From spiritual intelligence to spiritual care: A transformative approach to holistic practice.

Spiritual care has long been known for being as important as difficult to deliver. Many barriers to spiritual care practice have been reported but are still difficult to overcome. Yet, the answer may not be centred in the patient needs but in the healthcare provider' spiritual self-awareness and self-consciousness. The debate is then opened on what concepts should really be addressed: spiritual care or spiritual intelligence and which should be trained since spiritual intelligence enhancement can bring many other benefits beyond increased quality of care, such as self-growing tools to better cope with the hardiness of the profession. This paper introduces the debate around this issue, and opens the discussion to different perspectives and approaches to a troublesome educational subject.

Student Views on a Novel Holistic Surgical Education Curriculum (iG4): A Multi-national Survey in a Changing Landscape.

AIM: Essential Skills in the Management of Surgical Cases (ESMSC Marathon Course™) Integrated Generation 4 (iG4) is the first reported multifaceted undergraduate surgical course aiming to provide holistic surgical teaching. In this prospective observational study, we explored students' views on the iG4 curriculum, and identified how it can potentially address modern challenges in surgical training. MATERIAL AND METHODS: Medical students were invited to apply to the course online and were screened against pre-defined criteria. A multi-national structured questionnaire incorporating five domains related to the course curriculum and our dedicated research network, was designed and distributed to participants after successful completion of the course. RESULTS: Forty-one students from European and Asian medical schools completed the course and filled in the survey. The median overall evaluation score of the course was 4.73 out of 5 (interquartile range=4.21-4.72) and all students found that iG4 served the vision of holistic surgical education. ESMSC had a positive motivational effect towards following a career in surgery (p=0.012) and 92.7% of students declared that it should be an essential part of a future medical school curriculum. There was no statistically significant difference (p>0.05) in results between participants of different countries of study, year of studies or age group. CONCLUSION: The ESMSC Marathon Course™ is perceived as a unique course model, with an established educational value and a positive motivational effect towards surgery. It might potentially be implemented in future medical school curricula as an essential element of undergraduate surgical education. The iG4 curriculum has opened a new exciting horizon of opportunities for advancing undergraduate holistic surgical education.

Integrating Medical Humanities into medical school training.

Medical teaching must include new knowledge and technologies and how these affect patient care. The Medical Humanities can contribute to a more holistic and caring view of health and disease.

Systems based model: A Holistic Approach to Developmental Movement Education.

Considering the human body as a dynamic system, a given movement is the result of contributing sub-systems (Thelen and Smith, 1994). In this view, gains in movement performance occur as subsystem performances become optimized. Movement instruction offered from a systems perspective is aimed optimizing learner's performance through evolving understanding and through application. The Holistic Approach to Developmental Movement Education (HADME) is a systems-based instructional model that depicts the interactive process between learner and practitioner. This mind-body approach utilizes 11 steps to optimize movement performance: A) Current Understandings, B) Increased Insights of Evaluation, C) Truthful Reflection of Current State, D) Systematic Modification to Optimize Performance, E) Application of the Change Tool to Change Target Pattern, F) Fine-Tune Learner Perception Tool Application, G) Improved Understanding Through a Point of Control, H) Expanded Systemic Understanding of Learner's Knowledge/Movement, I) Isolation of Target Muscle for a Constant Steady Flowing Movement, J) Gained Conceptual Understanding of Movement and K) Increased Knowledge of Systemic Inputs. The instructor adopting this viewpoint may experience continual insights on how to best optimize the performance for an increasing range of learners display unique systemic variations. Gaining insights on how to overcome movement limitations through optimizing subsystem performances, the learner taking part in a HADME may experience greater movement enjoyment and hopefully, a more active lifestyle.

7th International Conference on Human Values in Higher Education: Education for holistic human health.

