Religious awareness training for medical students: effect on clinical interpersonal behavior.

To the Editor: We conducted a pilot study to examine the effect of religious-awareness training on medical students' "bedside manners." Research has documented physician avoidance of religious inquiry due to discomfort and lack of training. (1-3) Other research suggests that medical students exposed to religion in medicine display more empathy and positive attitudes toward religion in the clinic. (4) Our study was an interface of these lines of research using an experimental design.

We randomized third-year medical students to receive general patient supportiveness training (ST; n = 12, 6 women) or ST plus religious-awareness training (RAT; n = 15, 10 women). Students were blind to hypotheses and groups were trained separately. In the ST group, students learned to assess patient psychosocial concerns and assist in managing those concerns. There was no mention of religion. In the RAT group, in addition to ST, religious issues were presented as part of the psychosocial presentation. Ways of supporting patients emotionally, informationally, and instrumentally were taught regarding the health relevance of positive religious coping, including use of the HOPE spiritual history method.

One week following training, students interviewed the same standardized patient. The standardized patient rated the students' interpersonal behaviors on seven 5-point Likert scales (0 = poor, 4 = excellent). These ratings yielded two subscores: Affective behavior (eg, acknowledging patient distress, showing interest in patient as a person, warmth) and communication behavior (eg, using lay language, speaking to patient as an adult without condescension).

Using analysis of variance, we examined training and gender effects on outcomes. We found that training and gender interacted to influence affective behavior, but not communication behavior. For women, those who received RAT displayed significantly (P < 0.05) better affective behavior (M = 3.2, SD = 0.3) than those who received ST only (M = 2.6, SD = 0.7). Expressed in pooled standard deviation units, this mean difference corresponded to a Cohen's d ratio of 1.1, a large effect. Among men, training did not influence affective behavior.

Although limited by sample size, this pilot study demonstrated that a brief training session in religious awareness can positively impact effective interpersonal behavior among women medical students. Why the training did not impact men is a question for future research. Results contribute to understanding the role of religious awareness in medical education, including augmentation of positive process behaviors in the clinical encounter. (5)

Acknowledgments

This study was supported by the Lutheran Foundation, St. Louis, MO, and the Marchetti Jesuit Endowment, Saint Louis University, St. Louis, MO. The authors are grateful to Gail Furman, PhD, Rahul Dillon, and Wayland Lim for their valuable assistance with this project.

John T. Chibnall, PHD

Mary Ann Cook, PHD

Douglas K. Miller, MD

From the Department of Psychiatry, Saint Louis University School of Medicine, St. Louis, MO; JVC Radiology and Medical Analysis LLC, St. Louis, MO; and Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, IN.

References

1. Armbruster CA, Chibnall JT, Legett S. Pediatrician beliefs about spirituality and religion in medicine: associations with clinical practice. Pediatrics 2003;111:e227-235.

2. Chibnall JT, Brooks CA. Religion in the clinic: the role of physician beliefs. South Med J 2001;94:374-379.

3. Chibnall JT, Bennett ML, Videen SD, et al. Identifying barriers to psychosocial spiritual care at the end of life: a physician group study. Am J Hospice Palliat Med 2004;21:419-426.

4. Chibnall JT, Jeral JM, Cerullo MA, et al. Medical school exposure to spirituality and response to a hypothetical cancer patient. J Cancer Educ 2002;17:188-190.

5. Levin JS, Larson DB, Puchalski CM. Religion and spirituality in medicine: research and education. JAMA 1997;278:792-793.

Reprint requests to John T. Chibnall, PhD, Saint Louis University School of Medicine, Department of Psychiatry, 1221 S. Grand Blvd., St. Louis, MO, 63104. Email: [e-mail]

This study was supported by the Lutheran Foundation, St. Louis, MO, and the Marchetti Jesuit Endowment, Saint Louis University, St. Louis, MO. None of the authors has any commercial/proprietary associations or interests that might pose a conflict of interest in connection with this manuscript. This study was approved by the institutional review board of Saint Louis University; all participants gave written informed consent to participate.