Residency Course Summaries

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=22 BGCOLOR="#FFFFFF" TEXT="#080000" bgproperties="fixed" background="04b000d2egerdp.png"> <div> </div> </td> </tr><tr> <td valign="top" width=1 BGCOLOR="#333399" TEXT="#080000" background="04aa2c00erkjzj.png"> <bR> </td> <td valign="top" height=458 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <FONT SIZE="5" COLOR="#336600" FACE="Times New Roman" ><I>The George Washington Institute for Spirituality and Health</I></FONT>   <A NAME="top_of_page"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>  <FONT SIZE="1" COLOR="#000000" FACE="Times New Roman" > |    <B> </B></FONT><FONT SIZE="2" COLOR="#0000BF" FACE="Times New Roman" ><A HREF="index.htm" TARGET="_top" TITLE="The George Washington Institute for Spir"><U><B>home</B></U></A></FONT></div> <div> <A HREF="id41.htm" TARGET="_top" TITLE="The GWish Residency Awards"><U><B>Return to Residency Awards</B></U></A><B>        </B></div> <div> <IMG SRC="04c07040.png" border=0 width="263" height="4" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B>Residency Course Summaries</B></div> <bR> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>JOHN TEMPLETON SPIRITUALITY AND MEDICINE AWARD FOR PRIMARY CARE RESIDENCY TRAINING PROGRAMS - PROGRAM SUMMARIES</B></div> <bR> <div> <B><IMG SRC="0ebfd0a0.png" border=0 width="253" height="10" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0edfd0a0.png" border=0 width="253" height="10" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <div> <B>PROGRAM: </B>Curriculum on Religious and Spirituality Practices </div> <div> <B>PROGRAM DIRECTOR:</B>  Samuel M. Putnam, MD, MPH, <B>Boston Medical Center, Boston University School of Medicine</B>, Boston, MA</div> <div> <B>YEAR AWARDED: </B>2000</div> <bR> <div> The Boston University Primary Care Training Program is one of the oldest and largest Primary Care programs in the country.  Its psychosocial curriculum, along with other components of the program, is shared with the traditional internal medicine residency program.  Within the psychosocial curriculum, we are implementing a new curriculum on Spirituality and Religious Practices.  The learning objectives and goals of this curricular enhancement are:</div> <bR> <div> To teach residents the importance of a patient's S&R in maintaining health and coping with illness. </div> <div> To provide the residents with the skills necessary to comfortably discuss a patient's S&R and to identify the appropriate setting for initiating the discussion.</div> <div> To provide opportunities for residents to use resources from the religious community that will help them in their care of patients in various stages of life/health.  This includes making appropriate referrals to a hospital chaplain and learning to work as a team with the chaplain and community clergy.</div> <bR> <div> These objectives will be incorporated into the objectives of the psychosocial curriculum which are to teach: interviewing skills; the elicitation of cultural beliefs regarding health; diagnosing and managing common psychiatric illnesses; self-awareness of personal biases and styles affecting health care; and the empirical database underlying the effect of interviewing and psychosocial skills on outcomes of care.  Through readings, lectures, and seminars, we will acquaint residents with the data on S&R in health care.  In the core training sessions for interviewing skills, we will teach residents to elicit patients' spiritual beliefs about their illnesses.  Throughout the psychosocial curriculum we will emphasize that S&R issues relate to each of the basic objectives of the psychosocial curriculum because:</div> <bR> <div> Patients' concerns about their illness will inevitably involve spiritual ones if the illness is serious enough.</div> <div> Many patients' beliefs about their illnesses involve spiritual beliefs</div> <div> Patients' S&R will likely stimulate residents' thoughts and feelings about their own S&R.</div> <div> It will be important to consider barriers around S&R issues that both patients and physicians have if there is to be a free flow of thoughts and feelings on these issues.</div> <bR> <div> A new element in the psychosocial curriculum will be the implementation of a biweekly conference for nurses, social workers, residents, attendings, and fellows working on the Hematology-Oncology Service.  One conference will be on the Hematology-Oncology Ward; the other will be in the Hematology-Oncology Clinic.  A Hospital Chaplain will attend each of these conferences.  At this conference, patients will be presented to determine if there are any ways in which the Chaplains Service or services in the religious community outside the Hospital might be more involved in their care.  Since all residents rotate on this service, this will be a good opportunity for them to learn how chaplains and others in the religious community can be of assistance in taking care of patients with spiritual needs.  </div> <bR> <div> Since we expect that modeling by faculty preceptors, on the wards and in the clinics, will have the greatest impact on the residents' motivation to learn skills and attitudes necessary to elicit patients' spiritual concerns, we will conduct two faculty development workshops with the help of the Chaplains Service.  </div> <bR> <div> The incorporation of the new curriculum on S&R occurs at the same time that the psychosocial training for medical residents is embracing two other topics: End of Life Issues and Cultural Diversity Awareness.  The End of Life curriculum, funded through the Robert Wood Johnson Foundation, includes lectures/seminars and a mandatory rotation for all residents on a hospice service.  Cultural Diversity Awareness is being developed by a taskforce that includes residents, faculty, the Dean for Minority Affairs and represents a broad base of cultural and ethnic backgrounds.  </div> <bR> <div> <IMG SRC="0effd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0f1fd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> <B>PROGRAM: </B>Spirituality and Family Medicine: From Self Care to Patient Care</div> <div> <B>PROGRAM DIRECTOR: </B>Gowri Anandarajah, MD, <B>Brown University School of Medicine, Memorial Hospital of Rhode Island</B>, Pawtucket, RI</div> <div> <B>YEAR AWARDED: </B>2000</div> <div>      </div> <div> The Spirituality and Family Medicine curriculum is a required longitudinal curriculum that is built seamlessly into the existing overall residency curriculum. It emphasizes the complex and multidimensional nature of health and healing and the role of spirituality in the medical care of the whole person: body, mind and spirit.  It also emphasizes the importance of finding balance and harmony in one's own professional and personal life.  The curriculum focuses on moving from spiritual self-care and understanding to the spiritual care of patients and families and uses a variety of teaching methods, settings and instructors.  It attempts to help residents to: (1) develop healthy spiritual self-understanding and self-care skills;  (2) understand the ways in which spirituality may affect health, well-being, and health care decisions; (3) understand the role of a family physician in helping with the spiritual needs and concerns of patients from diverse cultural and spiritual backgrounds;  (4) assess whether spiritual factors are helping or hindering the patient's healing process; (5) develop skills needed to integrate general spiritual care (eg. compassion, presence) into routine medical encounters and how to sustain these skills; (6) understand the resources available for the spiritual care of patients and their families. </div> <bR> <div> <B>Required Core Curricular Elements</B></div> <div> 1st Year Residents:</div> <div> Session 1:  1 hr tutorial during FM rotation: "Introduction to Spirituality   and Medicine"  (concepts, research, assessment methods etc)</div> <div> Session 2:  1/2 day conference/retreat on Spirituality and Medicine:   "The care of the body, mind and spirit: from self-care and understanding to patient care"</div> <div> Session 3:  1 hr discussion during OB month: " Spiritual and cultural considerations in bereavement care for families who have experienced poor pregnancy outcomes"</div> <bR> <div> 2nd Year Residents:          </div> <div> Session 4:  1/2 day rounds with hospice chaplain during geriatrics/rehab month</div> <div> Session 5:  1/2 day conference on Spirituality and Medicine: "The care of body, mind, spirit .."</div> <div>           </div> <div> 3rd Year Residents:</div> <div> Session 6:  1/2 day rounds with hospital chaplain during community medicine month</div> <div> Session 7:  1/2 day conference on Spirituality and Medicine: "The care of body, mind, spirit .."</div> <div> Session 8:  debriefing session in behavior medicine seminar (Spring) - "personal and professional challenges to incorporating spiritual assessment and spiritual care into medical practice"</div> <bR> <div> <B>Family Medicine Grand Rounds --"Meditation and the Relaxation Response" and "Spiritual and cultural diversity and the care of the dying patient"</B></div> <bR> <div> <U>Elective Experience </U>-- Monthly Spirituality and Medicine Discussion Group</div> <bR> <div> <IMG SRC="0f3fd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0f5fd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> <B>PROGRAM:</B> Spirituality and Health</div> <div> <B>PROGRAM DIRECTOR(S):</B> Antonnette V. Graham, PhD (lead director), Julie Keller, MD, <B>Case Western Reserve University Family Practice Residency of University Hospitals of Cleveland</B>, Cleveland, OH</div> <div> <B>YEAR AWARDED: </B>2000</div> <bR> <div> Many patients believe their physical, mental, and spiritual health are interrelated and research suggests that spirituality can play a positive role both in prevention of health problems and in coping and recovery. Primary care patients are interested in the effects upon their health of their spiritual beliefs.  However, family physicians often fail to inquire about the importance of spirituality in the lives of their patients. The goals of the Curriculum on Spirituality are to prepare family practice physicians to address spiritual concerns by increasing their knowledge about the importance of spirituality in their patients and in their own lives, by helping them to develop skills to assess and support the spiritual resources of their patients, and by increasing their ability to refer patients to appropriate spiritual care professionals. The curriculum will be presented through a systematic program that integrates lectures, skill building workshops, clinical and community experiences and faculty development. Lectures will focus on: </div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Introduction to Spirituality and Health</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The Differences and Similarities in the Major Religions </div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Spirituality in the Life Span</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Research in Spirituality and Health</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Spiritual History Taking </div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Cultural Sensitivity, Spirituality and Health Care</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The Role of Shame, Forgiveness and Hope</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Recognizing Harmful Spiritual Views</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Referrals for Spiritual Care</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">A Team Approach to Spiritual Care</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Spiritual Needs of the Care Givers</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Variations in the Integration of Spirituality and Medical Care : Sufism and Paranormal Healing in