Pettus Mark C
University of Massachusetts School of Medicine, Pittsfield, 01201, USA.
Acad Med. 2002 Jul;77(7):745. doi: 10.1097/00001888-200207000-00033.
To promote greater sensitivity to and heightened awareness of the relevance and therapeutic potential of integrating medicine and spirituality in the healing process of patients cared for by our medical residents. Strategies for clear, effective, and empathetic communication are integrated into the curriculum.
With the support of The University of Massachusetts Medical School Macy Initiative in health communication, funded by the Josiah Macy, Jr. Foundation, we have fully implemented a medicine-spirituality curriculum as an integral aspect of our residency program. Current strategies include (1) new house officers participate in the workshop "Communicating Bad News," which is based on a videotaped interaction and experiential role-play about the challenging "art" of sharing bad and often traumatic news; (2) a monthly lecture series that looks at various aspects of religious and spiritual practices and their implications on science and health with topics including the following: taking a spiritual history, exploring world religious views from a Judeo-Christian perspective, studying Eastern philosophies such as Buddhism and Hinduism, and discussing cultural diversity's effect on how people understand and cope with illness; (3) residents receive a comprehensive, evidence-based syllabus that encompasses all of the medical literature relating to spirituality, religion and health; (4) local hospice professionals give end-of-life care lectures about pain management, palliation, advanced directives, and ethical implications; (5) our residents spend one or two days per year with our pastoral care leaders and one to two days per year with our hospice team; (6) monthly ward rounds with a faculty member who emphasizes the spiritual dimension of a particular case and the faith-based resources in our hospital and community.
Traditionally, graduate medical education has not emphasized the importance of spirituality as a "target" for routine inquiry, understanding, and sharing in the context of patient care. We are beginning to see that residents need to be aware of the relationship between spirituality and health, as a consequence of this curriculum. Because the curriculum is seamlessly integrated into a preexisting infrastructure (e.g., noon conferences, ambulatory off-site experiences, walk-rounds, etc.), it has been relatively easy to implement. Focusing on the literature has also provided a "scientific door" that has made this more palatable. Over time, we will foster a growing alliance of the medical and faith communities in our rural area. This has potent implications for community health initiatives. Two of our residents have already volunteered to give talks at local congregations. Spirituality and religion are sensitive and personal areas that can be awkward to embrace and openly discuss. By remaining sensitive and respectful of all views, we strive to diminish the obstacles and enable a more provocative, enlightening residency experience. As a consequence, we are forced to reconsider what it is to be a "healer" and what it is to be "healed." Annual verbal and written feedback will allow us to refine our curriculum. I anticipate this to be a permanent aspect of our residents' training.
提高我们的住院医师在照顾患者的治疗过程中，对医学与精神性相结合的相关性和治疗潜力的敏感度和认知度。清晰、有效且富有同理心的沟通策略被纳入课程。
在由小约西亚·梅西基金会资助的马萨诸塞大学医学院梅西健康沟通倡议的支持下，我们已全面实施了一门医学 - 精神性课程，作为住院医师培训项目的一个组成部分。当前的策略包括：（1）新入职的住院医师参加“传达坏消息”工作坊，该工作坊基于一段录像互动以及关于分享坏消息且往往是创伤性消息这一具有挑战性的“艺术”的体验式角色扮演；（2）每月举办一系列讲座，探讨宗教和精神实践的各个方面及其对科学和健康的影响，主题包括：获取精神病史、从犹太 - 基督教视角探索世界宗教观点、研究佛教和印度教等东方哲学，以及讨论文化多样性对人们理解和应对疾病的影响；（3）住院医师会收到一份全面的、基于证据的教学大纲，其中涵盖了所有与精神性、宗教和健康相关的医学文献；（4）当地临终关怀专业人员就疼痛管理、姑息治疗、预先指示和伦理问题进行临终护理讲座；（5）我们的住院医师每年与我们的牧师关怀负责人共度一到两天，每年与我们的临终关怀团队共度一到两天；（6）每月与一位教员进行病房查房，教员会强调特定病例的精神层面以及我们医院和社区中基于信仰的资源。
传统上，毕业后医学教育并未强调精神性作为患者护理中常规询问、理解和分享的“目标”的重要性。由于这门课程，我们开始看到住院医师需要意识到精神性与健康之间的关系。因为该课程无缝融入了现有的基础设施（如午间会议、门诊校外体验、巡诊等），所以实施起来相对容易。专注于相关文献也提供了一扇“科学之门”，使这一课程更容易被接受。随着时间的推移，我们将在我们的农村地区促进医学和信仰社区之间日益紧密的联盟。这对社区健康倡议具有重要意义。我们的两名住院医师已经自愿在当地教会进行演讲。精神性和宗教是敏感且个人化的领域，接受并公开讨论可能会令人尴尬。通过保持对所有观点的敏感和尊重，我们努力减少障碍，营造更具启发性、更能带来启发的住院医师培训体验。因此，我们被迫重新思考成为一名“治疗者”意味着什么以及被“治愈”意味着什么。年度口头和书面反馈将使我们能够完善我们的课程。我预计这将成为我们住院医师培训的一个永久性组成部分。
