Moral, Religious, and Spiritual Dimensions to Medical Formation
Moderator: Nicholas Sparks, PhD (c), Saint Louis University
Panelists: Kristin Collier, MD, Associate Professor of Medicine, Director of Program on Health, Spirituality and Religion, University of Michigan; Kimbell Kornu, MD, PhD, Provost's Professor of Bioethics, Theology and Christian Formation, Belmont University; Andrew Michel, MD, Associate Professor of Psychiatry, Belmont University; and Morgan Wills, MD, President and CEO, Siloam Health
A conception of the nature and boundaries of medicine is instilled, implicitly and explicitly, during medical education. The training of physicians involves initiation into a culture with its own traditions of thought and practice, embodying a specific conception of the human being, what is needed for their care, and what sort of training is appropriate for those charged with the care of human life. This panel discussion centers on the moral, spiritual, and religious dimensions of medical education. This panel of academic clinicians—an internist, a psychiatrist, a palliative care physician, and an internist/CEO—each reflect on the place of morality, spirituality, and religion within/beside the contemporary medical imaginary, and on robust alternatives to medical education apart from the contemporary medical imaginary.
The first panelist, an academic palliative care clinician, will present the vision for a new Christian medical school that is in the accreditation process. The mission is explicitly Christian yet prioritizes hospitality and openness to all students. A distinguishing mark is its commitment to character and virtue formation as fundamental to the training of good physicians. As Alasdair MacIntyre has shown, every virtue ethic is grounded and contextualized within a larger narrative. As part of its Christian vision, the curriculum will frame its virtue formation in light of the Christian narrative of creation, fall, and redemption in Christ. This cosmic narrative framing enables the curriculum to engage in fundamental issues that the traditional medical curriculum does not address but only assumes, such as: What is medicine? Why is medicine even necessary and what is medicine for (i.e., why is there disease and death, and what is the proper response)? What is health? What is illness? Such a framing creates a space to deconstruct the technocratic, bureaucratic, and Baconian assumptions of modern medical training. Yet, such framing also creates a space to provide a robust constructive account of medical training that is incarnational: embodied, integrative, relational, and imbued with wonder. In this way, the curriculum integrates head and heart, spiritual and medical, scientific and clinical, and theory and practice, oriented towards the whole-person formation of competent and compassionate physicians in service to patients as whole persons.
The second panelist, an academic psychiatrist, explores formative practices that might enrich and prepare students to encounter the breadth of the human condition. The modern practice of medicine, as conceived and instantiated within the Enlightenment tradition, assumes an ethic of objective mastery over disease that is heavily reliant on the prowess of empirical knowing. Likewise, students entering this tradition have been long schooled and selected for traits that heavily reinforce rational control over nature and experience. Nevertheless, the breadth of human illness, disease, tragedy, and uncertainty inevitably draws students of medicine into terrains where a reliance on a hypercognitive epistemology is unable to sustain a deeply coherent practice. What formative practices might be available to students that would enrich them in ways of being and knowing to prepare them psychologically, morally, and spiritually for the disillusionments inherent in the practice of medicine? Is it absurd to imagine that medical students might be invited into contemplative practices of prayer and reflection that encourage vigilant attention to one’s internal life, thick phenomenological presence to the patient as an “other” increasingly un-othered, and surrender of self in freedom and honest abandon to the intuitive power of “not-knowing” beyond all rational knowing?
The third panelist, an academic internist, will review her work at a public medical school in the realm of formation and professional identity formation. Medicine is a moral, spiritual practice as medicine, by its very nature is steeped in meaning. How do we, as medical educators, assist our medical students in professional identity formation, in a milieu that is increasingly foreign to deep discussions of meaning? Formation, by definition, means to ‘give shape.’ We, as medical educators, can assist our learners in ‘giving shape’ to what it means to be a professional in the vocation of medicine. As Warren Kinghorn has written, medical school “professionalism statements are written to capture consensus, and they rarely acknowledge the external moral traditions on which the virtues depend, because doing so would, in a pluralistic culture, entail the risk of moral disagreement and division.” (Kinghorn et al. 2007) The panelist agrees that “meaningful education in professionalism must look beyond the consensus statements and deeply engage the particular cultural traditions external to the practice of medicine that sustain the professional virtues.” This panelist will review how moral formation in medical education should embody an open pluralism, one in which students with a religious and or spiritual identity are free to lean into their own traditions and be supported in doing so, in their work of moral formation. Allowing this recognizes the reality that there is no ‘view from nowhere’ and that the marginalization of religion and spirituality from the work of moral formation is antithetical to the tenets of DEI within medical education and harmful for those students who have these beliefs as we strive to help them understand not only meaning in medicine, but how they can develop an integrated personal-professional identity that will assist them in the trials ahead in their work.
The fourth panelist, an internist/CEO at a Christian nonprofit health center, will share from his team’s experience mentoring medical students from a variety of faith backgrounds in a community clinic setting. Such non-traditional settings, he attests, can play a vital role in the formation of future physicians. As Fred Hafferty has argued, the “hidden curriculum” in medication is best challenged when we “create structures that allow individual [students] to reflect upon the larger structural picture of which they are a part.” (Hafferty 1998) That challenge is particularly compelling when the community-based setting is both explicitly and implicitly shaped by “thick” practices of a particular faith tradition that is experience on its own terms. This panelist will reflect on how particular rituals, staffing practices, team dynamics, and financial incentives form a unique opportunity for students to empirically “taste” an alternative way of practicing medicine. By creating an atmosphere conducive to self-reflection on the part of trainees about the assumptions of the traditional medical training system, faith-based community immersions provide an invaluable catalyst to broader efforts to form virtuous medical professionals who care for the whole person.