the Middle East</div> <bR> <div> Clinical experiences will vary by year of training. First year residents will conduct a community assessment of spiritual resources, such as types and locations of religious institutions, services they provide, and clergy names and telephone numbers in the neighborhood where most of their patients reside. They will have the opportunity to meet local clergy and to develop a referral network. They will compile the information regarding the resources into a Spiritual Resource Manual for patients and providers. Second year residents will accompany chaplains on hospital rounds and attend home visits, medical rounds and team conferences with the medical director and chaplain of a local hospice. Third year residents will attend group meetings at a wellness community for cancer patients and their family members that focus on healing the mind, body and spirit. Residents will be videotaped in their clinical care to encourage and support the incorporation of spiritual care into daily practice. Residents will attend a support group lead by faculty members who will invite the discussion of spiritual issues in their clinical work and in their own lives. </div> <bR> <div> In order to prepare faculty for incorporating spirituality into their clinical work and teaching, they will attend sessions on spirituality and religion, ethical issues related to integrating spiritually into clinical care, cultural aspects of spirituality and assessing spirituality in clinical and professional life. Through this comprehensive training experience, family medicine residents and faculty will develop a clinical style that incorporates spirituality into patient care.</div> <bR> <div> <IMG SRC="0f7fd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0f9fd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> <B>PROGRAM:</B> Family Practice Residency Training Program</div> <div> <B>PROGRAM DIRECTOR: </B>David Nowels, MD, MPH, <B>University of Colorado Health Sciences Center</B>, Denver, CO</div> <div> <B>YEAR AWARDED: </B>2000</div> <div>                </div> <div> We will present a curriculum to allow learners at two Family Medicine residency-training programs of the University of Colorado to investigate the intersections of spirituality with health and the delivery of healthcare.  The curriculum will consider spirituality <I>as "that which pertains to ultimate meaning and purpose in life"</I>.  It will allow the residency training programs to accomplish a variety of objectives that focus the attention of the learner on persons with illness rather than on diseases.  Overall it will be structured around spirituality as a source of meaning, spirituality as a source and framework of values, and spirituality as a context for appreciating human diversity.  To that end we will address issues of suffering, holism, and cultural and spiritual diversity.  The program is designed to accomplish the following: a) increase learners' awareness of the importance of spirituality and its relationship to health and healthcare delivery; b) enhance learners' sensitivity to diverse beliefs and cultures; c) provide learners with tools they can use in clinical settings to explore the impact of spiritual and religious beliefs with patients and their families on their health and healthcare; d) provide learners with tools they can use in these interactions with patients and families.</div> <bR> <div> The curriculum is competency based, extends across each year of training and is integrated with the complete curriculum.  We will use multiple educational methods including lectures, workshops, projects by small groups, journal club, movie nights, and extensive clinical precepting by chaplain interns.  Use of chaplain interns provides educational opportunities for several professional groups.  The specific objectives of this curriculum are:</div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Learners will gain knowledge of the interaction between spirituality and health at the individual patient level, including potential negative impact of religious/spiritual beliefs or practices on health.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Learners will exhibit an understanding of potential mechanisms for how spiritual beliefs and activities might positively impact health.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Learners will gain insight into spiritual beliefs and practices of faith traditions other than their own, and identify how these might impact health.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Learners will assess their own spiritual beliefs and practices.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Learners will learn, practice, and appropriately apply specific skills in taking spiritual history form patients - including how elements of the history impact health and healthcare.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Learners will identify some spiritual issues of the organization and delivery of healthcare.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Learners will understand role of the chaplain/spiritual advisor in health and illness - exhibiting appropriate understanding of when/how to access and refer.</div> <bR> <div> Evaluation consists of formative and summative measures.  Competency for each objective will be assessed for all learners.  A needs assessment using previously developed survey instruments addressing programmatic and personal spiritual beliefs and activities will be performed at the beginning of the year and aspects of that will be repeated yearly.  Evaluative methods will include structured self-report, observer reports, chart review, analysis of log-book of interactions between residents and chaplain interns, and participant evaluations of lecture and activities.