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Spirituality and Religion in Canadian Psychiatric Residency Training
In 1999, to support the incorporation of training in religion and spirituality into residency curricula, the National Institute for Healthcare Research (a nonprofit advocacy organization) established the John Templeton Foundation Spirituality and Medicine Award for Psychiatric Residency Training Programs. By 2001, 16 psychiatric residency programs in the US had received this award. In most of the programs, the mandatory curriculum spans the length of the residency and has both a didactic and a clinical component. Time devoted to the didactic component ranges from 12 to 81 hours. The clinical component includes group case-based discussions, teaching clinical interviewing skills needed to take a religious and spiritual history, formal collaboration with chaplains, and mandatory case-based supervision during clinical rotations. Many of the programs also offer both clinical and research elective opportunities.
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Table 2 Religion and spirituality training available in 14 of 16 Canadian
psychiatric residency training programs
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Training available
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Number of residency programs
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Lectures
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4a
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Research electives
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3
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Case-based supervision
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9
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Clinical electives
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2
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No training available
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4
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aNumber of hours of lectures at each of the 4 programs: 1, 1, 3, and 4
hours respectively.
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Incorporation of Religion and Spirituality into Canadian Curricula
Given the growing importance of training in religious and spiritual issues in clinical psychiatry, we surveyed Canadian psychiatry residency programs to evaluate the current availability of training. In June 2001, we mailed a letter describing recent developments in US curricula to the program directors of all 16 Canadian residency programs. The letter asked for a complete outline of didactic teaching, case conferences, and supervision in which religion and spirituality were directly addressed. from September to November 2001, we sent follow-up phone calls and e-mails to programs that had not yet responded. We received 14 responses.
Of the 14 responding programs, 10 did not provide didactic teaching (Table 2). The 4 programs that provided mandatory didactic teaching devoted to it 1 hour, 1 hour, 3 hours, and 4 hours of teaching, respectively. Six of the10 programs that did not provide didactic teaching offered case-based supervision to interested residents, usually in the context of psychotherapy supervision. Three of the 4 programs that provided mandatory lectures also had case-based supervision available. Four programs provided no formal or informal instruction whatever. Two programs offered formal elective experiences, including the opportunity to spend one-half day weekly working with members of a denominational counselling service. In 3 programs, residents were involved in related research endeavours, with supervision being provided by faculty working actively in this area.
A limitation of this survey is that it did not formally assess residents’ perceived need for training in this area nor did it evaluate their satisfaction with currently available training. However, informal discussions with residents across the country show support for the introduction of a formal lecture series.
In summary, most Canadian training programs currently do not offer residents training that will prepare them to competently address the interface of psychiatry and religion or spirituality. Mandatory training is limited to 4 residency programs that provide between 1 and 4 hours of teaching. Most available case-based supervision relies both on resident motivation and on supervisor interest and knowledge base in this area.
Proposal for a Canadian Curriculum
We have developed an academic curriculum (Table 3) to address the lack of currently available training. Because the field of religion and spirituality is vast, the proposed curriculum is limited to 10 academic sessions (90 to 120 minutes each) to facilitate its incorporation into existing curricula. We have excluded such areas of study as the sociology of religion and the role of rituals in cultures and religions in an effort to keep the focus on clinical relevance; however, they can be added if time and resident interest allows. The particular religious traditions covered in sessions 3 to 6 should be selected to reflect local diversity and challenges in clinical practice.
The proposed curriculum differs in its approach from the curriculum developed by Larson and colleagues (21). Rather than focusing on the needs of specific groups, such as substance abusers, the proposed curriculum emphasizes imparting basic knowledge about specific religious and spiritual traditions. This shift in emphasis will allow residents to become familiar with an overall approach to religious and spiritual issues in clinical care and to acquire a basic knowledge of several traditions reflecting Canada’s culturally and religiously diverse population. This specific knowledge of several traditions can serve as a framework to be expanded as needed in addressing clinical situations.
Suggested course faculty include members of psychiatry, religion, and anthropology departments, as well as clergy and other religious leaders from the community. We recommend that course faculty supply additional references to reflect local diversity and supplement the suggested references.
To allow further course development, a method of evaluating the effects of adding a lecture series (such as the one proposed) to core curricula is needed. Changes in resident and faculty attitudes, in comfort levels with applying newly gained skills, and in practice patterns need to be evaluated and followed. If rigorous evaluation shows that the curriculum is well received and effectively meets its goals, educators in other specialties and areas of health care, such as undergraduate medical training and nursing, may be interested in adopting a similar model.
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Table 3 Selected elements of a proposed academic lecture series on religious
and spirituality in psychiatrya
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Session
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Objectives
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Introduction
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-
Course overview
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Historical relation between psychiatry and religion
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Review of recent research on religion and spirituality and mental health
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Definitions of religious and spiritual concepts
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Religion and spirituality in human development
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-
Review of prestage and 6 stages of religious faith, as developed by James
Fowler (integrates theories of the major developmentalists Piaget, Erikson,
and Kohlberg)
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Review of the integrative psychobiological approach to personality development,
as described by Cloninger, with a focus on developmental steps 9 to 15
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Overview of selected major religions – Buddhism, Taoism, Hinduism
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-
To learn about Eastern traditions, with a focus on attitudes toward mental
health
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Overview of selected major religions – Christianity
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-
To learn about Christian traditions, with a focus on attitudes toward mental
health
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To learn about working in collaboration with chaplains and other clergy
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Overview of selected major religions – Islam
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-
To learn about Islamic traditions, with a focus on attitudes toward mental
health
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Overview of selected major religions – Judaism
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-
To learn about Judaic traditions, with a focus on attitudes toward mental
health
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Transpersonal psychology
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-
Review of definitions of transpersonal terms (for example, spiritually
transformative experiences [STEs]), kundalini episodes, and spiritual emergencies)
and theories
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Case-based discussion (for example, differentiating STEs from psychosis)
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First Nations spirituality and Shamanism
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-
Overview of First Nations traditional spiritual beliefs and practices
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Role of shamans in past and present aboriginal cultures
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To learn about referring to spiritual healers
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Religious and spiritual issues in psychotherapy
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-
To distinguish healthy and unhealthy religiosity and spirituality, as well
as to differentiate psychopathology from traditional spiritual practice
and discuss therapeutic intervention options
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To review the impact of religious and spiritual beliefs and practices on
transference, countertransference, and boundary issues in the therapeutic
relationship
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Resident-facilitated case conference
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-
Cases prepared by residents and submitted to the course director to be
discussed by residents and a panel of faculty selected by the course director
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aA more detailed course outline is available from the first author.
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Conclusion
Psychiatry residents would benefit from receiving mandatory training in religious and spiritual issues as they pertain to psychiatry. Currently, Canadian psychiatry residency programs offer minimal instruction in this area. The proposed 10-session lecture series can be incorporated into existing curricula to begin addressing this need.
Acknowledgement
The authors thank Dr Shamina Henkel for help with course development.
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Author(s)
Manuscript received January 2002, revised, and accepted July 2002.
1. Departmental Assistant, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia.
2. Clinical Professor of Psychiatry, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia.
Address for Correspondence: Dr A Grabovac, Department of Psychiatry, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1
e-mail: agrabovac@bccancer.bc.ca
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