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Spirituality and Religion in Psychiatry Residency Programs M. Jafferany, MD G-2 Resident Hennepin-Regions Psychiatry Program.

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Presentation on theme: "Spirituality and Religion in Psychiatry Residency Programs M. Jafferany, MD G-2 Resident Hennepin-Regions Psychiatry Program."— Presentation transcript:

1 Spirituality and Religion in Psychiatry Residency Programs M. Jafferany, MD G-2 Resident Hennepin-Regions Psychiatry Program

2 INTRODUCTION The relationship between spirituality and medicine has been the focus of considerable interest in recent years. 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. 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.

3 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. Over the last two decades, mental health professionals have recognized the importance of religion in the lives of many people in US. Incorporation of patients spirituality into mental health assessment and treatment plans is gaining momentum. Incorporation of patients spirituality into mental health assessment and treatment plans is gaining momentum.

4 Patients vs. Providers A clear disparity exists between religiosity of general population and mental health professionals. 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. There is a growing public interest in incorporating spirituality and religiosity in health care delivery.

5 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. 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. 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 Bergin Ae, Jensen JP. Religiosity of psychotherapists: a national survey. Psychotherapy :3-7

6 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. 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. 94% of inpatients believe spiritual health to be as important as physical well being. 77% wanted spiritual issues to be considered in their care 77% wanted spiritual issues to be considered in their care 68% reported no discussion of their religious beliefs by physicians. 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

7 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. 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. 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

8 Debate continues Debate continues regarding the optimal ways of addressing issues related to spirituality and religion. Debate continues regarding the optimal ways of addressing issues related to spirituality and religion. It is well known now that patients belief system plays a key role in patient development and remain a powerful influence on responses to current illness, treatment and life demands. It is well known now that patients 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 Different schools of thoughts

9 Proponents They point to research findings that support a positive relationship between spirituality and health. 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. 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):

10 Opponents They argue that scientific evidence for an association between spirituality and health status is lacking. 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 patients religious or spiritual affairs They concern about several ethical issues regarding physician involvement in a patients religious or spiritual affairs Sloan RP, Bagiella E, Powell T. Religion Spirituality and Medicine. Lancet 1999; 353:664-67

11 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. 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. 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 (1):81-9

12 H O P E Questionnaire H- Sources of Hope, comfort, meaning, strengths, peace, love, connection H- Sources of Hope, comfort, meaning, strengths, peace, love, connection O- Organized religion O- Organized religion P- Personal spirituality and Practices P- Personal spirituality and Practices E- Effects on medical care and end of life issues E- Effects on medical care and end of life issues

13 A P A APA has recognized that psychiatrists require basic understanding of religious and spiritual issues. APA has recognized that psychiatrists require basic understanding of religious and spiritual issues. Curricular changes in US residency programs, since then followed. 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. 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

14 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. 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 Results suggest that Religious ideation by resident candidates is a relatively unimportant variable in the programs' selection Religious ideation by resident candidates is a relatively unimportant variable in the programs' selection Didactic instruction on any aspect of religion is infrequent Didactic instruction on any aspect of religion is infrequent Clinical supervision on religious dynamics is variable Clinical supervision on religious dynamics is variable Academic progression is rarely impeded by behaviors emanating from residents' religious values. 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

15 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 patients 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

16 ACGME Requirements ACGME program requirements for residency training in psychiatry were amended to reflect these new changes. 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. 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 : Program requirements for residency education in psychiatry Chicago IL: American Medical Association; 1995

17 A Model Curriculum The curriculum is organized into 11 modules that address the following topics: The curriculum is organized into 11 modules that address the following topics: The relation between religion and mental health. The relation between religion and mental health. Interviewing and assessment skills Interviewing and assessment skills Religion and spirituality in human development Religion and spirituality in human development Working with clergy Working with clergy Working in the C-L settings Working in the C-L settings Introduction to God images Introduction to God images Introduction to charismatic religious experience Introduction to charismatic religious experience Introduction to cults Introduction to cults Religious and spiritual issues in the treatment of women, substance abuse and abused persons. 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

18 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. 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. By 2001, 16 psychiatric residency programs in US had received this award.

19 JTF Award programs In these programs, the mandatory curriculum spans the length of residency and include both didactic and clinical components. 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. Time devoted to the didactic component ranges from 12 to 81 hours. The clinical component includes The clinical component includes Group case-based discussions Group case-based discussions Teaching clinical interviewing skills needed to take a religious and spiritual history. Teaching clinical interviewing skills needed to take a religious and spiritual history. Formal collaboration with chaplains Formal collaboration with chaplains Mandatory case based supervision during clinical rotations. Mandatory case based supervision during clinical rotations. Offering of clinical and research elective opportunities. Offering of clinical and research elective opportunities.

20 Religion and Spirituality in Canadian curricula in 14/16 programs TRAINING AVAILABLE Residency programs Lectures 4 Research electives 3 Case-based supervision 9 Clinical electives 2 No training available 4

21 A New Proposal for Canadian Curricula Introduction to religion and spirituality and Psychiatry. Introduction to religion and spirituality and Psychiatry. Religion and spirituality in human development Religion and spirituality in human development Overview of selected major religions (Buddhism, Taoism, Hinduism) Overview of selected major religions (Buddhism, Taoism, Hinduism) Christianity Christianity Islam Islam Judaism Judaism Transpersonal psychology Transpersonal psychology First Nations spirituality and Shamanism First Nations spirituality and Shamanism Religious and spiritual issues in psychotherapy Religious and spiritual issues in psychotherapy Resident-facilitated case conference Resident-facilitated case conference

22 A New Proposal for Canadian Curricula ……. The proposed curriculum is limited to 10 academic sessions ( minutes each). The proposed curriculum is limited to 10 academic sessions ( minutes each). This differs from Larsons model in emphasizing basic knowledge about specific religious and spiritual practices. This differs from Larsons 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. 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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