Student Attitudes toward Wellness, Empathy, and Spirituality in the Curriculum

Objective: To accomplish curricular goals for medical student self-care and sensitivity to patients' cultures, values, spirituality, and end-of-life wishes, the faculty at Southern Illinois University School of Medicine instituted a series of reflective readings and small-group discussions for freshman medical students. Description: These sessions help students recognize their own views of other cultures, death, and spirituality and share those views with their peers under faculty guidance. The small-group discussion sessions were included in the school's Student Wellness Program in order to reinforce the concept that discussion of difficult issues is a part of physicians' care of themselves. Additional optional sessions on topics related to spirituality and physician wellness were included in the Wellness Program. Ten sets of readings were selected and small-group discussions were held. Up to 12 students could participate in a given discussion session. Two faculty (a clinician and a basic scientist) were present as facilitators. For each set of readings, an average of 42% of the class of 72 students participated; 47% of all 72 students reported attending four or more of the sessions, with 25% attending seven to ten sessions. Sixty percent of attendees reported that they would “treat patients differently than they might have before attending the session.” At the end of the freshman year, the students were asked to complete anonymously a newly developed Wellness, Empathy and Spirituality in Health Care (WESIHC) questionnaire assessing their attitudes toward inclusion of spirituality in the medical encounter, discussion of personal or patient feelings, and their perceptions of their own wellness.1 Of the 72 students, 47 returned the questionnaire. Of those, 54% were male, 87% reported attending optional empathy discussions (those described above), and 80% had participated in other optional Wellness Program activities. Analysis of the questionnaire responses yielded three factors: (1) spirituality—the low scorers believe that spirituality is important in the patient-doctor relationship; (2) feelings—the low scorers are more comfortable expressing their emotions or having others do so; and (3) wellness—the high scorers rate themselves as being emotionally and physically healthy. The women students were more comfortable in the areas of feelings (t(45) = 5.54, p < .001) and spirituality (t(45) = 2.49, p < .02). The men rated their own wellness higher than did the women (t(45) = 2.17, p < .05). The students who had participated in the spirituality sessions rated themselves as being somewhat more spiritually oriented (t(35) = 1.87, p < .08). Discussion: Long-term follow-up of these students (repeat of the WESIHC questionnaire at the end of year three of medical school and the end of year one of residency training) will reveal whether these findings change as students progress through the medical curriculum. Practitioners and students in other health care disciplines will be asked to complete the WESIHC questionnaire as well in order to define these patterns in other fields. The long-term follow up with students and residents will be important in determining the impact of this course on physicians' attitudes toward the Wellness Program.