A Can of Worms: Respecting Process while Conveying Content in teaching Medical Trainees about Culture and Religion
Rania Awaad, M.D., Clinical Instructor in Psychiatry and Director, Stanford Muslims and Mental Health Lab, Stanford University School of Medicine
Belinda Bandstra, M.D., Clinical Assistant Professor, Psychiatry and Behavioral Sciences, Stanford University School of Medicine
Sara Ali, M.D. Stanford University School of Medicine
By the end of this session, participants will be able to
(1) Characterize the tension between presenting didactic content and allowing for process in teaching culture and religion to trainees.
(2) Describe key features of knowledge, skills and attitudes that trainees should develop in dealing with issues of culture and religion/spirituality.
(3) List examples of innovative ways of meeting the professionalism milestone of delivering treatment that is sensitive to diversity, as well as understanding the intersection between one’s own cultural background and beliefs and one’s interactions with patients.
Practice Gap:
The professionalism milestones state that a trainee should be able to “3.1 elicit beliefs, values, and diverse practices of patients and their families and understand their potential impact on patient care,” and “4.3 deliver treatment sensitive to diversity and discuss (their) own cultural background and beliefs, in the ways in which these affect interactions with patients.” Indeed, in our increasingly diverse world, it is imperative that trainees learn cultural competence to become well-rounded medical professionals. However, the literature describes that addressing culture with US clinical trainees is like “opening up a huge can of worms” (Willen et al. 2010): there is an affective potency that surrounds these issues that cannot be ignored. The discussion of religion/spirituality in overall health is similarly emotionally charged, and raises issues of the tension between presenting didactic content and allowing for process. This workshop introduces a curriculum that addresses both process and content in a culture and religion/spirituality course.
Abstract:
The issue of patient culture and its effect on access to medical services has been important in American medicine for many years. However, despite much effort to increase equity and cultural sensitivity, studies continue to demonstrate disparities in treatment by culture, race, and ethnicity throughout the medical field. Similarly, religion/spirituality is a major issue in medicine: 75-90% of ill patients report spiritual or religious needs during hospitalization (Fitchett et al. 1997) and over 70% of those spiritual needs are addressed minimally or not at all by the health care system (Balboni et al. 2007). Despite the staggering importance of this, it remains remarkably difficult to teach culture and religion/spirituality to trainees. Resistance and heightened affect are frequently evoked when these issues are brought up. Questions of what topics should be taught, and in what sort of learning environment, are open for debate in the literature.
This workshop reviews the literature on courses in culture and religion offered to medical trainees, distilling key themes as well as recurrent challenges in teaching these topics. We will then present a curriculum that attempts to bridge process and content, including calling upon trainees to reflect on their own cultural and spiritual identities, and their own clinical encounters with otherness and difference. Our curriculum:
(1) begins by guiding trainees through a discussion of what it feels like to talk about culture in the didactic context;
(2) reviews the cultural formulation standardized in the DSM-5 and challenges trainees to apply the formulation to their own personal cultural experience(s);
(3) addresses the culture of medicine;
(4) discusses cases where culture is a noted factor in the relationship between the patient and the provider;
(5) looks at how, when and where one might address spirituality in patient care;
(6) considers the barriers and boundaries of addressing spirituality as well as the possibility of harm in bringing spiritual/religious issues into the medical context;
(7) addresses spiritually-laden themes in patient care, such as guilt, death/dying/suicide and mindfulness/meditation.
We will present some preliminary survey data regarding the effectiveness of our curricular approach, and facilitate discussion regarding best practices in teaching these topics.
Belinda Bandstra, M.D., Clinical Assistant Professor, Psychiatry and Behavioral Sciences, Stanford University School of Medicine
Sara Ali, M.D. Stanford University School of Medicine
By the end of this session, participants will be able to
(1) Characterize the tension between presenting didactic content and allowing for process in teaching culture and religion to trainees.
(2) Describe key features of knowledge, skills and attitudes that trainees should develop in dealing with issues of culture and religion/spirituality.
(3) List examples of innovative ways of meeting the professionalism milestone of delivering treatment that is sensitive to diversity, as well as understanding the intersection between one’s own cultural background and beliefs and one’s interactions with patients.
Practice Gap:
The professionalism milestones state that a trainee should be able to “3.1 elicit beliefs, values, and diverse practices of patients and their families and understand their potential impact on patient care,” and “4.3 deliver treatment sensitive to diversity and discuss (their) own cultural background and beliefs, in the ways in which these affect interactions with patients.” Indeed, in our increasingly diverse world, it is imperative that trainees learn cultural competence to become well-rounded medical professionals. However, the literature describes that addressing culture with US clinical trainees is like “opening up a huge can of worms” (Willen et al. 2010): there is an affective potency that surrounds these issues that cannot be ignored. The discussion of religion/spirituality in overall health is similarly emotionally charged, and raises issues of the tension between presenting didactic content and allowing for process. This workshop introduces a curriculum that addresses both process and content in a culture and religion/spirituality course.
Abstract:
The issue of patient culture and its effect on access to medical services has been important in American medicine for many years. However, despite much effort to increase equity and cultural sensitivity, studies continue to demonstrate disparities in treatment by culture, race, and ethnicity throughout the medical field. Similarly, religion/spirituality is a major issue in medicine: 75-90% of ill patients report spiritual or religious needs during hospitalization (Fitchett et al. 1997) and over 70% of those spiritual needs are addressed minimally or not at all by the health care system (Balboni et al. 2007). Despite the staggering importance of this, it remains remarkably difficult to teach culture and religion/spirituality to trainees. Resistance and heightened affect are frequently evoked when these issues are brought up. Questions of what topics should be taught, and in what sort of learning environment, are open for debate in the literature.
This workshop reviews the literature on courses in culture and religion offered to medical trainees, distilling key themes as well as recurrent challenges in teaching these topics. We will then present a curriculum that attempts to bridge process and content, including calling upon trainees to reflect on their own cultural and spiritual identities, and their own clinical encounters with otherness and difference. Our curriculum:
(1) begins by guiding trainees through a discussion of what it feels like to talk about culture in the didactic context;
(2) reviews the cultural formulation standardized in the DSM-5 and challenges trainees to apply the formulation to their own personal cultural experience(s);
(3) addresses the culture of medicine;
(4) discusses cases where culture is a noted factor in the relationship between the patient and the provider;
(5) looks at how, when and where one might address spirituality in patient care;
(6) considers the barriers and boundaries of addressing spirituality as well as the possibility of harm in bringing spiritual/religious issues into the medical context;
(7) addresses spiritually-laden themes in patient care, such as guilt, death/dying/suicide and mindfulness/meditation.
We will present some preliminary survey data regarding the effectiveness of our curricular approach, and facilitate discussion regarding best practices in teaching these topics.