</div> <bR> <div> <IMG SRC="0fbfd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0fdfd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> <B>PROGRAM:      </B>PRISM  (Program for the Integration of Spirituality in Medicine)</div> <div> <B>PROGRAM DIRECTOR(S): </B>R. Keith Dobyns, DO, MDiv, S. Elizabeth Kelly, MDiv, <B>Kettering Medical Center Network - Grandview and Kettering Medical Centers</B>, Kettering, OH</div> <div> <B>YEAR AWARDED:</B> 2000</div> <bR> <div> The Program for the Integration of Spirituality and Medicine teaches spiritual observation and encourages spiritual reflection as legitimate components of primary care medicine.  The curriculum emphasizes understanding the spirituality and religious traditions of patients, in order to individualize their medical care.  It challenges participants to integrate spirituality into medical practice. By learning to recognize and value spiritual integration in its many forms, we hope that physicians will gain a deeper understanding of, and thus take better care of, their patients, their peers and themselves.</div> <bR> <div> A series of six lectures at each participating institution is open to the hospital community, including attending physicians, house staff, nurses, social workers, chaplains and local clergy.  Response panels for each talk include health care professionals of multiple faith traditions.  Lecture topics include: Introduction to Spirituality; Health Care in the Major Religious Traditions; Participation in Prayer and Religious Ritual; Spiritual vs. Psychiatric Illness; Clinical Hope vs. Existential Hope; and The Means of Medicine vs. the Ends of Faith.  Additionally, six teaching sessions will be held in each residency and internship class during the year, in alternating months with the lecture series.   These cover topics that require more open discussion than the lecture format will provide: Breaking Bad News: A Skills Workshop; Respecting those of Other Faiths; The Spiritual Challenge of Dementia; Confidentiality and Confession; Medical Rituals; and Spiritual Assessment.</div> <bR> <div> The two course directors and other chaplaincy staff regularly attend morning report at their respective institutions.  This provides opportunities to establish relationships with residents, to facilitate pastoral care referrals, and to include spirituality as an integrated component of diagnosis and treatment.  Residents and interns from each participating training program are assigned to participate in pastoral care rounds for one-half day in each of their training years.  This involves "shadowing" an experienced chaplain during pastoral care visits.  We will develop opportunities to explore spiritual assessment, listen to narrative and metaphor, and participate in ritual and prayer as appropriate.</div> <bR> <div> The course directors participate in the training of hospital chaplains through the Kettering Medical Center Internship and Residency in Clinical Pastoral Education.  This participation specifically promotes pastoral care to physicians and other health care professionals.  Clergy participation in the lecture series has been invited, to give community clergy exposure to particular issues in medical spirituality.  This exposure seeks to promote an ongoing dialogue between clergy and physicians, and to promote respect and support for each other's calling.</div> <bR> <div> A year-end interdisciplinary conference on Spirituality & Medicine is planned for physicians and clergy, with waived tuition for participant interns and residents. Specific format, topics, and speakers are still being developed.</div> <bR> <div> <IMG SRC="0fffd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="101fd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> <B>PROGRAM: </B>Spirituality in Whole Person Care</div> <div> <B>PROGRAM DIRECTORS: </B>John K. Testerman, MD, PhD, Ann M. Ronan, MA, Loma Linda University School of Medicine, Loma Linda, CA</div> <div> <B>YEAR AWARDED: </B>2000</div> <bR> <div> Whole person care, which includes addressing the spiritual needs of patients, is central to our institutional mission.  The proposed curriculum builds on existing institutional and departmental strengths in spiritual care, pulling previously scattered elements together into a coherent educational program and adding new and integrating material.  Although the curriculum is specifically designed for our Family Practice residents, it is hoped that it can serve as a blueprint for other residencies and the teaching of medical students.  The overall goal is twofold: First, for resident physicians to learn how to help patients identify their spiritual strengths and recruit their spirituality as a positive factor in healing.  Second, for residents to develop their own spiritual strengths as they cope with the stresses of patient care and struggle to achieve balance in their lives.  The objectives:</div> <div> Effectively include spiritual assessment as part of a routine history.</div> <div> Identify beneficial and detrimental religious coping styles and their effects on health and quality of life.</div> <div> Communicate effectively and compassionately with chronically ill and dying patients and their families. </div> <div> Recognize the effects of culture and religion on health care choices and coping styles.</div> <div> Describe and apply recent research findings on the role of spirituality and religion on health.</div> <div> Explore their own belief systems and spiritual practices and understand how these might impact care of patients.</div> <div> Recognize and develop an action plan to meet their own spiritual needs and cope positively with the stresses of professional training and practice.</div> <bR> <div> PGY I residents will be introduced to an overview and rationale of the curriculum, including its philosophical, historical and scientific bases.  They will learn to take a spiritual history.  In the hospital inpatient setting, they will participate in bedside "integrative rounds" with spiritual care, behavioral science and clinical ethics professionals followed by group discussion.  