The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

An Innovative Approach to Cultural Competency and Spirituality Education for Medical Students

Authors: Andrew M. Tannous, MD, Joseph R. Fuchs, MD, Paritosh Kaul, MD

Abstract

Objectives: Professional organizations have recognized the need to educate and empower medical students for equitable and inclusive care. One component of providing such care for patients of diverse backgrounds is culturally sensitive and patient-centered communication. The aim of this work was to improve skills in culture competency and spiritual history taking by implementing an interactive, educational session for undergraduate medical students. The session included an introduction to spiritual history, education about Kleinman’s Explanatory Model, and an integrated case incorporating spiritual history taking and cultural understanding.

Methods: The intervention employed didactics and dyad role-playing clinical scenarios. Learners included first-year (n = 104) and fourth-year (n = 54) medical students. Participants completed an 8-item pre-post survey to assess the value of cultural competence and spiritual history taking (attitude), importance of assessing cognition (knowledge), and importance of assessing the learner’s ability to practice this history (skill). Medical student religiosity was measured using the Duke University Religion Index.

Results: For both groups of learners, there was a statistically significant improvement between the pre- and postintervention surveys in medical students’ attitude, knowledge, and skill. Results of the Duke University Religion Index found that a majority of participants infrequently attended organized religious services. Despite this, a statically significant proportion of participants agreed that it is important to identify patients' religion/spirituality following the intervention (P < 0.05).

Conclusions: The educational intervention used in this study fills a curricular gap in effectively integrating cultural competency and spiritual history-taking education. Limitations include that the study did not explore the long-term retention of knowledge or performance in the clinical setting.

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References

1. Smedley BD, Stith AY, Nelson AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press; 2003.
 
2. Awosogba T, Betancourt JR, Conyers FG, et al. Prioritizing Health Disparities in Medical Education to Improve Care. Ann N Y Acad Sci 2013;1287:17-30.
 
3. King CJ, Gamble D, Guiton G, et al. Student Clinical Experiences in Cross-Cultural Education. South Med J 2023;116:390-394.
 
4. Periyakoil VS. Building a Culturally Competent Workforce to Care for Diverse Older Adults: Scope of the Problem and Potential Solutions. J Am Geriatr Soc 2019;67(S2):S423-S432.
 
5. Koenig HG. Medicine, Religion, and Health: Where Science and Spirituality Meet. West Conshohocken, PA: Templeton Foundation Press; 2008.
 
6. Puchalski C, Ferrell B, Virani R, et al. Improving the quality of spiritual care as a dimension of palliative care: the Report of the Consensus Conference. J Palliat Med 2009;12:885-904.
 
7. Abdulla A, Hossain M, Barla C. Toward comprehensive medicine: listening to spiritual and religious needs of patients. J Gerontol 2019;5:1-6.
 
8. Fleenor DW, Atkinson HG, Karani R, et al. An innovative approach for integrating mandatory, longitudinal spirituality training into the medical school curriculum. J Assoc Am Med Coll 2022;97:215-221.
 
9. Borneman T, Ferrell B, Puchalski CM. Evaluation of the FICA tool for spiritual assessment. J Pain Symptom Manage 2010;40:163-173.
 
10. Liu J, Gill E, Li S. Revisiting cultural competence. Clin Teach 2021;18:191-197.
 
11. Shepherd SM, Willis-Esqueda C, Newton D, et al. The challenge of cultural competence in the workplace: perspectives of healthcare providers. BMC Health Serv Res 2019;19:135.
 
12. Zegers C, Auron M. Addressing the challenges of cross-cultural communication. Med Clin North Am 2022;106:577-588.
 
13. Lang Q, Roberson-Moore T, Rogers KM, et al. Cultural considerations in working with Black and African American youth. Child Adolesc Psychiatr Clin N Am 2022;31:733-744.
 
14. Anandarajah G, Mitchell M. A spirituality and medicine elective for senior medical students: 4 years’ experience, evaluation, and expansion to the family medicine residency. Fam Med 2007;39:313-315.
 
15. Schonfeld TL, Schmid KK, Boucher-Payne D. Incorporating spirituality into health sciences education. J Relig Health 2016;55:85-96.
 
16. Smothers ZPW, Tu JY, Grochowski C, et al. Efficacy of an educational intervention on students’ attitudes regarding spirituality in healthcare: a cohort study in the USA. BMJ Open 2019;9:e026358.
 
17. Perechocky A, DeLisser H, Ciampa R, et al. Piloting a medical student observational experience with hospital-based trauma chaplains. J Surg Educ 2014;71:91-95.
 
18. Ledford CJW, Seehusen DA, Canzona MR, et al. Using a teaching OSCE to prompt learners to engage with patients who talk about religion and/or spirituality. J Assoc Am Med Coll 2014; 89:60-65.
 
19. Koenig HG, Büssing A. The Duke University Religion Index (DUREL): a five-item measure for use in epidemological studies. Religions 2010;1:78-85.
 
20. Jumat MR, Chow PKH, Allen JC, et al. Grit protects medical students from burnout: a longitudinal study. BMC Med Educ 2020;20:266.
 
21. Vitorino LM, Cazerta MF, Corrêa NR, et al. The influence of religiosity and spirituality on the happiness, optimism, and pessimism of Brazilian medical students. Health Educ Behav 2021: 49:884-893.
 
