Medical Education

Spirituality and Medicine: views and opinions of teachers in a Brazilian Medical School

Journal: Manuscript ID: Manuscript Type: Keywords:

Medical Education MED-2010-0946 Short Report Clinical Education, Curriculum Development/Evaluation, Medical Humanities, Physician/Patient Relationship

Fo

rR

ev ie w

Page 1 of 4

Medical Education

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60

Spirituality and Medicine: views and opinions of teachers in a Brazilian Medical School. Abstract: The study of Spirituality/religiosity (S/R) in health has become increasingly relevant to modern medicine. Although many physicians consider adequate to address this issue with patients and believe religious aspects can influence medical practice , few address it with patients. We aim with the present study to show the opinions of medical teachers from a Brazilian Medical School regarding Spirituality and its interface with medicine and health. Fiftythree medical teachers from a Brazilian State University were interviewed. Most of them believe that faith, spirituality and even prayer can influence their patients treatment. Furthermore, majority wants to address this aspect with patients and believes this is one of the roles of a medical school. However, less than a quarter of these professionals address this issue frequently or teaches it in their medical classes and more than 90% strongly agree that Brazilian Medical Schools are not giving all required information in this field. In conclusion, the study shows that medical teachers think spirituality dimension is important for their patients and even students. Nevertheless, lack of knowledge, fears and lack of training keep them away from integrating this in clinical practice and in medical education.

Introduction: The study of Spirituality/religiosity (S/R) in health has become increasingly relevant to modern medicine. In 1994, 17 US medical schools provided teaching on religious and spiritual issues as applied to medicine. In 2004, this number has risen to 84 medical schools(1,2).

Although many physicians consider adequate to address this issue with patients and believe religious aspects can influence medical practice, few address it with patients (2). We aim with the present study to show the opinions of medical teachers from a Brazilian Medical School regarding Spirituality and its interface with medicine and health.

Methods: The study was carried out in 2007. Medical teachers from a Brazilian State University were selected for analysis. This university graduates 90 students every year and approximately 200 medical teachers are responsible for their teaching process. For inclusion, those professionals had to be physicians, officially registered in the University and agreed to participate. No age, gender or department limits were applied. Medical students (MS) were trained to apply a sixteen-question standardized questionnaire regarding Spirituality and its interface with health and medicine with the following issues: impact of faith and prayer in patient treatment, barriers and comfort of addressing spirituality, spirituality in medical schools and teachers own religiosity. All 16 questions were multiple choice. Teachers were selected according to the following procedure: (1)Three Medical students (MS)carried out the interviews with the teachers; (2) All 4 Medical School campus buildings were evaluated by the students in predefined days; (3) Teachers were selected consecutively

Fo

rR

ev

iew

Medical Education

Page 2 of 4

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60

by the MS as been found in their departments and; (4) Data were compiled after these interviews using SPSS 17. Results: For final analysis, it was included 53 medical teachers (27% of all medical teachers were found). No teacher refused to participate. The sample was composed mostly by men (51.9%), with mean age of 50.64 (+8.9) years and 25.83 (+8.9) years of graduation. Forty-seven (90.4%) reported that believes in God or something superior and 31.7% attends to the religious services at least once a week. The most evaluated departments were: Internal Medicine (13.0%), (26%), followed by

Surgery/Orthopedics

(22.3%),

Gynecology/Obstetrics

Anesthesiology

(9.3%),

Pediatrics (7.4%), Neurology (7.4%), Public Health (5.6%) and others (9%). Table 1 shows the results from interviews. More than seventy-two percent of medical teachers believed that faith or spirituality can positively influence the treatment of their patients, 75.5% believed that prayer could have effects in the patients treatment, 62.3% want to address spirituality with patients and 50% believed that it is important for a medical school to prepare students for this issue. Furthermore, 60% stated they usually address spirituality with the

patient (only 20.4% frequently).

Nevertheless, only 43.4% reported they feel prepared to address this issue, 27.8% have ever mentioned this issue in their classes and 92.3% felt that the Brazilian medical schools are not

giving all required information in this field.

The most prevalent barriers cited by medical teachers were: lack of time (11.3%), lack of knowledge (9.3%), lack of training (9.3%), fear (9.3%) and being not comfortable to address (5.6%).

Discussion: The present study reveals that medical teachers from this Brazilian Medical School believe that faith, spirituality and even prayer can have influence in their patients treatment. Furthermore, majority wants to address this aspect with patients and believes this is one of the roles of a medical school. However, less than a quarter of these professionals address this issue frequently or teaches it in their medical classes and more than 90% strongly agree that Brazilian Medical Schools are not giving all required information in this field. These results present a clear difference between medical teachers opinion and their action or training. Teachers believe this issue is important but do not address it in clinical practice. Why does this happen? According to Lucchetti and Granero, there are some resistance to the introduction of these courses due to lack of Brazilian studies and various preconceptions about sectarianism and religious coercion(3). Another explanation is the many barriers reported by those teachers: Lack of time, lack of knowledge, lack of training and fear. In fact, little training is available for

Fo

rR

ev

iew

Page 3 of 4

Medical Education

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60

Brazilian medical students regarding spirituality, which has repercussions in their formation and even when they became teachers. In other realities, such as United States (US) or United Kingdom, most schools have such training (4,5). In US, the increase in spirituality and medicine curricula is in part due to a John Templeton Foundation funded program entitled The GWish Spirituality and Medical Education Program directed by the George Washington Institute for Spirituality and Health at the George Washington University. These initiatives are important in order to promote and break barriers. Medical students should learn that their patients are not only biological cells, but are biopsycho-socio-spiritual human beings and, that every dimension has its own importance in the healing process. However, in order to learn any subject, teachers must conduct discussions, give lectures and practice classes. Without a formal education in spirituality and health, this objective is almost

Fo

impossible.

