Summary of Integrated Spirituality
and Medicine Curriculum at MUSC

Learning Objectives

1.      Spirituality in Health Care, elective course Years 1 and 2

Learning Objectives:

(1)  Define and interpret the meaning of these important concepts: healing, health, faith, spirituality, mindfulness, guilt, forgiveness, shame, suffering, hope, care, grief, and virtue/human flourishing;

(2)  Learn how to know when it is appropriate or necessary to talk to a patient about faith, how to handle religious issues in practice, and how to do a spiritual assessment (spiritual history) with a patient;

(3)  Recover the traditions of religious reflection on birth, suffering, well-being, and death, with application to issues in patient care and clinical ethics; and

(4)  Learn effective and ethical ways to help patients activate spiritual resources for healing and wellness, integrally related to the patient’s cultural milieu and religious orientation.

.     Spirituality is a vital component of health, as borne out by extensive research. 

The clinician’s ability to discern a patient’s spiritual values, personal meanings and vital connections, and to respect and enhance these spiritual dimensions in the care of the patient, may vastly increase therapeutic benefit.  By means of thorough, critical, and experiential understanding and interpretation of key concepts from spiritual traditions (listed above), we lay the foundation for a careful examination of the ways faith/spirituality and science-based health care intersect in the research and clinical practice of today’s doctor.  Specifically, the clinical conditions correlated with spiritual concepts include pregnancy and childbirth, the good heart, chronic pain and illness or disability, psychiatric illness, diabetes, addiction, and dying with cancer.

Since this course was a winner of the Spirituality and Medicine Curricular Award in 1998 and with annual reports having been made, and because the syllabus is nine pages long, we present here only this brief summary, considering that the course has been carefully scrutinized.

The course comprises 28 contact hours in seminar format, plus reading and interviewing, for 2h credit.  We offer the course both Fall and Spring semesters. Enrollment is capped at 15.  Dr. Keller is the Course Director and has been teaching the course for 11 years.

2.      Doctoring I, Longitudinal Patient Care Experience (LPCE)

Learning Objectives:

(1)  Consider the evidence for the premise that a patient’s values, beliefs, and religious or spiritual practices affect their health and should be assessed by the physician;

(2)  Learn how to assess patients’spirituality by taking a spiritual history.

            Dr. Thiedke is Course Director for Doctoring I and II.  Working in small groups with preceptors, all entering medical students have two practice sessions at the beginning of first semester where they learn the components of the medical interview and practice doing it on each other.  They read and discuss two articles describing how to take a spiritual history (using the HOPE acronym) and incorporate that in their initial learning of how to take a medical history.  In a third session with standardized patients, each student performs the whole interview including the spiritual history.  During the semester, students are assigned community physician-preceptors also.

            Note on evaluation: all Doctoring Curriculum course components and instructors are evaluated by students, under the direction of the Office of Curriculum and Evaluation, utilizing the standard PACE evaluation.  The results are given to all course directors and instructors, analyzed, and used for refinement of the courses.

3.      Doctoring II,  LPCE (continued, second semester)

Learning Objectives:

(1)  Reinforce the use of the spiritual assessment technique by incorporation in interviews with patients in physicians’ offices in the community;

(2)  (projected)  In the topical seminars on addiction and on chronic pain, address ways that themes from spiritual traditions (i.e., shame and grace, mindfulness meditation) illuminate dynamics and suggest effective approaches to treatment.

            Continuing to work in small groups, students are in the offices of community physicians where they have the opportunity to interview patients using the skills learned earlier.  They debrief in their groups where good technique is reiterated.  In connection with topical sessions on addiction and chronic pain, specific articles will be included in reading packets that integrate relevant spiritual insights and skills into their learning, and into their structured interviews with two sets of standardized patients.  (The readings and the rationale derive from units of the Spirituality in Health Care course.)

4.      Doctoring III,  Introduction to Clinical Ethics

Learning Objectives:

(1)    Learn about the empirical evidence and ongoing research in the area of faith or spirituality and health, including how spirituality positively impacts healing;

(2)    Learn ethical guidelines concerning disclosure of one’s own spiritual orientation, seeking patient information of this nature, and praying/counseling with patients;

(3)    Explore ethical and religious implications of research on the “faith factor.”

Dr. Keller is Course Co-Director for Introduction to Clinical Ethics.  One two-hour seminar (in small groups) in this third-semester core course is devoted to “Spirituality in Clinical Care.”  Students and preceptors discuss readings (Puchalski and Romer, 2000; Sloan, 2000) and case studies that explore techniques of spiritual assessment and raise issues that could occur in the doctor-patient relationship.  Attention is also given to the increasing body of research in this domain (including research conducted at MUSC), encouraging student questions and responses.  The basic aims of this unit are to consolidate student learning of ways to incorporate spiritual assessment techniques into patient care and deal honestly with students’ questions or concerns related to this unconventional approach.