In the outpatient clinic, they will videotape encounters with patients and review the videotaped sessions with course faculty.  Both the integrative rounds and video reviews will continue throughout the three years.  Also continuing through the 3 years are resident group support sessions with chaplain personnel. </div> <bR> <div> During the PGY II year, the residents will learn about how religious and cultural beliefs impact on health care decisions and health practices, especially as they relate to the areas of preventive medicine, use of alternative and complementary medicine, pregnancy and childbirth, and end-of-life care.  Didactic and role play sessions will teach them to identify and address religious coping styles as researched by Ken Pargament.</div> <bR> <div> The PGY III residents will develop action plans for developing their own spiritual resources as part of learning to bring into balance the various aspects of their lives.  Becoming familiar with James Fowler's faith development paradigm, they will understand how faith grows and changes during the stages of the life cycle.  They will learn to communicate effectively and compassionately with chronically ill and dying patients and their families.  Residents will make home visits with hospice staff and may voluntarily choose to participate in a spiritual formation group.</div> <bR> <div> <B><IMG SRC="104fd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="106fd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <div> <B>PROGRAM: </B>Spirituality and the Practice of Medicine</div> <div> <B>PROGRAM DIRECTORS: </B>Beth Boyer Kollas, MS, MDiv, PhD, CAAP, Chad D. Kollas, MD, FACP, FCLM, <B>Orlando Regional Healthcare System</B>, Orlando, FL     </div> <div> <B>YEAR AWARDED: </B>2000</div> <div>      </div> <div> The "Spirituality and the Practice of Medicine"<B> </B>curriculum is designed to train internal medicine residents to care for their patients in a more holistic approach, integrating mind, body, and spirit through the practice of relationshipcentered care (RCC) and the re-integration of spirituality into medical practice.  Our focus on RCC philosophies and skills in teaching the connection between spirituality and medicine coincides with the current trend in medicine toward RCC and further underscores the value of spirituality in the practice of medicine.  Similarly, this proposed course design emphasizes scientific research data reported in the literature as foundational for the re-incorporation of spirituality into medicine. It stresses an evidence-based approach to the course construct which will be monitored through an ongoing research study exploring resident physician spirituality and its affect on patient care. </div> <bR> <div> Course topics will be taught using didactic lectures, experiential small groups, journal clubs, spiritual exercises, and clinical rotations with a spiritual care specialist as a part of an internal medicine inpatient team.  This multi-dimensional construct in learning will be used to ensure the completion of all learning objectives, and to offer a more comprehensive approach to learning.  The lecture series will include:</div> <bR> <div> Introduction: "Re-Integrating Spirituality into the Practice of Medicine"</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The Link between Spirituality and Medicine</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Relationship-Centered Care (RCC)</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Spirituality Versus Religion</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Religion/Spirituality in Healthcare Issues</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Religion/Spirituality and Medicine in the Research Literature</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Interviewing & Assessing Spiritual Practices, Beliefs and Attitudes: </div> <div> Part 1-The Physician</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Interviewing & Assessing Spiritual Practices, Beliefs and Attitudes: </div> <div> Part 2-The Patient</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Spiritual Interventions:The Practical Incorporation of Spirituality in Medicine</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Review: Spirituality and the Practice of Medicine </div> <bR> <div>      We will designate a "spiritual care specialist" [SCS] to participate on teaching rounds with one inpatient team each week.  The spiritual care specialist will participate in teaching rounds with emphasis on the following:  To teach residents how to perform an effective spiritual assessment of their inpatients;  To teach residents how to identify patients' spiritual issues in the context of their illnesses;  To assist with patients' treatment plan by helping to identify and form spiritual supports when needed; and, To help residents identify and understand their own spirituality and how it affects their development as physicians.</div> <bR> <div> It is the vision of this course construct to provide more than a general knowledge base concerning the major religious traditions, inclusive spirituality, spiritual needs and issues of patients, spiritual interventions and research data; rather, it was designed also to provide resident physicians with an opportunity to gain knowledge of self, skills that promote contemplation and reflection, and the values of self-care, self-awareness, and self-growth in order that they may be more compassionate, more caring physicians as well as healthier individuals.</div> <bR> <div> <B><IMG SRC="108fd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="10afd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <bR> <div> <B>PROGRAM: </B>Creating a Healing Relationship - Integrating medicine, culture and spirituality</div> <div> <B>PROGRAM DIRECTORS: </B>Stephen Kliewer, DMin.