Bringing Wonder into Medicine: A Film-Based Curriculum
Carla Gober-Park, PhD., Director, Center for Spiritual Life and Wholeness, Loma Linda University
April Wilson, M.D.,MPH, Program Director, Preventive Medicine Residency, Loma Linda University
The future of healthcare is not “high-tech.” There will always be higher and higher “tech”. The future of healthcare is in people caring for people. However, the current culture and healthcare climate is the greatest challenge to this. While there are many reasons, there is one that rises above the others – the education and practice of healthcare. Studies (see Betancourt and Flynn, 2015) are beginning to show that continuity of care is directly related to how the patient feels in relation to the physician. Lack of connection, not listening, hurried or unthinking statements made by the physician all result in patients feeling that the physician is biased, prejudiced, uncaring, and/or incompetent. This often results in a patient not being compliant and potentially suffering further down the road. In addition, the reasons for physician behavior are complex. During a course for first year medical students (6 weeks into the first year), one medical student complained that he was being “forced” to be “selfish.” He explained, “I do nothing but study and think of myself; my friends and family are all focused on me, and I certainly have no time for service to others. And I don’t think this will end when I complete medical school. I will be revered by most, have more money than most, and the selfishness will continue.” When the professor turned to the rest of the class and asked how many other students could relate, ALL hands went up. One student remarked, “I’m afraid I will lose the wonder of medicine that made we want to be a physician in the first place. I entered the field because I felt called, but not called to be selfish.”
People in the field of healthcare have resonated with the importance of listening to and understanding the patient’s story. But there remains a lingering question: How do you teach physicians and other health caregivers to care in that way? – in a way that brings meaning to the physician as much as it does to the patient? – in a way that brings “wonder” into medicine? What does it mean, not only to be called, but to foster that calling all along the journey of a career in healthcare? These questions led us to carefully consider potential ways of breaking through the intellectualization that often impedes the healing process. Doctors and nurses are often viewed as dispensing agents and patients as objects to be re-situated. The challenge of bringing a sacred understanding of the human back into focus was huge. We wanted to develop the type of curriculum that could (and would) result in a culture shift within an educational and clinical institution – something that everyone would agree to – become committed to – regardless of their faith tradition or background – something that could be taught as well as practiced.
It soon became obvious that to get at the deepest levels of attitude and perception, we needed to incorporate the aesthetic, using story and metaphor to get through the intellectualization process in order to engage feelings and attitudes.
For this reason, we decided on the avenue of film to create a curriculum for physicians that would also be used for other healthcare professionals (nursing, physical therapy, dentistry, medical students, etc).
This curriculum is built around six films that are each 5-10 minutes in length, and are accompanied by a journaling process (both of which explore the intersection of spirituality and healthcare). These are not the traditional “teaching” films, but films developed from a more artistic/creative standpoint, for the purposes of affecting attitudes, as much as teaching skills. The curriculum also includes a clinical rounds segment, which provides opportunities for physicians and others to interview patients, with a debriefing and feedback/learning process led by a chaplain afterwards. This process highlights the importance of physician – chaplain collaboration in the teaching process.
The workshop will include the following:
Introduction: Discussion of how the film-based curriculum impacts culture change as much as personal change of the healthcare practitioner.
Films: We will present some of the films to help the participant understand both philosophy and content, illustrating how spiritual concepts can be used in an aesthetic work to more immediately affect thoughts, feelings, attitudes, and behaviors.
Journaling process: The journaling process that accompanies the films will be explored and questions addressed.
Clinical rounds: The clinical rounds developed for teaching these concepts will be described, discussed and questions answered. Taped excerpts from physicians and medical students experiencing these rounds (debriefing conversations) will be played for the audience. In addition, we will explore the importance of physician – chaplain collaboration.
Research: Research associated with the curriculum and clinical rounds will be shared and discussed.
Culture shift: The panel will join together in discussing how this type of mechanism contributes to culture shift within an institution.
Those presenting in this workshop are those who developed, teach and do research on this curriculum. This curriculum is newly developed (as of 2016) and is being used in a variety of healthcare disciplines within one health care educational and clinical entity and has been requested by several others.