22. Puchalski CM, Vitillo R, Hull SK, et al. Improving the spiritual dimension of whole person care: reaching national and international consensus. J Palliat Med 2014;17:642-656.
 
23. Fuchs JR, Fuchs JW, Hauser JM, et al. Patient desire for spiritual assessment is unmet in urban and rural primary care settings. BMC Health Serv Res 2021;21:289.
 
24. Williams JA, Meltzer D, Arora V, et al. Attention to inpatients’ religious and spiritual concerns: predictors and association with patient satisfaction. J Gen Intern Med 2011;26: 1265-1271.
 
25. Townsend M, Kladder V, Ayele H, et al. Systematic review of clinical trials examining the effects of religion on health. South Med J 2002;95:1429-1434.
 
26. Naghi JJ, Philip KJ, Phan A, et al. The effects of spirituality and religion on outcomes in patients with chronic heart failure. J Relig Health 2012;51:1124-1136.
 
27. Borneman T, Ferrell B, Puchalski CM. Evaluation of the FICA tool for spiritual assessment. J Pain Symptom Manage 2010;40:163-173.
 
28. Kleinman A, Benson P. Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS Med 2006;3:e294.
 
29. Atkinson HG, Fleenor D, Lerner SM, et al. Teaching third-year medical students to address patients’ spiritual needs in the surgery/anesthesiology clerkship. MedEdPORTAL. 14:10784.
 
30. Association of American Medical Colleges. Excellence in academic medicine. https://www. aamc.org/about-us/equity-diversity-inclusion. Published January 11, 2024. Accessed January 11, 2024.
 
31. American Academy of Family Physicians. Diversity, equity & inclusion (DEI) in family medicine. https://www.aafp.org/about/who-is-the-aafp/initiatives/diversity-equity-and-inclusion.html. Published January 9, 2024. Accessed January 11, 2024.
 
32. American Academy of Hospice and Palliative Medicine. Diversity, equity, and inclusion. https://aahpm.org/membership/diversity/. Published January 9, 2024. Accessed January 11, 2024.
 
33. American Academy of Pediatrics. Diversity and inclusion. https://www.aap.org/en/about-theaap/american-academy-of-pediatrics-equity-and-inclusion-efforts/diversity-and-inclusion. Published January 10, 2024. Accessed January 11, 2024.
 
34. American College of Obstetricians and Gynecologists. Diversity, equity, and inclusive excellence at ACOG. https://www.aap.org/en/about-the-aap/american-academy-of-pediatrics-equity-and-inclusion-efforts/diversity-and-inclusion. Published January 11, 2024. Accessed January 11, 2024.
 
35. American College of Surgeons. Inclusive excellence. https://www.facs.org/about-acs/inclusive-excellence/. Published January 11, 2024. Accessed January 11, 2024.
 
36. American Psychiatric Association. Diversity & health equity. https://www.psychiatry.org/psychiatrists/diversity. Published April 6, 2024. Accessed April 6, 2024.
 
37. Quest TE, Periyakoil VS, Quill TE, et al. Racial equity in palliative care. J Pain Symptom Manage 2021;61:435-437.
 
38. Cain CL, Surbone A, Elk R, et al. Culture and palliative care: preferences, communication, meaning, and mutual decision making. J Pain Symptom Manage 2018;55:1408-1419.
 
39. Swihart DL, Yarrarapu SNS, Martin RL. Cultural religious competence in clinical practice. StatPearls. Published online 2023. https://www.ncbi.nlm.nih.gov/books/NBK493216/. Accessed January 11, 2024.
 
40. Koenig HG, Perno K, Erkanli A, et al. Effects of a 12-month educational intervention on clinicians’ attitudes/practices regarding the screening spiritual history. South Med J 2017;110: 412-418.
 
41. Lucchetti G, de Oliveira LR, Koenig HG, et al. Medical students, spirituality and religiosityResults from the multicenter study SBRAME. BMC Med Educ 2013;13:162.
 
42. Pew Research Center. Religious landscape study. https://www.pewresearch.org/collections/religious-landscape-study/. Published May 12, 2015. Accessed April 7, 2024.
 
43. Osório IHS, Gonçalves LM, Pozzobon PM, et al. Effect of an educational intervention in “spirituality and health” on knowledge, attitudes, and skills of students in health-related areas: a controlled randomized trial. Med Teach 2017;39:1057-1064.
 
44. Crozier D, Greene A, Schleicher M, et al. Teaching spirituality to medical students: a systematic review. J Health Care Chaplain 2022;28:378-399.
 
45. Jones KF, Paal P, Symons X, et al. The content, teaching methods and effectiveness of spiritual care training for healthcare professionals: a mixed-methods systematic review. J Pain Symptom Manage 2021;62:e261-e278.
 
46. Damiano RF, DiLalla LF, Lucchetti G, et al. Empathy in medical students is moderated by openness to spirituality. Teach Learn Med 2017;29:188-195.
 
47. Lie D, Boker J, Cleveland E. Using the Tool for Assessing Cultural Competence Training (TACCT) to measure faculty and medical student perceptions of cultural competence instruction in the first three years of the curriculum. J Assoc Am Med Coll 2006;81:557-564.