Bibliography
Hafferty, Frederic W. “Beyond Curriculum Reform: Confronting Medicine’s Hidden Curriculum.” Academic Medicine. 1998. Volume 73, issue 4. 403-407.
Kinghorn, Warren A., McEvoy, Matthew D., Michel, Andrew, Balboni, Michael. “Professionalization in Modern Medicine: Does the Emperor Have Any Clothes?” Academic Medicine. 2007. Volume 82, issue 1. 40-45.
The first panelist, an academic palliative care clinician, will present the vision for a new Christian medical school that is in the accreditation process. The mission is explicitly Christian yet prioritizes hospitality and openness to all students. A distinguishing mark is its commitment to character and virtue formation as fundamental to the training of good physicians. As Alasdair MacIntyre has shown, every virtue ethic is grounded and contextualized within a larger narrative. As part of its Christian vision, the curriculum will frame its virtue formation in light of the Christian narrative of creation, fall, and redemption in Christ. This cosmic narrative framing enables the curriculum to engage in fundamental issues that the traditional medical curriculum does not address but only assumes, such as: What is medicine? Why is medicine even necessary and what is medicine for (i.e., why is there disease and death, and what is the proper response)? What is health? What is illness? Such a framing creates a space to deconstruct the technocratic, bureaucratic, and Baconian assumptions of modern medical training. Yet, such framing also creates a space to provide a robust constructive account of medical training that is incarnational: embodied, integrative, relational, and imbued with wonder. In this way, the curriculum integrates head and heart, spiritual and medical, scientific and clinical, and theory and practice, oriented towards the whole-person formation of competent and compassionate physicians in service to patients as whole persons.
The second panelist, an academic psychiatrist, explores formative practices that might enrich and prepare students to encounter the breadth of the human condition. The modern practice of medicine, as conceived and instantiated within the Enlightenment tradition, assumes an ethic of objective mastery over disease that is heavily reliant on the prowess of empirical knowing. Likewise, students entering this tradition have been long schooled and selected for traits that heavily reinforce rational control over nature and experience. Nevertheless, the breadth of human illness, disease, tragedy, and uncertainty inevitably draws students of medicine into terrains where a reliance on a hypercognitive epistemology is unable to sustain a deeply coherent practice. What formative practices might be available to students that would enrich them in ways of being and knowing to prepare them psychologically, morally, and spiritually for the disillusionments inherent in the practice of medicine? Is it absurd to imagine that medical students might be invited into contemplative practices of prayer and reflection that encourage vigilant attention to one’s internal life, thick phenomenological presence to the patient as an “other” increasingly un-othered, and surrender of self in freedom and honest abandon to the intuitive power of “not-knowing” beyond all rational knowing?
The third panelist, an academic internist, will review her work at a public medical school in the realm of formation and professional identity formation. Medicine is a moral, spiritual practice as medicine, by its very nature is steeped in meaning. How do we, as medical educators, assist our medical students in professional identity formation, in a milieu that is increasingly foreign to deep discussions of meaning? Formation, by definition, means to ‘give shape.’ We, as medical educators, can assist our learners in ‘giving shape’ to what it means to be a professional in the vocation of medicine. As Warren Kinghorn has written, medical school “professionalism statements are written to capture consensus, and they rarely acknowledge the external moral traditions on which the virtues depend, because doing so would, in a pluralistic culture, entail the risk of moral disagreement and division.” (Kinghorn et al. 2007) The panelist agrees that “meaningful education in professionalism must look beyond the consensus statements and deeply engage the particular cultural traditions external to the practice of medicine that sustain the professional virtues.” This panelist will review how moral formation in medical education should embody an open pluralism, one in which students with a religious and or spiritual identity are free to lean into their own traditions and be supported in doing so, in their work of moral formation. Allowing this recognizes the reality that there is no ‘view from nowhere’ and that the marginalization of religion and spirituality from the work of moral formation is antithetical to the tenets of DEI within medical education and harmful for those students who have these beliefs as we strive to help them understand not only meaning in medicine, but how they can develop an integrated personal-professional identity that will assist them in the trials ahead in their work.
The fourth panelist, an internist/CEO at a Christian nonprofit health center, will share from his team’s experience mentoring medical students from a variety of faith backgrounds in a community clinic setting. Such non-traditional settings, he attests, can play a vital role in the formation of future physicians. As Fred Hafferty has argued, the “hidden curriculum” in medication is best challenged when we “create structures that allow individual [students] to reflect upon the larger structural picture of which they are a part.” (Hafferty 1998) That challenge is particularly compelling when the community-based setting is both explicitly and implicitly shaped by “thick” practices of a particular faith tradition that is experience on its own terms. This panelist will reflect on how particular rituals, staffing practices, team dynamics, and financial incentives form a unique opportunity for students to empirically “taste” an alternative way of practicing medicine. By creating an atmosphere conducive to self-reflection on the part of trainees about the assumptions of the traditional medical training system, faith-based community immersions provide an invaluable catalyst to broader efforts to form virtuous medical professionals who care for the whole person.
Bibliography
Hafferty, Frederic W. “Beyond Curriculum Reform: Confronting Medicine’s Hidden Curriculum.” Academic Medicine. 1998. Volume 73, issue 4. 403-407.
Kinghorn, Warren A., McEvoy, Matthew D., Michel, Andrew, Balboni, Michael. “Professionalization in Modern Medicine: Does the Emperor Have Any Clothes?” Academic Medicine. 2007. Volume 82, issue 1. 40-45.