Perelman School of Medicine student Leah Zuroff shadows chaplain resident Dasha Saintremy in Penn Medicine's trauma unit.
For hundreds of years, spirituality and religion played significant roles in medicine. Indeed, the church originally issued medical licenses to physicians, many of whom were monks or priests. The first hospitals were built by built by religious groups. But, with the advances in medicine and technology, religion and spirituality existed only on the periphery of medical practice.
In the last decades of the 20th century, the pendulum began to slowly swing back. Research in the field showed that not only were spirituality and religious beliefs important parts of many people’s lives, but they also had an impact on a person’s physical and mental health. “Medicine is inherently an emotional, psychological and existential experience,” said Horace DeLisser, MD, of Medicine. “Spirituality is a part of people’s identify. Understanding these beliefs helps to better care for patients and form relationships.”
A new Certificate in Spirituality and Health at Penn’s Perelman School of Medicine will teach students how to incorporate spirituality into their medical practice – and feel comfortable in that role.
Learning How to Listen
Although students complete requirements for the certificate throughout the four years of medical school, the cornerstone of the program is the summer internship program. The six-week program, which medical students complete after their first year, comprises several components. Meeting and talking with patients is one. “Being able to engage patients – listening and being present for them –while grappling with issues is an important part of your repertoire as a physician,” said DeLisser, who is director of the certificate program. “I want my students to be comfortable dealing with patients around religious and spiritual conversations.”
There were no time limits on these visits with patients. The students could talk for however long the patient wanted, finding out what was important to them. “I think the patient population is extremely receptive to talking. Many poured their hearts out,” said second-year PSOM student Dominque Bohorquez of her experiences. The visits also helped her feel more comfortable in speaking with patients. “It got me out of my shell.”
Chaplain resident Pauline Jennett shows medical student Dominque Bohorquez the Pastoral Care documentation screens, completed for every trauma patient.
After each visit, students were asked to create and discuss a “verbatim report” in which they try to reconstruct the conversation word-for-word. “We want to get them thinking about the conversation, to mentally walk through it,” DeLisser said. “A lot of what we mean by spirituality is relationship building, being able to connect with people in more than superficial ways.”
Students not only learned how to retain a conversation but also to determine where it was accurate and where they saw it through their own experiences, DeLisser said.
Another component of the program --shadowing chaplains to patient care units and in the trauma unit at Penn Presbyterian -- “gives students a greater awareness of what patients and families go through,” said James Browning, director of Pastoral Care at HUP and co-director of the summer internship. “It’s a new reality for them.
“When students encounter a spiritual belief, they have to figure out how it fits in with both the patient and family. It helps them look at the whole, not just the sum of parts,” he continued. “A person’s belief system is part of healing.”
“It was an intense experience,” Bohorquez said. “I didn’t know what a chaplain did before. Now I see they are vital to the health-care team.”
Exploring Different Religions
Recognizing their own limitations is another lesson for students to learn, Delisser said. “If a family is struggling with the impending death of a loved one, you see that they’re challenged and maybe suggest a chaplain stop by. Part of the training is that you’re thinking in those terms and appreciate the power of doing something like that.”
Field trips to different religious or faith-based programs help students expand their knowledge and understanding of beliefs among people. “It’s an immersion experience in a religion, hearing the sound of it, being in the environment having conversations with the people. And learning how it affects their decisions about medical care,” said Rhoda Toperzer, who helped launch the summer internship. “There’s a very big difference between reading something and being a part of it.”
Med student Krystal Hill learns more about the role of the chaplain in Trauma from Fuminobu Komura, chaplain resident.
Last summer’s visits took students to see a Muslim family, a Buddhist temple, a faith-based health center in North Philadelphia, and a Santería, a Cuban religious practice that blends African pagan practices with Catholicism. “It exposes students to different traditions, even if they disagree with it,” Toperzer said. “If patients feel comfortable talking with a physician, they’ll talk about these practices. Otherwise, they’ll keep it a secret.”
The program also brings in guests to speak about different religious beliefs. “One of the patients I spoke with was Jewish and I felt connected because I had a deeper understanding of the traditions,” said Krystal Hill, also a second-year med student.
During the internship, the students are also instructed in mindfulness meditation to help them process their emotional reaction to loss and grief. “A provider who can take care of him or herself is better able to take care of patients,” DeLisser said. Additional certificate requirements, which students complete during their remaining three years at the PSOM, include lectures related to spirituality and health, additional observational experiences and an experience in counseling, advising or mentoring.
“Part of professional development is dealing with many kinds of emotional, psychological challenges,” DeLisser said. “Being able to engage that spiritual realm as a physician ultimately helps you do your work better.
“My hope is that 10 years from now, these students will look back and see this program as one of the most important things they did during medical school … that it was transformative.”