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Spirituality and Religion in Psychiatry Residency Programs M . Jafferany, MD G-2 Resident Hennepin-Regions Psychiatry Program INTRODUCTION ► The relationship between spirituality and medicine has been the focus of considerable interest in recent years. ► Studies suggest that many patients believe that spirituality plays an important role in their lives and positive correlation between patient and spirituality or religious commitment and health outcome. Spirituality and Psychiatry ► Over the last two decades, mental health professionals have recognized the importance of religion in the lives of many people in US. ► Incorporation of patient’s spirituality into mental health assessment and treatment plans is gaining momentum. Patients vs. Providers ►A clear disparity exists between religiosity of general population and mental health professionals. ► There is a growing public interest in incorporating spirituality and religiosity in health care delivery. Gallup Polls ►A Gallup poll survey in 1996 found that 96% of American believe in God and 21% of psychiatrists and 28% of clinical psychologists are atheist or agnostic. ► Another survey in 1990 found that 72% of Americans agree that “My whole approach to life is based on my religion”, while only 39% of psychiatrists and 33% of clinical psychologists accepted this statement. Gallup GH. Religion in America 1996 Princeton NJ. The gallop organization 1996. Bergin Ae, Jensen JP. Religiosity of psychotherapists: a national survey. Psychotherapy. 1990. 27:3-7 Beliefs and Attitude of Inpatients about Spirituality ► 203 family practice adult inpatients at two hospitals were interviewed regarding their views on the relationship between religion and health. ► 94% of inpatients believe spiritual health to be as important as physical well being. ► 77% wanted spiritual issues to be considered in their care ► 68% reported no discussion of their religious beliefs by physicians. King DE , Bushwic B. Beliefs and attitudes of hospital inpatients about faith healing and prayer. J Fam Pract 1994: 39:349-52 Spiritual Needs ►A survey comparing the spiritual needs of 51 psychiatric inpatients with those of 50 medical inpatients reported that 80% of psychiatric patients and 88% of medical inpatients expressed the need of for prayer. ► In addition, 65% of psychiatric patients and 66% of medical patients expressed a need for a visit from a chaplain to pray with them. Fitchett G, Burton LA, Savin AB The religious needs and resources of psychiatric patients. J Ner Ment Dis 1997; 185:320-6 Debate continues ► Debate continues regarding the optimal ways of addressing issues related to spirituality and religion. ► It is well known now that patient’s belief system plays a key role in patient development and remain a powerful influence on responses to current illness, treatment and life demands. ► Different schools of thoughts Proponents ► They point to research findings that support a positive relationship between spirituality and health. ► Clinicians take a spiritual history during the assessment process and remain open to discussing spiritual issues during the course of treatment. Barnes LL, Plotnikoff J, Fox K, Pendleton S. Spirituality, religion and pediatrics: interesting worlds of healing. Pediatrics. 2000; 106(4):899-908 Opponents ► They argue that scientific evidence for an association between spirituality and health status is lacking. ► They concern about several ethical issues regarding physician involvement in a patient’s religious or spiritual affairs Sloan RP, Bagiella E, Powell T. Religion Spirituality and Medicine. Lancet 1999; 353:664-67 H O P E model ► HOPE questionnaire was developed as a teaching tool to help medical students, residents and practicing physicians, begin the process of incorporating spiritual assessment into medical interview. ► It covers the basic areas of inquiry for physicians to use in formal spiritual assessments. Anandarajah G, Hight E. Spirituality and medica practice: using the HOPE question as a practical tool for spiritual assessment. Am Fam Physician. 2001. 63(1):81-9 H O P E Questionnaire ► H- Sources of Hope, comfort, meaning, strengths, peace, love, connection ► O- Organized religion ► P- Personal spirituality and Practices ► E- Effects on medical care and end of life issues APA ► APA has recognized that psychiatrists require basic understanding of religious and spiritual issues. ► Curricular changes in US residency programs, since then followed. ► More than one third of medical schools in US, now offers courses in religion and spirituality. Puchalski CM, Larson DB. Developing curricula in spirituality and medicine. Acad Med 1998; 73:970-4 Religion and Spirituality in US curricula ► 80% of the members of the A A D P R T programs responded to a survey on the role of religion in psychiatric education. ► Results suggest that Religious ideation by resident candidates is a relatively unimportant variable in the programs' selection Didactic instruction on any aspect of religion is infrequent Clinical supervision on religious dynamics is variable Academic progression is rarely impeded by behaviors emanating from residents' religious values. Sansome RA et al. The role of religion in psychiatric education: A national survey. Acad Psychiatry. 1990; 14:34-8 APA Practice Guidelines for the Psychiatric Evaluation of Adults These guidelines were updated in 1995 to include gathering information on “important religious influences on the patient’s life” in the personal history and performing an evaluation that is sensitive to the patients’ religious and spiritual beliefs. American Psychiatric Association: Practice guidelines for the psychiatric evaluation of adults. Am J Psychiatry 1995; 152(11 suppl.):64-80 ACGME Requirements ► ACGME program requirements for residency training in psychiatry were amended to reflect these new changes. ► Two changes in the ACGME requirements related specifically to include didactic and clinical instruction on religious and spiritual factors. American Medical association. Graduate Medical Education Directory 1995-1996: Program requirements for residency education in psychiatry Chicago IL: American Medical Association; 1995 A Model Curriculum ► The curriculum is organized into 11 modules that address the following topics: The relation between religion and mental health. Interviewing and assessment skills Religion and spirituality in human development Working with clergy Working in the C-L settings Introduction to God images Introduction to charismatic religious experience Introduction to cults Religious and spiritual issues in the treatment of women, substance abuse and abused persons. Larson DB, Lu Fg, Swyers JP. A model curriculum for psychiatry residency training programs: religion and spirituality in clinical practice. Revised ed. Rockville, MD. National institute of healthcare research; 1997 John Templeton Foundation Spirituality and Medicine Award ► National institute of healthcare research in 1999, established JTF award to support the incorporation of training in religion and spirituality, into residency curricula for psychiatric residency training programs. ► By 2001, 16 psychiatric residency programs in US had received this award. JTF Award programs ► In these programs, the mandatory curriculum spans the length of residency and include both didactic and clinical components. ► Time devoted to the didactic component ranges from 12 to 81 hours. ► The clinical component includes Group case-based discussions Teaching clinical interviewing skills needed to take a religious and spiritual history. Formal collaboration with chaplains Mandatory case based supervision during clinical rotations. Offering of clinical and research elective opportunities. Religion and Spirituality in Canadian curricula in 14/16 programs Residency TRAINING AVAILABLE programs Lectures 4 Research electives 3 Case-based supervision 9 Clinical electives 2 No training available 4 A New Proposal for Canadian Curricula ► Introduction to religion and spirituality and Psychiatry. ► Religion and spirituality in human development ► Overview of selected major religions (Buddhism, Taoism, Hinduism) ► Christianity ► Islam ► Judaism ► Transpersonal psychology ► First Nations spirituality and Shamanism ► Religious and spiritual issues in psychotherapy ► Resident-facilitated case conference A New Proposal for Canadian Curricula ……. ► The proposed curriculum is limited to 10 academic sessions (90 -120 minutes each). ► This differs from Larson’s model in emphasizing basic knowledge about specific religious and spiritual practices. ► Suggested course faculty include members of psychiatry, religion and anthropology departments as well as clergy and other religious leaders from the community.
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