The 7th International Conference on "Human Values in Higher Education: Education for Holistic Human Health" (ICHVHE-18) was held from April 26 to 28, 2018, at Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan. This conference also celebrated the 50th year of Indo-Bhutan friendship. ICHVHE-18, was the culmination of the collaborative efforts of eight universities, two from Bhutan and six from India. The ICHVHE is an annual conference aimed at developing a shared vision of holistic, humane education, particularly in institutions of higher learning. The initial plan is to implement human values and education for holistic health in higher education within India and other SAARC nations. Delegates from five SAARC nations, viz, Bhutan, India, Nepal, Bangladesh and Maldives, participated in this conference. Ultimately, the effort is to provide universal human value-based education to every child, globally.

Toward a National Conversation on Health: Disruptive Intervention and the Transformation from Health Care to Health.

Over a century ago, Abraham Flexner's landmark report on medical education resulted in the most extensive reforms of medical training in history. They led to major advances in the diagnosis and treatment of disease and the relief of suffering. His prediction that "the physician's function is fast becoming social and preventive, rather than individual and curative," however, was never realized.Instead, with the rise of biomedical science, the scientific method and the American Medical Association, the health care system became increasingly distanced from a holistic approach to life that recognizes the critical role social determinants play in people's health. These developments created the beginning of the regulatory controls that have come to define and shape American health care - and our unhealthy obsession with illness, disease and curative medicine that has resulted in a system that has little to do with health.To realize Flexner's prediction, and to transform health care into a holistic system whose primary goals are focused on health outcomes, six disruptive interventions are proposed. First, health needs to be placed in the context of community. Second, the model of primary care needs to be revised. Third, big data need to be harnessed to provide personalized, consumable, and actionable health knowledge. Fourth, there needs to greater patient engagement, but with fewer face-to-face encounters.Fifth, we need revitalized, collaborative medical training for physicians. And finally, true transformation will require market-driven, not regulatory-constrained, innovation. The evolution from health care to health demands consumer-driven choices that only a deregulated, free market can provide.

Teaching Spiritual Care Within Nursing Education: A Holistic Approach.

Student nurses are unprepared to meet the spiritual needs of patients, and are often uncomfortable addressing this. This article aims to describe the student perspective of spirituality in relation to the holistic care model. Findings from the study provide insight about preparing nursing students to deliver spiritual care in nursing practice.

Psychosocial issues discovered through reflective group dialogue between medical students.

BACKGROUND: The biopsychosocial model is a comprehensive approach emphasizing holistic medical care. However, medical curricula that incorporate narrative reflective writing and group dynamic discussion of psychosocial issues among patients and their family members in reflective dialogue groups are currently underutilized. The aim of this study was to determine psychosocial issues among patients and their family members through medical students' reflective dialogue groups. METHODS: This study was completed as part of a pediatric clerkship. Fifty medical students were rotated to the department of Pediatrics. They completed a narrative writing assignment concerning patients' psychosocial issues and participated in a reflective group discussion during the rotation. The recordings of the six reflective group sessions were transcribed for thematic analysis. A six-step theme generation process was conducted in the first reading stage of all transcripts by four researchers. Subsequently, initial codes were generated and potential themes sought before possible themes were reviewed and thematic maps generated. Names for each theme were defined and a scholarly report of the analysis was presented through a consensus-based approach. RESULTS: A total of 108 psychosocial issues were coded and categorized as the following six main themes: medical communication, the intricate medical ecological system, role and function of a family, development of medical professionalism, ethical dilemmas, and various patient perspectives from diverse cultural backgrounds. All these themes underlie the complexity of clinical encounters. CONCLUSIONS: Clinical care is an extremely complex interactive ecological network involving human behavior, family, and public health care systems. The discovery of psychosocial problems by medical students as narrators in this study illustrates that medical care should focus not only on illnesses but also patients' psychosocial narratives.

Spirituality at the end of life.

PURPOSE OF REVIEW: There is increasing emphasis on medical care of the whole patient. This holistic approach encompasses supporting the spiritual or religious needs of the patient. Particularly at the end of life, spiritual concerns may come to the fore as patients recognize and accept their impending death. Physicians may also recognize this spiritual distress but may not be clear on how to provide spiritual support. RECENT FINDINGS: Tools to screen for spiritual concerns are available for physicians to use. Some physicians wish to go further, supporting patients at the end of life in their spiritual quest. Other physicians express concern about causing more distress to patients in a time of significant need. Descriptions of educational tools, as well as the difference between spiritual generalists and spiritual specialists have emerged. Integration of chaplains into the medical team caring for patients at the end of life will also enhance care of the whole patient. SUMMARY: The increasing emphasis on whole patient care is leading to increasing focus on spiritual concerns of patients. Although not every patient has an interest in spiritual conversation, most do and medical teams will need to become more educated about appropriate spiritual engagement.

