Knight has shown how the moral growth of medical students involves a spiritual journey. He may, however, present too sanguine a portrayal of the extent to which the medical education environment promotes this moral and spiritual growth. Medical school may indeed be more abusive than supportive. Admitting more women to medical school and teaching more humanities courses, while worthwhile, will not necessarily promote the goals that Knight appropriately advocates.
Spiritual conflicts and concerns often accompany serious illness, but many family physicians are slow to recognize these concerns or unsure how to address them. The case of a patient with spinal cord injury and who later developed an astrocytoma is used to illustrate a team approach that involved a family physician, a spiritual counselor, and a psychologist. Narrative writing exercises in which the patient was encouraged to tell his own story also played a role in treatment. We present a case report demonstrating the role of a spiritual counselor as an integrated member of the team caring for the patient and the benefits from explicit attention to the spiritual dimension in the care of this patient. Our report differs from most academic presentations because the patient himself (JC) is a co-author and provides a firstperson account of this experience. To better represent the realities of practice, the next 3 sections of this article represent 3 different voices-first, the voice of the physician as modulated through the medical record; second, the voice of the patient; and third, the voice of the spiritual counselor. (The psychologist caring for JC was invited to contribute to the discussion also but elected not to do so.) Medical Case ReportJC was 35 when he first presented to HB at the Family Practice Center. At age 16, he had been struck by a car while riding a bicycle, sustaining fracture and dislocation of T3 through T5 with transverse myelitis. He also suffered from severe facial lacerations that required enucleation of the left eye and extensive repair of the forehead; a pneumothorax; and 4 broken ribs. During hospitalization lasting more than 3 months, he underwent laminectomy, tracheostomy, and insertion of a suprapubic catheter. He suffered residual ptosis of the right eyelid. Stage IV pressure sores developed that were surgically revised 6 months after initial hospitalization. He was discharged from rehabilitation with what the record described as "excellent mental status."At the time he sought care from Family Practice, JC was working as promotions director for a local TV station and living with his wife and two adopted children. He was seeing a urologist at a referral center for ongoing bladder management. Initial care was directed at diet and exercise management of obesity related to his wheelchair confinement.Six months later, JC was hospitalized for 12 days for urosepsis. The hospital course was complicated by emotional distress and lability, explained by the patient as being related to flashbacks to his spinal cord rehabilitation experiences. After hospital discharge, the patient continued to function well socially and emotionally, and mental health care was not initiated.
In response to prevalent unprofessional behaviors during the 1990s, the medical school administration at Michigan State University's College of Human Medicine developed a student curriculum for professional development, called "The Virtuous Student Physician." However, as students adopted these professional aspirations and attributes, they noted that faculty members were not being held to the same standards.The medical school's senior associate dean for faculty affairs and development convened a task force to reframe professionalism for all faculty, residents, and students. Our first step was to survey our faculty regarding their awareness of the student professionalism curriculum and their own perceived professional weaknesses. This survey showed the following: most faculty members were aware of "The Virtuous Student Physician" curriculum, that faculty members identified social responsibility as the most difficult attribute to achieve, and that the most difficult behavior identified was working to resolve problem behaviors with colleagues.The task force then developed a new curriculum "The Virtuous Professional: A System of Professional Development for Students, Residents, and Faculty." The task force identified three core virtues (Courage, Humility, and Mercy) and reframed the professional attributes encompassed by these virtues to be aspirational for the entire learning community. The faculty of the College subsequently adopted the new principles and practices, including the use of routine, anonymous student evaluation of faculty professionalism.We are currently collecting data from student evaluations of their clinical faculty members. We plan to use this feedback to guide faculty development and recognize those who model exemplary professionalism as well as to address those who engage in unprofessional behavior.
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