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Medical Students Learn 'Holistic Medicine' Approach

medical students

If you sit in on first-year medical school class at Marian University, you might notice something slightly different.

"The person is made up of mind, body and spirit," explains a teacher at the front of a lecture hall, filled with more than 100 future doctors.

Marian University's medical school is an osteopathic school. Instead of becoming an M.D. (medical doctor), a student here becomes a D.O. (doctor of osteopathic medicine).

Osteopathic doctors can practice all the same kinds of medicine as M.D.'s, but they are trained through a more holistic approach.

It's that approach that attracted second-year student Kevin Kreuger, who says he's particularly interested in the interaction of spirituality and medicine.

"I think there's a big misconception within medicine that, or even within our culture, that things are socially taboo or that we can't be politically correct if we're talking about these topics, but a lot of patients want to talk about these things with doctors, especially when they're in difficult circumstances or in an emotionally vulnerable state," he says. "So I see that as an opportunity." 

The issue of spirituality in medicine is something that's being addressed across the country, and in some instances across the world.

That line of thinking is becoming more widespread.

There are 31 accredited osteopathic medical schools in the U.S. and 10 of them have opened in the past decade. Marian opened just two years ago.

"This is a national level process," says Dr. Paul Evans, the dean of the Marian University School of Osteopathic Medicine. "The issue of spirituality in medicine is something that's being addressed across the country, and in some instances across the world."

How Patients Want To Address Spirituality

Doctors realize that many patients want to talk about spiritual issues, especially if they are in dire circumstances.

A 2003 study from the National Institutes of Health found that one third of patients wanted to be asked about their religious beliefs during a routine office visit. Forty percent said they would welcome a spiritual inquiry if they were hospitalized, and that number jumped to 70 percent when patients imagined themselves in a situation where they were dying.

In many instances, addressing those spiritual needs is still left up to assigned chaplains.

IU Health Chaplain Shawn Gerber often provides patients, friends or families at IU Health Bloomington Hospital words of encouragement or prayer.

But Gerber can't see everyone in the building, and some people might not think they're in a difficult enough situation to need a chaplain, which is why he also advises doctors not to be shy about connecting with patients on a spiritual level.

"The important thing is to learn how to meet other people where they're at, to figure out where patients are spiritually," he says.

Doctors who have been working with patients for decades say that process can be difficult, especially when they're already consumed with a patient's physical needs.

"Sometimes my question very simply to people is, 'I can tell this is really hard, where do you turn for strength?'" says Dr. Rob Stone, who works in palliative care at IU Health. "I think patients really crave a sense that their physician is a human being, and so I think maybe there is a loss of balance there and we can figure out ways to get more balance."

Where Medical Schools Come In

Academic leaders are starting to consider whether that balance needs to be found first in medical schools. 

Patients really crave a sense that their physician is a human being.

The idea of spirituality training for doctors isn't new. Dr. Christina Puchalski, who founded the George Washington Institute for Spirituality and Health at The George Washington University, pushed for a greater focus on the intersection of spirituality and medicine in the 1990s.

She also developed what's called the FICA assessment. It is similar to a typical medical history doctors make their patients fill out, but this one measures spiritual issues and helps doctors know how patients would like them to address those matters if they come up during treatment.

Puchalski and others say the next phase for incorporating spirituality and medicine is to offer more courses on it. Some even suggest courses shouldn't just be offered, which they already at many medical schools, but required.

Marian University's first class of medical students is just entering the third year, and Dean Paul Evans says the school is trying to structure the curriculum to incorporate more spirituality.

"We by intent have incorporated that into our clerkship syllabi for the third year and the fourth year," he said. "It's variable depending on what your rotation is, so for example if your doing a palliative care rotation where there are a lot of issues of death and dying, that's very important. On the other hand, if you're doing a radiology rotation, looking at images, not as much."

Evans adds that he would support spirituality training becoming a part of medical students official competencies they must master to graduate.

The rub is that spirituality would be another requirement in an already packed course load.

"Those first two years of medical schools, I think all medical schools have some parts of their curriculum, alongside the anatomy, physiology, and pathology, where they address some of these issues, I think really trying to get at caring and what it means to take care of people," says Dr. Rob Stone. "But they end up always getting crowded by these other big subjects like anatomy and physiology. and a lot of these get lost when you get into the third year based in the hospital. So start strong, but finish weak is the way a lot of it goes."

But the prospect of additional coursework doesn't seem to scare students at Marian University. Kevin Kreuger says he'd welcome spirituality training be incorporated into the curriculum.

Fellow student Emily Krash agrees.

"I think it's good that we've had a lot of lectures on ethics and virtues that everyone is required to listen to, so even if [the medical students] don't have a spiritual life, they have to recognize that a lot of their patients will," Krash says.

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