Comparative Assessment of a New Holistic-Oriented and an Old Specialty-Specific Undergraduate Curriculum in Removable Prosthodontics: A Study Based on Senior Students' Perceptions.

PURPOSE: A survey was conducted in the Dental School, Aristotle University, Thessaloniki, Greece, (i) to assess the perceptions and experiences of senior dental students, Classes of 2014 and 2015, toward the old, specialty-specific (OC) and new, holistic-oriented (NC) undergraduate curriculum, respectively, in removable prosthodontics and (ii) to identify areas of improvement in prosthodontic training. MATERIALS AND METHODS: Structural components of both curricula were collected, including the total number of (i) laboratory/lecture/clinical training hours, (ii) written examinations, (iii) mandatory clinical cases, and (iv) European Credit Transfer and Accumulation System (ECTS) credits. A 20-item closed-type questionnaire using a five-point Likert scale was distributed in two consecutive groups of seniors, Classes of 2014 (n = 54) and 2015 (n = 57); 54 OC and 57 NC senior students filled out the questionnaire. RESULTS: A greater percentage of NC students stated that (i) they felt less confident to carry out jaw relation recording and removable partial denture metal framework design and (ii) the time allocated for clinical training was less sufficient. Students of both curricula reported that the laboratory courses and lectures contributed little to their clinical performance. Implant restorations and prosthetic management of patients with craniomandibular disorders were the most popular treatment options that the respondents felt that should be incorporated in the undergraduate curriculum. CONCLUSIONS: As a general trend, students completing the revised curriculum reported more difficulties during their training and felt more insecure about their clinical competences. To enhance students' self-confidence in prosthodontics, more effective preclinical training methods, introduction of additional treatment options, and alternative educational methods should be considered.

Visión holística de nuevos desafíos: paradigmas tecnológicos y fundamentos bioéticos en la Medicina futurista / Holistic view of new challenges: technological paradigms and bioethical basis of Futuristic Medicine

Introducción.La medicina del siglo XXI será un punto de fusión de numerosas nuevas tecnologías. Surgirán transformaciones en los paradigmas de la atención médica. Objetivo: Ofrecer una visión de lo que podría ser la atención médica futura. Material y Métodos: Se revisa en la literatura médica las ultimas y nuevas herramientas tecnológicas al servicio de la Medicina, sus posibles transformaciones y aplicación futura a través de la exploración en las principales bases de datos indexadas en los últimos 7 años, que originarán un cambio en el pensamiento científico y una visión predictiva en la atención médica a nivel mundial que realizaran reflexiones sobre enfoques médicos que origina la medicina traslacional. Se analiza el papel de la nanotecnología en la farmacología futurista, así como la genética y robótica, y se establecen comparaciones entre la cantidad de investigaciones por países y el estado actual en la América Latina y cómo influirán los nuevos adelantos científicos en la bioética lo que pudiera dar origen al transhumanismo. Resultados: El influjo de las nuevas tecnologías está ligado con el desarrollo económico y social, por lo que su aplicación no será equitativa, existiendo una diferencia importante en la formulación de patentes, investigaciones indexadas y citaciones entre países desarrollados y subdesarrollados, donde ningún país latinoamericano se encuentra entre los primeros 10 lugares del ranking mundial. Conclusiones: La tecnología actual le da solución a algunos problemas, pero no ha sido capaz de dominar muchas enfermedades. La utilización de la nanotecnología, la genética y la robótica provocarán cambios en los paradigmas de enfrentamiento a las enfermedades. Pudieran ocasionar deshumanización y problemas bioéticos(AU)

