Integration of Spiritual History in Medical Curriculum of Medical Schools in Pakistan
Saima Ali, MBBS, FCPS (Pediatrics), DCH, Professor of Pediatric Medicine, Peshawar Medical College Peshawar
The revised World Health Organization (WHO) definition of health is that ” Health is a dynamic state of complete physical, mental, spiritual and social well being and not merely the absence of disease or infirmity”.
The addition of this 4th dimension i.e. spirituality in definition of health has opened new era of debate about:
• What shall be the benefits of introducing spirituality which is vaguely defined in different religions and communities?
• How to integrate spirituality in curriculum for under graduate and post graduate medical students?
The quality debate on first question about the benefits of introducing spirituality has been solved in Meta analysis of literature that has proved positive influence of spirituality especially on patient well being, enhanced coping, compliance for medication and early recovery. Spirituality has also been found instrumental in medical students in improving their attitude of compassionate care for patients.
Regarding the issue of integration of spiritual history, an outstanding author Christina Puchalski introduced the FICA for obtaining spiritual history. Other examples are HOPE, SPIRIT etc.
Pakistan is a country of 18 million people. The health education system of Pakistan is regulated by Pakistan Medical & Dental Council (PM&DC). As an affiliated medical college and Institute, we took an initiative in Peshawar Medical College Peshawar and Institute of Kidney Diseases Hayatabad Peshawar, to evolve a comprehensive strategy of integrating spiritual history in history taking of undergraduate and postgraduate medical students.
We are a pioneer in Pakistan by taking the first step of introducing integration of spiritual history in medical curriculum.
The learning objectives of this integration for medical students were:
1. The students must be able to elicit spiritual history.
2. Recognize the importance of spiritual history in spiritually motivated patient so as to help in overall compassionate management of patient.
3. Identify the need for provision of spiritual healer/ Chaplin to the patient.
4. Understand their own spirituality and how can it improve their professional development and find the basis of being called as physicians.
We devised a pneumonic for taking spiritual history, based upon the Quranic Translation for soul or spirit as “ROOH”.
R Recognize: Ask patient how he recognizes the importance of spirituality in health
O Objectivity: Ask patient what are the objectives of his inclination for spirituality e.g. Love, forgiveness, seeking attachment with God etc.
O Observance: Ask patient how frequent he attends the spiritual gathering, rituals, prayers etc.
H Helpfulness: Ask patient how spiritual intervention like prayers, lamentation and submission will help him in his medical care of decision making, coping, compliance and recovery.
The introduction of this pneumonic of commonly used term “ROOH” after validation and revalidation has resulted in significant improvement of 50 under- graduate medical students and 20 postgraduate residents in understanding the role of spirituality in management of patients and will enhance their professional skills after their graduation.
The revised World Health Organization (WHO) definition of health is that ” Health is a dynamic state of complete physical, mental, spiritual and social well being and not merely the absence of disease or infirmity”.
The addition of this 4th dimension i.e. spirituality in definition of health has opened new era of debate about:
• What shall be the benefits of introducing spirituality which is vaguely defined in different religions and communities?
• How to integrate spirituality in curriculum for under graduate and post graduate medical students?
The quality debate on first question about the benefits of introducing spirituality has been solved in Meta analysis of literature that has proved positive influence of spirituality especially on patient well being, enhanced coping, compliance for medication and early recovery. Spirituality has also been found instrumental in medical students in improving their attitude of compassionate care for patients.
Regarding the issue of integration of spiritual history, an outstanding author Christina Puchalski introduced the FICA for obtaining spiritual history. Other examples are HOPE, SPIRIT etc.
Pakistan is a country of 18 million people. The health education system of Pakistan is regulated by Pakistan Medical & Dental Council (PM&DC). As an affiliated medical college and Institute, we took an initiative in Peshawar Medical College Peshawar and Institute of Kidney Diseases Hayatabad Peshawar, to evolve a comprehensive strategy of integrating spiritual history in history taking of undergraduate and postgraduate medical students.
We are a pioneer in Pakistan by taking the first step of introducing integration of spiritual history in medical curriculum.
The learning objectives of this integration for medical students were:
1. The students must be able to elicit spiritual history.
2. Recognize the importance of spiritual history in spiritually motivated patient so as to help in overall compassionate management of patient.
3. Identify the need for provision of spiritual healer/ Chaplin to the patient.
4. Understand their own spirituality and how can it improve their professional development and find the basis of being called as physicians.
We devised a pneumonic for taking spiritual history, based upon the Quranic Translation for soul or spirit as “ROOH”.
R Recognize: Ask patient how he recognizes the importance of spirituality in health
O Objectivity: Ask patient what are the objectives of his inclination for spirituality e.g. Love, forgiveness, seeking attachment with God etc.
O Observance: Ask patient how frequent he attends the spiritual gathering, rituals, prayers etc.
H Helpfulness: Ask patient how spiritual intervention like prayers, lamentation and submission will help him in his medical care of decision making, coping, compliance and recovery.
The introduction of this pneumonic of commonly used term “ROOH” after validation and revalidation has resulted in significant improvement of 50 under- graduate medical students and 20 postgraduate residents in understanding the role of spirituality in management of patients and will enhance their professional skills after their graduation.