi.org/10.1056/nejm199001253220405.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Giancarlo Lucchetti
    • 1
  • Lidia Maria Gonçalves
    • 2
  • Alberto Gorayeb de Carvalho Ferreira
    • 3
  • Jorge Cecilio DaherJr
    • 4
    • 5
  • Alessandra Lamas Granero Lucchetti
    • 1
    • 6
  1. 1.School of MedicineFederal University of Juiz de ForaJuiz de ForaBrazil
  2. 2.Department of Internal MedicineUniversity of São PauloSão PauloBrazil
  3. 3.Department of PsychiatryInstituto de Medicina Integral Prof. Fernando Figueira (IMIP)RecifeBrazil
  4. 4.Instituto de Medicina do Comportamento Eurípedes BarsanulfoGoiâniaBrazil
  5. 5.Central de Medicamentos de Alto Custo Juarez BarbosaGoiâniaBrazil
  6. 6.Research Group on Medical EducationFederal University of Juiz de ForaJuiz de ForaBrazil

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