Abstract
Janet L. Roseman-Halsband, PhD, R-DMT, a regular contributor to the Alternative and Complementary Therapies journal, is known for and embraces the humanistic aspects of patient care. In this column, Dr. Roseman-Halsband discusses a unique project that she created to help residents become not only clinically competent physicians but caring healers as well.
Providing clinical skills for residents in medical training is of course expected. However, excellence in humanistic skills is also the signature of a true healer. The program addresses topics that are often referred to as the “hidden curriculum” in medical training—topics that are often devalued or that physicians ignore. Topics such as pressures to “be perfect,” crying, never making mistakes, breaking bad news, anger at patients, loss of patients, and other deeply emotional topics are not always addressed in medical education. In addition, physicians in residency training often do not receive enough support or have the chance to discuss their feelings in a safe space with their colleagues.
Unfortunately, a lack of training in compassionate medicine can often translate into the dehumanization of patient care. So, I created the program to provide skills for residents that address not only their patients' and families' needs, but the needs of the residents for wellness during residency training. It was my hope that if physicians were provided opportunities to talk about their challenges and given tools that could help them with their patients' interactions, it could make a significant difference not only for the patients and their families but also for the residents. I also wanted to ensure that my father would be recognized and that his passing would not be in vain.
The core of the training includes lectures and interactive discussions as well as tools to help empower physicians to discuss sensitive topics and also share their patient encounters in a safe space. This program is unique among medical curricula and also addresses educational program goals for residency training as well as cited accreditation agencies (ACGME) milestones, including patient care, interpersonal and communication skills, and professionalism. Some of the themes presented in the program include self-care and physician wellness, compassionate medicine, the power of healing, arts-based methodologies, breaking bad news, spiritual assessments, and evidence-based research on spirituality and case narratives.
Although I created the program a few months after the death of my father in 2009, it wasn't until several years later when I joined faculty at the Dr. Kiran C. Patel College of Osteopathic Medicine that the program was later disseminated through the Consortium for Excellence in Medical Education (CEME), and was offered to physicians at affiliated university residency sites. Since 2013, the program has been taught at several Patel College of Osteopathic Medicine's affiliated residency sites in South Florida, Rhode Island, and Georgia. In 2012, the current director of the CEME program, Joseph DeGaetano, DO, graciously opened the door so that a pilot program could be offered. Two residency sites, Broward Health Hospital in Fort Lauderdale, Florida, and University Hospital in Tamarack, South Florida, participated in a three-month program under the helm and support of two wonderful physicians, Mariaelena Caraballo, DO, and Natasha Bray, DO.
Data were collected from various sites offering this program to understand the impact of this curriculum better. Research findings validated the importance of providing lectures and small group discussions for physician residents on “taboo topics” and recognized that by offering this training, residents have opportunities to learn skills and to speak about their challenges in medicine. This research is a first step in validation of the importance of these topics and confirms that it is fundamental to the provision of clinical excellence.
When 78 of the residents were asked if they had had any previous exposure to self-care strategies in any coursework during medical school or residency training, 56% said they had not received any prior coursework, while 44% indicated that they had. The Sidney Project's emphasis on self-care is an important component in the program, and is integrated throughout the presentation of the program. Another important lecture and discussion topic in the program was “Breaking Bad News,” which included a hands-on primer for strategies for breaking bad news with patients and families, as well as precious time to discuss personal experiences by the residents. In this case, 28% of the participants indicated that they had training in breaking bad news during residency training or informal shadowing or during medical school, while 72% indicated that they had not received any formal training. When asked if they would like additional training in breaking bad news, 75% indicated that they would. In terms of Spirituality and Medicine coursework, 27% of the residents indicated that they had received prior coursework in spirituality and medicine, while 73% of the residents indicated that they had not. In addition, 13% had experience taking a patient's spiritual history, while 87% of residents indicated that they did not have any experience taking a patient's spiritual history. After each lecture, residents not only completed evaluation forms, but they were also given space to add any additional comments that they wanted to share. Residents indicated that this program was very helpful. Some of the residents' comments included: “Great course! I love that we are given an opportunity to come together and reflect on patient experiences and how spirituality and medicine and compassionate care can improve our relationships with patients, and also improve our clinical skills.” “Providing stress relief techniques was an important part of your lecture. We forget how to take care of ourselves. I think it is important to have lectures to remind us and to teach us how.” “Having these sessions has helped me reset my role as doctor and to learn that I can make a difference by showing compassion.” Those are just a few of the positive feedback comments received. More research needs to be completed that would focus on a specific medical discipline over a year long period of time in order to offer further research to validate the programs' efficacy.
Assistant Professor, Integrative Medicine
Dr. Kiran C. Patel College of Osteopathic Medicine
Nova Southeastern University
Fort Lauderdale, FL
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After the first year that this program was offered to the OB-GYN residents at Osceola Regional Medical Center, Kissemmee, Florida, I am really proud that the first-year residents asked for a second year of training, and this program was offered to all of the residents there, regardless of their status of training, until the hospital changed their residency program status. Anandarajah and Roseman found that it was possible for physicians to see “medicine as providing opportunities for them to grow in compassion, essentially employing medicine as a spiritual discipline.” 1,2 This consciousness of compassion and chance to integrate medical practice as a spiritual discipline also can be a natural conduit for the cultivation of self-compassion. In an article in a journal on death and dying, Lakhani found that speaking about death and dying is difficult and that “death remains a taboo subject for both the general public and doctors.” 3 Residents are deeply in need of training in these often-taboo topics, and educating physicians on the importance of compassionate care for both themselves and patients can help them to become consummate healers.
Mark Palazzolo, DO, Co-Program Director from the OB-GYN program at Osceola Regional Hospital in Kissimmee, Florida, where the program has been offered since their residency program began, stated about the program:
In recognizing the importance of training and graduating balanced women's health providers we have integrated the Sidney Project™ into the core curriculum and the program has been highly successful with tangible results. The specialty of OB-GYN is frequently involved with treating many emotional and spiritually difficult situations and diagnoses such as domestic violence, fetal loss, fetal genetic birth defects, breast and reproductive cancers, infertility, sexual abuse, etc., and the Sidney Project™ has developed progressive curricula in order to prepare our residents to communicate, educate and treat patients with these conditions. The program starts with self-care, and it is highly understood that physicians must be personally emotionally grounded and spiritually sound themselves in order to effectively navigate their patients, families and hospital staff through challenging situations. This program is one of the hallmarks of our OB-GYN resident training experiences and is fondly respected and appreciated by our residents and positively impacts women's health care in our community.
I hope that the Sidney Project in Spirituality and Medicine and Compassionate Care can continue to inspire other medical educators to be mindful of the importance and need to integrate this program as a vital part of clinical didactics. Residents who participated in the program during the grant year period received training to explore and reflect on compassionate medical training that is patient centered, received hands-on guidance, and learned skills for the integration of spirituality and compassionate care in the medical encounter. They also participated in discussions in a safe environment where humanistic care for both patients and residents is valued and recognized.
I know that The Sidney Project in Spirituality and Medicine and Compassionate Care makes a difference after years of teaching the curriculum and listening to residents who have participated in this program. I believe that this program can change the often dysfunctional medical education training to recognize and include training that is nurturing and compassionate to enhance a culture of caring. ■