Spirituality in medicine: a comparison of medical students' attitudes and clinical performance.

OBJECTIVE: The authors sought to examine attitudes about spirituality in medicine among medical students in psychiatric clerkships and determine whether instruction on concepts of spirituality in medicine had an effect on students' clinical performance in related tasks. METHODS: A total of 192 students entering psychiatric clerkships were randomly assigned to one of two groups; both groups received identical didactic instruction on spirituality in medicine. One group worked on a problem-based learning case that featured spirituality as a prominent theme, whereas the other group worked on problem-based learning cases that made no mention of it. Students completed pre- and posttest questionnaires, and their examination at the end of rotation included a standardized patient encounter requiring them to elicit a spiritual history. RESULTS: Among the 131 students who completed and returned both questionnaires, a significant difference (p=0.001) was noted between groups on students' self-reported knowledge of taking a spiritual history. However, students in the two groups received identical scores on the component of the examination requiring them to write a spiritual history. CONCLUSIONS: Although students who were exposed to material on spirituality in medicine reported greater understanding of the issue, no difference in clinical performance was observed.

Improving medical students' comfort with, and skill in handling, gender-related inquiries during the residency selection process.

OBJECTIVE: Previous work has identified that medical students experience instances of gender discrimination and sexual harassment during the residency selection process (i.e., "audition" elective rotations, residency interviews, and career counseling).(1,2) Examples of such instances include male students who report being counseled away from obstetrics-gynecology and a female student who reported being asked about her sexual orientation because of an expressed interest in breast disease. Students also report confusion about what constitutes an appropriate question or inappropriate gender-related comments. A common example is questioning about plans for child care during residency. We developed an education intervention focused on gender- and family-related issues that may arise during the residency selection process in an attempt to improve our students' ability to (1) recognize appropriate and inappropriate questions and situations and (2) handle such situations in a professional manner. DESCRIPTION: Our educational intervention is a voluntary, intense, active learning situation composed of four parts. First, data outlining the problem-including personal stories of students-are presented. Second, a faculty member with dual experience as a residency training director and dean for student affairs presents examples of appropriate and inappropriate questions (both types of questions can be uncomfortable if not contemplated in advance), potential ways to approach these questions, and a thoughtful approach for the student to take when integrating his or her experiences during the residency selection process with ultimate decisions about career and ranked programs. During the third part of the workshop, students draw two cases of 15 potential situations from a hat. They work in pairs, first to identify whether the case outlines an appropriate or inappropriate situation and second to develop and practice their responses. The session concludes with open discussion about the various scenarios and responses. DISCUSSION: This workshop has been well received by our medical students. In post-workshop surveys, students universally reported that the session was useful. Ninety percent of attendees felt better able to recognize appropriate and inappropriate questions and situations during the residency selection process. Seventy-seven percent of students reported that they felt better able to handle inappropriate situations during the residency selection process in a professional manner. Student comments reflected great satisfaction with the interactive nature of the exercise, interest in expanding the amount of time dedicated to the workshop, and a desire for clear rules about what can/cannot be said. Faculty offering the workshop reported satisfaction doing the workshop and noted that the greatest challenge in presenting the material is balancing the discussion about reasonable responses to inappropriate behaviors with the students' interest in performing well on all interviews in order to maximize their options. Interest in the program has resulted in the authors' being invited to share the workshop at an upcoming GME retreat for the institution's program directors. Based on these results we plan to continue the workshop in an expanded version. In addition, we plan to use this format of the workshop as a springboard for similar sessions for medical students interested in confronting issues of discrimination and harassment in the educational setting.