April Wilson, M.D.,MPH, Program Director, Preventive Medicine Residency, Loma Linda University
The future of healthcare is not “high-tech.” There will always be higher and higher “tech”. The future of healthcare is in people caring for people. However, the current culture and healthcare climate is the greatest challenge to this. While there are many reasons, there is one that rises above the others – the education and practice of healthcare. Studies (see Betancourt and Flynn, 2015) are beginning to show that continuity of care is directly related to how the patient feels in relation to the physician. Lack of connection, not listening, hurried or unthinking statements made by the physician all result in patients feeling that the physician is biased, prejudiced, uncaring, and/or incompetent. This often results in a patient not being compliant and potentially suffering further down the road. In addition, the reasons for physician behavior are complex. During a course for first year medical students (6 weeks into the first year), one medical student complained that he was being “forced” to be “selfish.” He explained, “I do nothing but study and think of myself; my friends and family are all focused on me, and I certainly have no time for service to others. And I don’t think this will end when I complete medical school. I will be revered by most, have more money than most, and the selfishness will continue.” When the professor turned to the rest of the class and asked how many other students could relate, ALL hands went up. One student remarked, “I’m afraid I will lose the wonder of medicine that made we want to be a physician in the first place. I entered the field because I felt called, but not called to be selfish.”
People in the field of healthcare have resonated with the importance of listening to and understanding the patient’s story. But there remains a lingering question: How do you teach physicians and other health caregivers to care in that way? – in a way that brings meaning to the physician as much as it does to the patient? – in a way that brings “wonder” into medicine? What does it mean, not only to be called, but to foster that calling all along the journey of a career in healthcare? These questions led us to carefully consider potential ways of breaking through the intellectualization that often impedes the healing process. Doctors and nurses are often viewed as dispensing agents and patients as objects to be re-situated. The challenge of bringing a sacred understanding of the human back into focus was huge. We wanted to develop the type of curriculum that could (and would) result in a culture shift within an educational and clinical institution – something that everyone would agree to – become committed to – regardless of their faith tradition or background – something that could be taught as well as practiced.
It soon became obvious that to get at the deepest levels of attitude and perception, we needed to incorporate the aesthetic, using story and metaphor to get through the intellectualization process in order to engage feelings and attitudes.
For this reason, we decided on the avenue of film to create a curriculum for physicians that would also be used for other healthcare professionals (nursing, physical therapy, dentistry, medical students, etc).
This curriculum is built around six films that are each 5-10 minutes in length, and are accompanied by a journaling process (both of which explore the intersection of spirituality and healthcare). These are not the traditional “teaching” films, but films developed from a more artistic/creative standpoint, for the purposes of affecting attitudes, as much as teaching skills. The curriculum also includes a clinical rounds segment, which provides opportunities for physicians and others to interview patients, with a debriefing and feedback/learning process led by a chaplain afterwards. This process highlights the importance of physician – chaplain collaboration in the teaching process.
The workshop will include the following:
Introduction: Discussion of how the film-based curriculum impacts culture change as much as personal change of the healthcare practitioner.
Films: We will present some of the films to help the participant understand both philosophy and content, illustrating how spiritual concepts can be used in an aesthetic work to more immediately affect thoughts, feelings, attitudes, and behaviors.
Journaling process: The journaling process that accompanies the films will be explored and questions addressed.
Clinical rounds: The clinical rounds developed for teaching these concepts will be described, discussed and questions answered. Taped excerpts from physicians and medical students experiencing these rounds (debriefing conversations) will be played for the audience. In addition, we will explore the importance of physician – chaplain collaboration.
Research: Research associated with the curriculum and clinical rounds will be shared and discussed.
Culture shift: The panel will join together in discussing how this type of mechanism contributes to culture shift within an institution.
Those presenting in this workshop are those who developed, teach and do research on this curriculum. This curriculum is newly developed (as of 2016) and is being used in a variety of healthcare disciplines within one health care educational and clinical entity and has been requested by several others.