5.      Family Medicine Core Clerkship

Learning Objectives:

(1)    Integrate an awareness of the importance of a patient’s beliefs, values, religious and spiritual practices into the actual care of patients.

(2)    Reflect on ways in which a patient’s spiritual beliefs may shape their interaction with the health care system, including physicians, nurses, hospital and outpatient settings, diagnostic testing, and therapeutics.

(3)    Consider ways in which the patient’s spiritual strengths might be identified collaboratively and called into play to support healing.

            The clerkship students meet twice a week in two-hour blocks to work through a series of problem-based learning cases that highlight common diagnoses and frequently encountered dilemmas in family practice.  In this format, information about each case is given out a few pieces at a time.  Students discuss appropriate diagnosis and treatment of the cases as new information is provided.  Two of the cases include explicit spiritual material that the students are asked to consider when, as a group, they discuss treatment planning for that patient.   

            Dr. Thiedke directs the clerkship and shares the teaching of the PBL portion with other faculty clinicians (listed).  The bulk of the student’s time in this clerkship involves seeing patients in the clinic with faculty and residents.  Our computerized medical record prompts the interviewer to ask about a patient’s spiritual beliefs as part of the social history template.  Each time students take a social history or witness a preceptor taking a social history, they are reminded that this information is part of a complete interview.

            During the month, students are asked to identify a patient who expresses a viewpoint or belief that is new to them.  Students then research this new idea on the Internet and elsewhere.  They post the case on the medical student Website along with what they have learned about it and something about their own personal growth in examining an issue from a new viewpoint.  Often this has to do with faith traditions that are different from their own.  Students engage in interactive dialogue concerning similar experiences they have had.  Designed to increase cultural sensitivity, this research and dialogue are mandatory and emphasized as critical learning.

            At the end of the clerkship, part of the student evaluation is done via a series of OSCE’s (Objective Structured Clinical Exams).  One OSCE involves a patient who has recently been started on antihypertensive medication and has not been taking it, preferring to try remedies that stem from his belief system.  For the student to succeed, he/she must take a thorough history and assess pertinent religious factors.

6.      Family Medicine Core Clerkship, Spirituality and Medicine seminar

Learning Objectives:

(1)    Clarify the distinction between religion and spirituality and the nature of both;

(2)    Consolidate learning to date in the area of spirituality and medicine, step by step, and draw more fully on personal meanings and experiences that influence how each student doctor will interact with patients in this area.

            This one-hour seminar with Dr. Keller is designed to lead students to explore more deeply their personal spirituality (as distinct from religious preferences), using a story by Rachel Naomi Remen, reflective exercises, and research data to facilitate insight and discussion.  Placed at the beginning of the month, the seminar also prepares students to profit maximally from the PBL and other aspects of the clerkship curriculum as described above.

7.      Fourth Year Psychiatry Clerkship, Power of the Spoken Word:  Spirituality and Medicine Seminar

Learning Objectives:

(1)    Develop skills in integrating spiritual assessment into the counseling of psychiatric patients when appropriate;

(2)    Determine what are appropriate interventions and appreciate what might be the consequences if the patient’s spiritual concerns are not addressed.

            Dr. King and Chaplain Wilson direct each monthly seminar in the fourth-year core Psychiatry clerkship.  Readings and two case studies are given to clerkship students in advance of this two-hour didactic seminar.  Students and preceptors analyze the cases using appropriate methods of spiritual assessment, and students discuss what kind of interventions are appropriate for each patient and why.            

            Finally, in regard to this proposed syllabus of integrated, coordinated courses taken by all medical students, all the courses that have been described are presently being taught.  While we believe this accomplishment of the last three years has been significant, we emphatically believe that the Spirituality and Medicine Curriculum at MUSC is on the verge of expansion into a third phase. 

            Phase I was the conceptual development and teaching of the “taproot” course, Spirituality in Health Care, and auxiliary electives.  Phase II was the initial creation of an integrated Spirituality and Medicine Curriculum in the core curriculum of medical school.  Phase III focuses primarily on: (1) the expansion of formal teaching into two additional clinical clerkships, (2) more extensive faculty development for expanded teaching venues, (3) full integration of spirituality and medicine with the new (proposed) Palliative Care/End Of Life Program based in the MUSC Hollings Cancer Center, and (4) strategic publication and dissemination of ideas and models.  With the enlarging core of faculty both prepared and dedicated to this enterprise, and with the institutional validation accorded by the Templeton award, we expect the next four years to be even more productive than the last.

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