Anandarajah Gowri, Roseman Janet, Lee Danny, Dhandhania Nupur
Department of Family Medicine and Section of Medical Science, Warren Alpert Medical School, Brown University and Hope Hospice & Palliative Care Rhode Island, Providence, Rhode Island, USA.
Nova Southeastern College of Osteopathic Medicine, Fort Lauderdale, Florida, USA.
J Pain Symptom Manage. 2016 Dec;52(6):859-872.e1. doi: 10.1016/j.jpainsymman.2016.06.006. Epub 2016 Oct 3.
Although spiritual care (SC) is recognized as important in whole-person medicine, physicians infrequently address patients' spiritual needs, citing lack of training. Although many SC curricula descriptions exist, few studies report effects on physicians.
To broadly examine immediate and long-term effects of a required, longitudinal, residency SC curriculum, which emphasized inclusive patient-centered SC, compassion, and spiritual self-care.
We conducted in-depth individual interviews with 26 physicians (13 intervention; 13 comparison) trained at a 13-13-13 residency. We interviewed intervention physicians three times over 10 years-1) preintervention, as PGY1s, 2) postintervention, as PGY3s, 3) eight-year postintervention, as practicing physicians. We interviewed comparison physicians as PGY3s. Interviews were audio-recorded, transcribed, and analyzed by four researchers.
Forty-nine interviews were analyzed. General: Both groups were diverse regarding personal importance of spirituality/religion. All physicians endorsed the value of SC, sharing rich patient stories particularly related to end of life and cultural diversity. Curricular effects: 1) skills/barriers-intervention physicians demonstrated progressive improvements in clinical approach, accompanied by diminishing worries related to SC. PGY3 comparison physicians struggled with SC skills and worries more than PGY3 intervention physicians, 2) physician formation-most physicians described residency as profoundly challenging and transformative. Even after eight years, many intervention physicians noted that reflection on their diverse beliefs and values in safety, coupled with compassion shown to them through this curriculum, had deeply positive effects. High impact training: patient-centered spiritual assessment; chaplain rounds; spiritual self-care workshop/retreats; multicultural SC framework.
A longitudinal, multifaceted residency SC curriculum can have lasting positive effects on physicians' SC skills and their professional/personal formation.
尽管精神关怀（SC）在全人医学中被认为很重要，但医生很少关注患者的精神需求，理由是缺乏相关培训。虽然存在许多精神关怀课程描述，但很少有研究报告其对医生的影响。
广泛考察一门必修的、纵向的住院医师精神关怀课程的即时和长期效果，该课程强调以患者为中心的包容性精神关怀、同情心和精神自我关怀。
我们对在一个13-13-13住院医师培训项目中接受培训的26名医生（13名干预组；13名对照组）进行了深入的个人访谈。我们在10年里对干预组医生进行了三次访谈——1）干预前，作为第一年住院医师时；2）干预后，作为第三年住院医师时；3）干预后八年，作为执业医生时。我们在他们作为第三年住院医师时对对照组医生进行了访谈。访谈进行了录音、转录，并由四名研究人员进行分析。
共分析了49次访谈。总体情况：两组在灵性/宗教对个人的重要性方面都具有多样性。所有医生都认可精神关怀的价值，分享了丰富的患者故事，尤其是与生命末期和文化多样性相关的故事。课程效果：1）技能/障碍——干预组医生在临床方法上表现出逐步改善，同时与精神关怀相关的担忧减少。第三年住院医师对照组医生在精神关怀技能方面存在困难，且比第三年住院医师干预组医生更担忧，2）医生成长——大多数医生将住院医师培训描述为极具挑战性且具有变革性。即使在八年之后，许多干预组医生指出，对他们在安全方面的不同信仰和价值观进行反思，再加上通过该课程所展现出的同情心，产生了非常积极的影响。高影响力培训：以患者为中心的精神评估；牧师查房；精神自我关怀工作坊/静修；多元文化精神关怀框架。
一门纵向的、多方面的住院医师精神关怀课程可以对医生的精神关怀技能及其专业/个人成长产生持久的积极影响。