(Lead Director), Ann Sinclair, MS, MSW, Elizabeth Steiner, MD, Val Krause, MD, <B>Oregon Health Sciences University School of Medicine</B>, Portland, OR</div> <div> <B>YEAR AWARDED:</B> 2000</div> <bR> <div> "Creating a Healing Relationship" is a curriculum designed to help Family Medicine residents explore the spiritual dimension of patient care.  Through a variety of methodologies residents will be asked to: </div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Explore the implications for patient-centered care of religious beliefs by held by patients,  </div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Define the impact of their own personal beliefs upon their lives and upon their ability to interact effectively with patients,  </div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Explain ways in which spiritual and clinical perspectives can both support and conflict with one another,</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Identify and utilize appropriately personal, institutional, and community resources for assistance in dealing with the spiritual dimensions of patient care,</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Be able to effectively integrate spirituality into the physician - patient relationship and feel comfortable with spiritual and cultural assessment tools as part of routine practice.</div> <bR> <div> Since we believe that the discussion of spirituality is integral to the practice of medicine, our curriculum is required.  It is presented throughout residency training, and in a wide range of contexts.  It routinely interfaces with other aspects of the curriculum to show the key role of spiritual and cultural care in daily practice.</div> <bR> <div> This curriculum is didactic, experiential and clinical.  Some elements are level specific and others are longitudinal. Level specific highlights include such components as an introduction to spirituality and medicine seminar during resident orientation, experiences with a 12 step and a hospice program, chaplain shadowing, and home visits with patients that focus on listening skills, spiritual assessment, and appropriate responses.</div> <bR> <div> There are a variety of longitudinal components.  One such activity is an ongoing series of lectures on topics related to medicine and spirituality that is part of the core didactic curriculum.  Other elements include videotape reviews of patient encounters involving spiritual issues, and monthly spiritual and cultural assessment and care rounds as part of the inpatient teaching program and resident Balint groups.  The Behavioral Medicine Inpatient Rounds provide yet another opportunity for residents to discuss the spiritual needs of patients and their families.</div> <bR> <div> <IMG SRC="10cfd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="10efd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> <B>PROGRAM:</B> Spirituality and Medicine Curriculum</div> <div> <B>PROGRAM DIRECTOR: </B>Kevin M. Fosnocht, MD, <B>University of Pennsylvania Health System, University of Pennsylvania School of Medicine</B>, Philadelphia, PA</div> <div> <B>YEAR AWARDED:</B> 2000</div> <bR> <div> Through a multidisciplinary effort, including the Departments of Medicine and Religious Studies of the University of Pennsylvania and the UPHS Office of Pastoral Care and Education, this yearlong curriculum will provide practical and patient-centered training in spirituality as it pertains to the primary care of patients.  The curriculum will be required for all second and third year Primary Care residents, and will be comprised of three concurrent modules: </div> <bR> <div> I.  Workshop/conference series.  The curriculum will center around a series of workshops and conferences on topics pertaining to spirituality and medicine.  The series will include the following topics and themes:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Interactive workshop designed to develop working definitions of important concepts that will be used throughout the curriculum.  These concepts include: spirituality, transcendence, religion, healing, ritual, symbol, and afterlife. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">A critical review of the literature pertaining to spirituality and medicine. After this session, the weekly journal club will include at least two journal article presentations of recent studies dealing with spirituality and medicine.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">A series of conferences led by a Religious Studies faculty member and a patient from the local community representing selected faith traditions. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Accessing providers of spiritual care: the practical steps to involve spiritual care providers in the care of the patient. This will involve both chaplaincy and community clergy. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Talking to patients about spiritual matters. After a preparatory session outlining techniques to open the discussion of spirituality with patients and how to perform a formal spiritual assessment, the residents will, as a group, critically review selected videotapes of residents with their patients as they inquire into spiritual issues. These sessions will be moderated by a psychiatry faculty member and a chaplain from the Office of Pastoral Care and Education.</div> <bR> <div> II. Field Rotations.<B>  </B>The residents will attend three weekly sessions in settings where issues of spirituality meet medicine.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Faith-based organizations that provide medical care.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">"On call" with the chaplain at either Presbyterian Medical Center or the Hospital of the University of Pennsylvania.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Chaplaincy residents' case presentation meetings. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Hospice rotation</div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">12-Step Group Meetings </div> <bR> <div> III.  The Doctor and the Patient.  