Introduction: Medicine in the 21st century will be a fusion point of numerous new technologies. Changes in the paradigms of medical attention will emerge. Objective:To present a view of what future medical attention could be. Material and methods:A review of the last and new technological tools at the service of Medicine is made, and their possible transformations and future implementation are studied through the search of the main databases of the data indexed during the last seven years, which will make a change in the scientific thought and a predictive view of the medical attention worldwide, and make reflections on the medical approaches that arise from translational medicine. The role of nanotechnology in the futuristic pharmacology is analyzed, as well as genetics and robotics; and comparisons are made regarding the amount of research by countries and the current condition in Latin America, and the way the new scientific innovations will influence in the Bioethics, which could give rise to transhumanism. Results:The influence of the new technologies is linked to the economic and social development. Therefore, its implementation will not be equitable, existing an important difference in establishment of patents, indexed research, and quotations between developed and underdeveloped countries, where no Latin American country is among the 10 first places in the world ranking. Conclusions:Current technology gives solution to some problems, but it has not been able to be acquainted with many diseases. The use of nanotechnology, genetics, and robotics will provoke changes in the confrontation paradigms of diseases, which could cause dehumanization and bioethical issues(AU)

The spiritual history in outpatient practice: attitudes and practices of health professionals in the Adventist Health System.

BACKGROUND: A screening spiritual history (SSH) is how health professionals (HP) identify patients' spiritual values, beliefs and preferences (VBPs) in the outpatient setting. We report on attitudes and practices of HPs in the largest Protestant health system in the U.S., the Adventist Health System (AHS). METHOD: Physicians or mid-level practitioners (N = 1082) in AHS-affiliated practices were approached and 513 (47%) agreed to participate. Participants were asked to identify a "spiritual care coordinator" (nurse/staff) and complete a questionnaire that assessed demographics, practice characteristics, religious involvement, and attitudes/practices concerning the SSH. Prevalence and predictors of attitudes/practices were identified. RESULTS: Questionnaires were completed by 427 physicians, 86 mid-level practitioners, and 224 nurses/staff (i.e., spiritual care coordinators). Among physicians, 45% agreed that HPs should take a SSH; of mid-level practitioners, 56% agreed; and of nurses/staff, 54% agreed. A significant proportion (range 31-54%) agreed that physicians should take the SSH. Participants indicated a SSH is appropriate for all outpatients (46-57%), well-visit exams (50-60%), the chronically ill (71-75%) and terminally ill (79-82%). A majority agreed the SSH should be documented in the medical record (67-80%). Few (11-17%) currently took a SSH, although most were at least sometimes willing to take a SSH (87-94%) or review the results thereof (86-98%). Self-rated importance of religion was the strongest predictor of SSH attitudes/practices. CONCLUSIONS: Many in the AHS say a SSH should be done, are willing to do it, and are willing to review the results, although few currently do so. Education, training, and support may help HPs identify and address patients' spiritual VBPs.

Making Whole: Applying the Principles of Integrative Medicine to Medical Education.

In the past few decades, the public's use of complementary and alternative medicine (CAM) has steadily increased. The term "integrative medicine" is often used to refer to the combination of CAM with conventional medicine. Many medical schools have incorporated didactic content on CAM and/or integrative medicine into their curricula. A frequently cited rationale for these course offerings is that medical students ought to be taught the basics of CAM in order to counsel patients on safe, effective therapeutic options. Schools have also offered these courses to meet the needs of students who are interested in incorporating CAM into future practices. In this article, the authors suggest that the core principles of integrative medicine--holistic worldview, centrality of the doctor-patient relationship, emphasis on wellness, and inclusiveness--are aligned with the goals of contemporary medical education and serve a critical function in the development of effective, humanistic physicians.

Workplace learning in midwifery education in Flanders (Belgium).

Workplace learning plays a crucial role in midwifery education. Twelve midwifery schools in Flanders (Belgium) implemented a new competency framework and aimed at implementing a more standardized and evidence-based method to learn and assess competencies, as well as to guide continuous competency development in practice. This paper describes the introduction of 'Embo's continuous workplace learning model', a holistic and competency-based method that integrates all workplace learning components. Available research evidence helps concluding the learning model is a feasible approach to organize workplace learning in such a way that continuous professional competency development is achieved.