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Spirituality and Religion in Psychiatry Residency Programs

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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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