Limitations: Some study limitations must be highlighted. First, it is a small amount of medical teachers from a specific university. Thus, some results could not apply for other institutions. Second, not all medical teachers were found in the days predefined for the interview (only 27% were found in these pre-defined days). In other words, some teachers from this university

were not enrolled in the present study.

Conclusion: In conclusion, the present study shows that medical teachers think spirituality dimension is important for their patients and even students. Nevertheless, lack of knowledge, fears and lack of training keep them away from integrating this in clinical practice and in medical education.

rR

ev

iew

References: 1. Puchalski CM, Larson DB. Developing curricula in spirituality and medicine. Acad Med. 1998;73:970-4. 2. Curlin FA, Lantos JD, Roach CJ, Sellergrene SA, Chin MH. Religious characteristics of U.S. physicians: a national survey. J Gen Intern Med. 2005;20:629-341. 3. Lucchetti G, Granero A. Integration of spirituality courses in Brazilian medical schools. Med Educ. 2010;44:527. 4. Forin AH, Barnett KG. Medical school curricula in spirituality and medicine. JAMA 2004;291:2883. 5. Neely D, Minford EJ. Current status of teaching on spirituality in UK medical schools. Med Educ 2008;42:17682.

Medical Education

Page 4 of 4

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60

Table 1: Opinions of medical teachers from a Brazilian Medical School regarding "Spirituality and Health"
Medical Teachers opinions Can Faith/Spirituality influence in patients treatment? Yes, positively Yes, negatively Yes, positively and negatively Dont have an influence No opinion Can prayer influence in patients treatment? Yes, positively Yes, negatively Yes, positively and negatively Dont have an influence No opinion Do you want to address spirituality/faith with your patients? Sim, raramente Sim, freqentemente No Do you usually address spirituality with your patients? Yes, rarely Yes, frequently No Do you feel prepared to talk about spirituality with your patients Yes No Sometimes Do you usually pray for or with your patient? Frequently Rarely Never Are Brazilian Medical Schools giving all required information in Spirituality and Health field? Yes No No opinion Do you believe the medical student should be prepared during university to address spirituality with patients? Yes No No opinion Have you ever addressed "Spirituality and Health" in a medical class? Sim No Do you believe in God or a High Power? Yes No No opinion Total n=53 Male 39 (72.2%) 14 (25.9) 40 (75,5%) 6 (11,3%) 2 (3,8%) 5 (9,4%) 15 (28,3%) 18 (34%) 20 (37,7%) 21 (39,6%) 11 (20,4%) 21 (39,6%) 23 (43,4%) 16 (30,2%) 14 (26,4%) 5 (9,6%) 13 (25%) 34 (65,4%) 48 (92,3%) 4 (7,7%) 21 (75%) 7 (25%) 21 (75%) 3 (10,7%) 1 (3,6%) 3 (10,7%) 7 (25%) 10 (35,7%) 11 (39,3%) 12 (42,9%) 6 (21,4%) 10 (35,7%) 9 (39,1%) 10 (35,7%) 9 (32,1%) 1 (3,7%) 6 (22,2%) 20 (38,5%) 25 (92,6%) 2 (7,4%) Gender Female 18 (72%) 7 (28%) 19 (76%) 3 (12%) 1 (4%) 2 (8%) 8 (32%) 8 (32%) 9 (36%) 9 (36%) 5 (20%) 11 (44%) 14 (60,9%) 6 (24%) 5 (20%) 4 (16%) 7 (28%) 14 (26,9%) 23 (92%) 2 (8%) <50 16 (64%) 9 (36%) 17 (68%) 4 (16%) 1 (4%) 3 (12%) 6 (24%) 11 (44%) 8 (32%) 8 (32%) 6 (24%) 11 (44%) 10 (40%) 7 (28%) 8 (32%) 3 (12%) 8 (32%) 14 (56%) 23 (92%) 2 (8%) Age >50 21 (84%) 4 (16%) 21 (84%) 1 (4%) 1 (4%) 2 (8%) 9 (36%) 7 (28%) 9 (36%) 12 (48%) 5 (20%) 8 (32%) 11 (44%) 8 (32%) 6 (24%) 2 (8,3%) 4 (16,7%) 18 (75%) 22 (91,7%) 2 (8,3%)

Fo

rR

15 (27,8%) 37 (68,5%)

47 (90,4%) 4 (7,7%) 1 (1,9%)

ev
26 (50%) 8 (15,4%) 18 (34,6)

iew
12 (44,4%) 5 (18,5%) 10 (37%) 7 (25%) 21 (75%) 25 (92,6%) 1 (3,7%) 1 (3,7%)

14 (56%) 3 (12%) 8 (32%) 8 (32%) 17 (68%) 22 (88%) 3 (12%) -

14 (56%) 3 (12%) 8 (32%) 8 (32%) 17 (68%) 22 (88%) 2 (8%) 1 (4%)

10 (41,7%) 4 (16,7%) 10 (41,7%) 7 (28%) 18 (72%) 24 (100%) -