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Examining Medicine's Spiritual Side

During medical school, the majority of students’ curriculum is centered around the biomedical sciences and how to relieve a patient’s physical pain.

But little attention is paid in the clinical years to relieving a patient’s spiritual distress.

Two GW professors are trying to help medical students explore the spiritual impact of their work by providing an opportunity for students to reflect on their call to serve others and what it means to be compassionate to their patients.

“A lot of medical students are overwhelmed by the pain and sadness their patients experience, and when they don’t get a chance to process it, it just gets buried,” says Christina Puchalski, M.D. '94, RESD '97, director of the George Washington Institute for Spirituality and Health (GWish). “Patients can lose their sense of meaning or their sense of who they are. Patients want compassionate doctors, not just technical ones.”

Thanks to a more than $455,000 grant from the John Templeton Foundation – an organization that funds research on a broad range of scientific and philosophical topics—Dr. Puchalski and Dr. Benjamin Blatt, medical director of the CLASS Clinical Skills Center in the George Washington University Medical Center, have created the GWish-Templeton Reflective Rounds.

One of the main purposes of the reflective rounds is for students to find meaning in their work, think about their own spirituality and learn appropriate boundaries with patients.

GW will pilot the program this spring with a group of third-year medical students to participate in a reflective round once a week for a month. The round will be led by a physician or a chaplain, and students will be split into groups of six to eight. During the rounds, students will be asked to discuss how their experiences with patients have impacted them and might affect their future actions and decision making.

GWish recently put out a request for proposals that will invite medical schools from the U.S. and Canada to apply to implement these rounds at their school. Proposals are due by April 8, and the top eight schools will be selected. Schools will be judged on the quality of their current courses in spirituality and health, the strength of the faculty who will teach the rounds and their plans for sustaining the rounds into the future.

“Medical students and physicians deal with very difficult life and death issues all the time, and yet unlike other professions, there is no method within the current culture to process what happens,” says Dr. Blatt, a professor of medicine in GW’s School of Medicine and Health Sciences.

Dr. Blatt says the rounds have the power to prevent burnout and depression in medical students.

“We hope that it’s going to develop doctors that are more in touch with themselves and more able to relate to and to communicate with their patients and more able to receive personal satisfaction from their profession,” he says.

GWish, which was created in 2001, has a mission of fostering a more compassionate system of health care through research, education and policy work that’s focused on addressing the spiritual needs of patients, families and health care professionals. GWish has become a leader in developing a field of spirituality and health. The organization works with medical schools and clinical sites both nationally and internationally to implement spirituality into their curriculum and practices.

“We have a health care system that’s really broken,” says Dr. Puchalski, a professor of medicine and health sciences. “Patients feel very fragmented in our system. Doctors don’t have adequate time to do patient education. It’s difficult for patients to talk to a pharmacist on the phone to understand their medications. At every level, there’s very high stress.”

Dr. Puchalski developed the first course on spirituality’s role in patient care in 1992. Today, more than 75 percent of U.S. medical schools include spirituality education in their curriculum for first or second-year medical students. But when students move into rotations for their third and fourth-year, spiritual development gets lost, says Dr. Puchalski.

“We need to have a reflective practice. Spiritual development needs to be part of professional development, says Dr. Puchalski. “Our role as a patient’s physician is not to just get lab results and diagnose and treat your patients’ physical pain. Our roles as doctors are to form deep, caring relationships with our patients and to help them find peace in the midst of suffering and distress.”

Dr. Puchalski says the word “spirituality” means much more than religion when it comes to health care.

“Spirituality refers to the search for meaning and purpose that is common to humanity. It also refers to the connectedness all people experience to others, nature, the significant or sacred. It is often the way people transcend or cope with suffering,” she says. “If students can reflect on who they are as people and reflect on how those relationships with patients impact them, they’ll become better doctors. Our relationships with patients have the potential to transform us all the time.”

Dr. Puchalski hopes the reflective rounds can eventually be implemented in all U.S. medical schools.

”I expect these rounds to set the stage for medical students to experience their sense of meaning in their professional life, an awareness of what has called them to serve others and learn the skills of reflection upon which to build their own capacity to provide compassionate care,” she says.