Spirituality, Religion, and Medicine Education for Internal Medicine Residents

Abstract

Purpose: Spirituality and religion affect patient health. This topic is often not included in medical resident education. We aimed to evaluate resident knowledge, attitudes, and skill regarding spirituality, religion, and medicine and to develop, implement, and evaluate a curriculum to improve these measures. Methods: Internal medicine residents at a large, urban academic center were surveyed to determine their baseline knowledge, attitudes, and skill regarding spirituality and religion (37.4% response rate, n = 46/123). A lecture and discussion-based curriculum was implemented over 1 year, followed by another survey (41.4% response rate, n = 51/123); χ2 statistic was used to compare pre- and postsurveys to evaluate the curriculum. Results: Baseline resident attitudes toward spirituality, religion, and medicine were high with most agreeing chaplains are valuable in patient care (93.5%) and that patient spiritual and religious beliefs can affect health (93.5%). Resident self-reported knowledge and skill were low with few knowing the training chaplains receive (4.3%) or reporting competence taking a spiritual history (15.2%). After the curriculum, resident self-reported knowledge increased regarding the role of chaplains (56.5%-80.4%, P = .011) and the training chaplains receive (4.3%-27.5%, P = .002). No significant postcurriculum change was seen in attitudes or skill. Conclusions: Most internal medicine residents have positive attitudes toward spirituality, religion, and medicine. They do not have adequate knowledge or skill to care for patients in this area, however. Implementation of a curriculum in spirituality, religion, and medicine improved resident self-reported knowledge. Future work should focus on revising the curriculum to better improve resident knowledge and skill.

Spirituality and religion in residents and inter-relationships with clinical practice and residency training: a scoping review

“…Among several relevant studies, more than 40% of the residents had received prior teaching regarding SR-related issues in medical school. 28 30 48 49 Prior training was associated with greater self-reported competency, 62 more positive attitudes towards SR 49 62 and increased likelihood to engage in routine inquiry about SR-related areas during patient encounters. 4 …”

“…There was some uncertainty about how the topic of SR should be broached during clinical encounters. Although many residents felt it was appropriate to discuss spiritual or religious concerns with patients, 28 31 48 49 56 63 others felt that topics related to SR were too personal to ask or had ethical concerns about raising such a topic during clinical encounter for fear of influencing the beliefs of patients regarding SR. 31 63 Most residents agreed that self-disclosure of one’s own beliefs about SR without permission of the patients was inappropriate. 61–63 In addition, there was uncertainty regarding who should initiate discussion about issues related to SR, 4 5 59 how routinely it should be asked 4 5 36 and under what circumstances.…”

“…Most residents had some religious preferences, 28 59 and at least half would describe themselves as ‘spiritual’, ‘religious’ or both. 31 35 38 63 In one study, more than 70% believed in God, reported that religion is important in their lives, and believe religion can help to manage their personal problems.…”

“… 45 53 Conversely, other studies showed that the majority of residents did not attend religious services more than a few times a year and less than 30% agreed that they carried their religious beliefs into their daily life. 28 32 62 The frequency of prayer varied across different studies. 32 61 62 …”

“…The majority of residents lacked knowledge on the SR-related concerns of patients, 28 the role of clergy/clinical chaplains 28 35 45 56 and the availability of spiritual assessment tools. 35 36 When asked, residents were not satisfied with their current knowledge and skills regarding spirituality, 41 with approximately 50% of residents feeling inadequately trained to address the SR-related issues of patients.…”