All residents will identify a patient in their continuity practice with whom they will delve into spiritual issues, including a formal spiritual assessment. This experience will culminate in a "clinical vignette", a presentation given by the resident which demonstrates how exploring the patient's spirituality affected the doctor-patient relationship and/or how the patient's spirituality played a role in his or her medical care. </div> <bR> <div> <IMG SRC="110fd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="112fd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> <B>COURSE TITLE: </B>Integration of Spirituality and Culture in Family Medicine</div> <div> <B>PROGRAM DIRECTOR: </B>Paul Bay, DMin, <B>St. Vincent Family Medicine Residency Program</B>, Indianapolis, IN</div> <div> <B>YEAR AWARDED: </B>2000</div> <div>                </div> <div> Our curriculum, <I>Integration of Spirituality and Culture in Family Medicine</I>, was developed in response to the needs of our residents and our patients.  Prior to residency training, only 8% (2 of 24) of our residents had a course in spirituality in medical school. With the opening of Seton Cove, a spirituality retreat center on our campus, in 1998, we saw an opportunity to address these needs in an ideal setting.  We began hosting quarterly meetings in 1999 to discuss issues relating to spirituality and to provide an atmosphere of support for our residents.  Through this attempt to incorporate spirituality into the curriculum, we became cognizant of our need to develop a unified, comprehensive and longitudinal curriculum to examine spiritual and cultural issues.</div> <bR> <div> Quarterly sessions at Seton Cove will continue providing a unique venue for notable speakers with additional time for the residents to have private class discussions.  Additional noon conferences throughout the year will include lectures, case presentations and analysis of the literature.</div> <bR> <div> Spirituality will be integrated throughout all rotation experiences.  Inpatient medicine will go beyond the science to identifying a patient's spiritual needs.  The spiritual dimension of end-of-life care will be discussed in geriatrics.  Psychiatry, behavioral science, medical ethics and primary care rotations will also join forces to provide this curriculum.  Our goal is to weave spirituality and culture into the fabric of our curriculum.</div> <bR> <div> A two-week elective in Spirituality in Medicine will give second and third year residents a more intensive learning experience with significant community outreach.  A highlight of the rotation will be the "Day of Discovery":  a day for residents to focus on their own spiritual attitudes and needs through guided self-reflection.</div> <bR> <div> The diverse community of Indianapolis will provide a rich resource of speakers including religious leaders, physicians, and local authorities and celebrities.  Other St. Vincent resources such as Hospice, the Institute on Aging, and our Multicultural Coordinator will contribute valuable time.</div> <bR> <div> We anticipate that this curriculum will have a far-reaching impact.  Beyond affecting how our residents practice medicine, we will impact our patients' perception of what a physician can do.  Community outreach will increase awareness of the services our clinic provides and will encourage more patients to take part.  Moreover, our hope is that our residents will identify their personal needs and connect with their calling as healers.</div> <bR> <div> "We are not human beings having a spiritual experience: we are spiritual beings having a human experience."  Pierre Teilhard De Chardin</div> <div> <IMG SRC="112fd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="112fd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <bR> <div> <B>PROGRAM: </B>Curriculum in Spiritual and Cultural Competence for Family Medicine</div> <div> <B>PROGRAM DIRECTOR: </B>Gary E. Myers, Ph.D., M.Div., Southern Illinois University School of Medicine</div> <div> <B>YEAR AWARDED: </B>2002</div> <bR> <div> <B>Residency Program Description: </B>The Family Medicine Residency Program of the Southern Illinois University School of Medicine consists of four programs located in Springfield, IL, Decatur, IL, Carbondale, IL, and Quincy, IL.  With a total of 78 residents it is one of the largest Family Medicine Residencies in the nation. The Spiritual and Cultural Competency Curriculum will be located at the Springfield location, which has 24 residents and is the largest of the four programs.</div> <bR> <div> <B>Curriculum Status:  </B>The curriculum is a required component of the Family Medicine Residency Program.  All PGY's are required to participate in each component of the curriculum.   As an indication of the importance given to this curriculum by the medical faculty, it will be included in the Residency Program's Core Curriculum Conference (CCC).  The CCC meets weekly to address issues central to the practice of family medicine.  The Spiritual and Cultural Competence in Family and Community Medicine Curriculum will have control of the agenda of the CCC on a monthly basis.  The CCC will anchor this curriculum in the mainstream of resident learning.</div> <bR> <div> <B>Overall Goal:</B> Training residents to provide medical care that sensitively and competently takes into account the diverse spiritual and cultural needs of their patients is the overall goal of </div> <bR> <div> <B>Structure:</B> Developing cross-spiritual and cultural competence in the practice of medicine requires three distinct, but related kinds of learning. They are:</div> <div> <U>Acquisition</U> of specific knowledge, skills, and attitudes relevant to the spiritual/cultural needs of patients</div> <div> <U>Clinical practice</U> of learned skills, such as, spiritual history taking, active listening for spiritual/cultural issues, spiritual assessment, making referrals to chaplains and clergy, and networking with community resources</div> <div> <U>Integration and Supervision</U> of acquired knowledge and skill with practice</div> <bR> <div> The learning needs of the residents determine the structure and content of the curriculum, as well as the venues in which the learning activities occur.  