f there is one area of human experience in which the importance of spirituality has achieved dramatically increased recognition in recent years it is medicine. And if any individual can claim to have initiated this cultural shift it is surely Dr. Christina Puchalski, founder and director of the George Washington Institute for Spirituality and Health (GWish).
Based at the George Washington University Medical Center, one of America’s top-ranked medical schools, during the past four years GWish has been the recipient of five grants from the Templeton Foundation totalling $2.5 million. The first grant program “Spirituality and Medicine U.S. Curricular Awards” set itself the ambitious target of having every accredited medical school in the United States incorporate spirituality into its curriculum. Did it succeed in that aim?
“Not every single one,” concedes Puchalski, “but we’ve been pretty successful in that we have about 102 of the 144 medical and osteopathic schools that have topics related to spirituality integrated into their curricula. So we’re very pleased with that progress. I would say we are 70 or 75 percent on the way, in terms of our goal. We’ve managed to have spirituality and health recognized as a field in medical education and that’s a very significant impact. In addition, in collaboration with the Association of American Medical Colleges (AAMC), GWish has developed learning objectives and outcomes for courses in spirituality and health.
Sustaining the groundwork achieved will require a new approach. The next step will be to develop a set of national competencies and standards in spirituality and health education based on the current state of the art in medical education. These competencies will be evaluated; the data will be put forth before the licensing bodies so that exam questions can be developed in spirituality and health. This raises the level of the subject content to an expectation for clinical practice.
To put her progress in context, Puchalski points out that integrating humanities studies into medical education has been a longstanding ambition and yet only about 15 or 20 percent of medical schools today have formal courses on the humanities. Medical Ethics, which has been a field for at least 35 years, has taken much longer to achieve the same level of integration into the curriculum as spirituality and health.
The second GWish grant supported the Institute’s “Spirituality and Medicine Residency Training Awards” program. Its objective was to link science and spirituality through interdisciplinary collaboration to provide new physicians with insight into the role spirituality plays in medicine and the well-being of their patients. Sixteen awards were given: eight in primary care and eight in psychiatry.
Puchalski reports that many people are now doing workshops on spirituality and health within the Society of General Internal Medicine (SGIM) which is heavily involved in residency training. Likewise the American Psychiatric Association and the Society of Teachers in Family Medicine have interest groups in spirituality and health and the former institution has made it a required part of psychiatry residency training programs.
A third grant program, “Spirituality and Health Initiatives for Practicing Healthcare Professionals” furnished some striking data about failure of communication between patients and healthcare workers. “We did a pilot study where we looked at seven hospital sites in the U.S.,” says Puchalski. “We studied these sites and what we found was very interesting. Initially, when staff as well as patients were interviewed, 75 percent of staff—that included physicians, nurses, chaplains, and social workers—felt that they were addressing patients’ spiritual needs; and yet only 15 percent of the patients said that they did.”
It turned out that staff was categorizing kindness and compassion as “spirituality,” highlighting the need for the kind of education GWish is promoting. While being compassionate and kind is part of spiritual care, patients also need their spiritual issues formally addressed. By the end of the study, there was a significant increase in the numbers of patients whose spiritual issues were addressed and there were increased programs for staff to address their spirituality as a basis of their calling to their professions. In two of these hospitals, in the units that participated in the GWish intervention, patient satisfaction ratings rose from 50 percent to 94 percent. GWish is currently working on expanding this pilot study, with funding from the Arthur Vinning Davis Foundation. The Templeton funding allowed GWish to engage other partners.
GWish also developed a spiritual history tool called FICA that is used in many medical school courses, in several medical textbooks, and in a variety of clinical settings. Through the Spirituality and Health Initiative for Practicing Healthcare Professionals grant, as well as private donors, a DVD FICA online teaching tool has been developed that will be available on the new GWish website.
The project “Spirituality and Medicine Research Assessment for Canada” had to be reconfigured in recognition of local conditions. Originally GWish had envisioned an awards program for Canada, but local advisers dissented. “They thought it would make more sense if the Canadian medical schools were somehow linked to the U.S. initiatives.” So GWish is now working to establish a conference to include both Canadian and American schools in developing competencies in spirituality and health. GWish is working with the AAMC and AFMC to accomplish this.
The “GWish United Kingdom Curricular Initiative in Spiritual Health” program shows promise, according to Puchalski, who decided the best way forward was to invite deans of British medical schools to a meeting to promote the integration of spirituality and health into medical curricula in the United Kingdom. She is working in collaboration with Dr. John Swinton, professor in practical theology and pastoral care at the University of Aberdeen. Puchalski is gratified that interest in her field is also growing internationally. “I can tell just by the number of people approaching me about trying to develop courses in Belgium, in Germany, in Brazil.” For her, scientifically, the big question is how to interpret spiritual/medical mechanisms. “We know that spirituality, more broadly defined, and even religion, have an impact on patient outcomes in some way,” she says. “But I think we’ve only scratched the surface. We really don’t know the mechanisms. And that’s the challenge for the field.”