A 10-Year Longitudinal Study of Effects of a Multifaceted Residency Spiritual Care Curriculum: Clinical Ability, Professional Formation, End-of-Life and Culture

Abstract Context Although spiritual care (SC) is recognized as important in whole-person medicine, physicians infrequently address patients’ spiritual needs, citing lack of training. Although many SC curricula descriptions exist, few studies report effects on physicians. Objectives To broadly examine immediate and long-term effects of a required , longitudinal, residency SC curriculum, which emphasized inclusive patient-centered SC, compassion and spiritual self-care. Methods We conducted in-depth individual interviews with 26 physicians (13 intervention;13 comparison) trained at a 13-13-13 residency. We interviewed intervention physicians 3 times over 10-years – (a) pre-intervention, as PGY1s; (b) post-intervention, as PGY3s; (c) 8-years post-intervention, as practicing physicians. We interviewed comparison physicians as PGY3s. Interviews were audio-recorded, transcribed and analyzed by four researchers. Results 49 interviews were analyzed. General : Both groups were diverse regarding personal importance of spirituality/religion. All physicians endorsed the value of SC, sharing rich patient stories particularly related to end-of-life and cultural diversity. Curricular effects : (a)Skills/Barriers - Intervention physicians demonstrated progressive improvements in clinical approach, accompanied by diminishing worries related to SC. PGY3 comparison physicians struggled with SC skills and worries more than PGY3 intervention physicians; (b)Physician Formation - Most physicians described residency as profoundly challenging/transformative. Even after 8-years many intervention physicians noted that reflection on their diverse beliefs/values in safety, coupled with compassion shown to them through this curriculum, had deeply positive effects. High impact training : patient-centered spiritual assessment; chaplain rounds; spiritual self-care workshop/retreats; multicultural SC framework. Conclusion A longitudinal, multifaceted residency SC curriculum can have lasting positive effects on physicians’ SC skills and their professional/personal formation.