The anchor of the curriculum is the monthly Core Curriculum Conference (CCC), which consists of didactic seminars, skill-building workshops and integrative case conferences. Residents' <U>acquisition</U> of knowledge, skills and attitudes will primarily occur in the various components of the CCC.  Clinical rotations provide supervised opportunities for residents to apply acquired knowledge and <U>practice</U> learned skills will real patients (each PGY is assigned to a different clinical rotation: PGY1--,  PGY2--, and PGY3--, and all years are assigned to a Continuity Clinic).  Formal integration and supervision occurs in the case conferences that are a component of the CCC.  Informal supervision occurs as a part of their regular contact with supervising faculty. </div> <div> <B>Venues: </B>The curriculum venues include the family medicine clinic (CCC and continuity clinic), Memorial and St. Johns Hospitals (clinical rotations, chaplaincy rounds), St. Johns Hospice (home visits with nurses and chaplains/end-of-life care, multidisciplinary staff meetings), the spiritual/religious community of the Springfield area (community networking activities), local churches, synagogues, mosques (learning about other faiths), movie nights at faculty homes, and occasional televideoed grand rounds.</div> <div> <IMG SRC="112fd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="112fd020.png" border=0 width="253" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> <B>Project:</B> Spirituality: Soulful Living and Dying</div> <div> <B>Project Director: </B>Mary F. Smith, MSW, Ph.D., <B>Albany Medical College, Department of Family and Community Medicine Residency Training Program, </B>Albany, New York.</div> <div> <B>Year Awarded:</B> 2003</div> <bR> <div> <B>Residency Program Description:</B> The Albany Medical College, Department of Family and Community Medicine Residency Training Program is a fully accredited 6-6-6 residency training program as well as an approved Osteopathic Internship site. The residency program, under the direction of Neil C. Mitnick, DO, is housed in a brand new clinical office building. Residents see their continuity patients at this site and provide inpatient care in both the Albany Medical Center Hospital, a regional tertiary care center and at St. Peter's Hospital, a local community hospital less than two miles away.</div> <bR> <div> <B>Curriculum:</B> Spirituality: Soulful Living and Dying is a year-long curriculum for all residents. The curriculum has three main components. The first is the away retreats, one at the beginning of the year and one at the end of the year and 4 follow-up sessions in between. Residents and their significant others will be invited to participate. The second part is 6 two-hour seminars to be presented to all residents during their regularly scheduled teaching sessions. Topics include: What is Spirituality? Is it Different from Religion?; Family Meetings; Spiritual Self-Understanding and Spiritual Assessment; Culture and Spirituality; Now that we are talking about spirituality, what do you do with it?; and Soulful Living and Dying. The third aspect of this project is rotational in nature where residents will participate in a faith based primary care prayer and healing center providing primary care to patients in an atmosphere of prayer and healing. In addition, during their geriatric month, residents will learn how to conduct family meetings often dealing with end of life issues or the diagnosis of chronic or terminal conditions.</div> <bR> <div> <B>Objectives of the Curriculum: </B>Spirituality: Soulful Living & Dying is a creative and new curriculum intended to encourage residents to question their notions of spirituality, understand the difference between spirituality and religion, and develop ways to talk with patients about spirituality. In addition to understanding the distinction between spirituality and religion, the specific, measurable objectives of this grant are to provide the time and place for residents to:</div> <div> Explore their own spirituality and how it impacts their patient-physician relationships.</div> <div> Learn tools to effectively include spiritual assessment as part of a routine history and to feel comfortable with spiritual and cultural assessment tools as part of routine practice.</div> <div> Explore the role of family physicians addressing spiritual needs of patients from diverse cultural and spiritual backgrounds.</div> <div> Communicate effectively and compassionately with chronically ill and dying patients and their families.</div> <bR> <div> <B>Evaluation Plan: </B>Three formal assessment tools will be used to generate information regarding the impact of this project. A session evaluation will be collected after each 2-hour seminar. A belief's survey will be given at the beginning of the year as baseline data. Finally, a Spirituality and Medicine pre and post instrument will be given to monitor resident reporting their dialogue with their patients regarding spirituality. </div> <bR> <div> <B>Staff:</B> 5 Family Practice clin<FONT SIZE="2" COLOR="#000000" FACE="Arial" >icians, 2 behavioral science faculty members and one consultant to assist with the retreats will teach in this project. </FONT></div> <bR> <div> <B><IMG SRC="114fd0a0.png" border=0 width="253" height="10" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="116fd0a0.png" border=0 width="253" height="10" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"> </B><FONT SIZE="2" COLOR="#0000FF" FACE="Arial" ><A HREF="#top_of_page" TITLE="Residency Course Summaries"><U><B>Return to top of page</B></U></A></FONT></div> <bR> </td> </tr></table></body>