This journal article reports on qualitative findings from a novel inter-professional curriculum that began as a pilot project at Johns Hopkins Bayview in 2011. Prior to coming to Duke in 2015 as a fellow in General Internal Medicine, I worked on this project with directors of pastoral care at both Johns Hopkins Hospitals in Baltimore, MD and my GIM mentor, Dr. Rachel Levine. In this post I hope to highlight some of the exciting features of this work.
Our idea was to bring practitioners and learners from our patients’ medical and spiritual care teams together to achieve better whole-person care.
My chaplain colleagues on the project introduced me to Clinical Pastoral Education (CPE), the nationwide system for training masters-level theology students to do the work of a hospital chaplain. Such programs began in the 1920’s and continue to exist at Johns Hopkins, Duke University Hospital, and many other public and private medical institutions. At Johns Hopkins Bayview, we added a CPE intern (chaplain trainee) to one inpatient team on the medicine wards. During a four-week rotation, each intern accompanied morning work-rounds on a weekly basis and assisted as an additional member of the team.
For our qualitative evaluation, we conducted multiple focus groups with chaplain and physician participants with the intent of identifying strengths and weaknesses of this inter-professional arrangement. Our participants perceived the following strengths:
Increased learning about communication skills for conversations about patients’ spiritual needs
Better team-based patient-centered care
Opportunities for the chaplain to provide emotional support to the medical team members
As we expected, participants identified several challenges of working together. Without appropriate introductions of team members, clearly outlined expectations, or mechanisms to provide feedback to learners, participants could become frustrated or marginalized. Many chaplains have limited experience in approaching physicians about a patient care, so being acknowledged by physicians as important members of the team could go a long ways to create cohesion.
In response to the strengths and challenges identified, I and my co-authors developed, implemented and studied a formalized curriculum that is now in its third year and has involved over twenty chaplain interns and over eighty medical residents. Nearly two-thirds of our residents now report being “very comfortable” with engaging in a conversation with a patient about a spiritual topic, and over 80% report having referred a patient to a chaplain at least once in the previous month of inpatient work.
A more detailed description of the curriculum and our evaluation is forthcoming this summer in the Journal of Graduate Medical Education.
Certainly not all hospitalized patients consider themselves as “religious” or “spiritual,” and chaplains are generally only involved with a minority of patients; however, we believe that for this group of residents, we have enhanced their knowledge of the meaningful support that chaplains can provide for their patients. My hope is that this inter-professional approach can be applied in other specialties and at other institutions like Duke.
Full citation:
Hemming P, Teague PJ, Crowe T, Levine R. Chaplains on the Medical Team: A Qualitative Analysis of an Interprofessional Curriculum for Internal Medicine Residents and Chaplain Interns. J. Relig. Health. 2015. Advance Online Publication. doi: 10.1007/s10943-015-0158-7 PMID 26578510 [Link]
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Learn more about Dr. Hemming from his GIM Spotlight.