Journal of Religion and Health
358
The Importance of Religion in Medical Education
MILTON
O. K E P L E R
The very thought of offering instruction in religion to medical students will certainly raise some academic eyebrows and produce some snorts of anger among the medical profession. A similar reaction occurred when the introduction of psychiatry into the medical curriculum was considered a few decades ago. The reasons for this latter reaction were complex, but certainly dislike and misunderstanding of some of the theories of the Freudian school were key factors. Today, only a few would question the value of psychiatry in medicine; it is an accepted part of the curriculum. Similarly, medicine has taken cognizance of the sociologic factors in the production of disease and disability, and the medical social worker is an important member of the health team. But the study of religion in medical school? Is it needed? Is it being offered? The answers to these questions were not available from the usual sources of information on medical education. 1 Accordingly, I undertook to survey the medical schools of this country and Canada to discover what, if anything, was being offered in the field of religion.2 In the spring of 1966, questionnaires were sent to the 100 schools of the United States and Canada, with a subsequent return of sixty-eight. Of the sixty-eight schools replying, twenty-seven offered some form of religious exposure in their curriculum, including ten state schools. Eleven other schools, which offered no instruction, stated they had felt a need in this area. Three other schools reported that this matter was under discussion or was going to be discussed. This means that roughly 40 per cent of those schools
Religion in Medical Education
359
replying offered some form of religious education, and if the fourteen schools that indicated a need for this instruction are added, the total equals 60 per cent of the schools replying that either were offering such exposure or considered it important enough to warrant discussion. Further, the results indicated that there were two main schools of thought as to how the religious factor should be presented: one felt that some kind of formal course should be given, while the other was equally insistent that this matter could not be formally taught, but rather must be transmitted to the students via the example and attitudes of the staff and faculty. Additionally, seven schools stated flatly that they felt no need for this kind of exposure, and twenty schools left the question unanswered; it is quke possible that some of the latter felt similarly. There were also several statements indicating some hostility toward or outright rejection of any instruction in the field of religion. Obviously, a substantial number of our medical schools are offering some form of exposure to the religious factor or are currently considering it. There is disagreement as to how it should be presented as well as some rejection of the idea in any form. The issues seem far from settled, but it is evident that the subject is of some interest to medical educators. Let us return to the question of whether instruction in religion is needed or not. The psychiatrists themselves have reminded us that although psychiatry may place a mentally disturbed person back on the right track, k is religion that can supply the answer to where the track is going. Religion, they remind us, can and does provide an answer to man's search for meaning--a search in which we all participate to some degree in our lifetime? Certainly many would agree that physicians must be aware of the importance of such a meaning--or lack of it--in the lives of their patients. Much is being said and written these days about "comprehensive care," "the whole-man concept," "total care," etc. If these catch-phrases are to be meaningful, they must connote knowledge and treatment of the total constitution of man. It follows that our medical students must get to know this totality and must be shown how to approach the problem of restoration of wholeness to the patient. The student must also learn to cope with such problems as
360
Journal of Religion and Health
death, grief, tragedy, and less-than-perfect "cures," as well as crippling and chronic conditions. Such knowledge makes up the full art of medicine. But where does the student find such knowledge? What does he think about a medical education that lacks concepts such as we are discussing here? There is evidence of growing unrest among medical students over a medical curriculum that often seems unconcerned with value systems and too detached from empathic contact with the patient: There are clear signs that today's students are greatly concerned with learning more about human values and developing a social conscience. In my experience with teaching the value of religion in a medical context, the subiect has been warmly received by many medical students. They want answers to questions being raised about the religious dimension of man and its meaning in a medical context. What importance do specific religious beliefs have for the patient who is ill? Will a Jewish woman recovering from a spontaneous abortion have the same feelings or problems as will a Roman Catholic woman? An atheistic woman? What does the chaplain do in his daily rounds of the hospital? H o w may the student or graduate physician utilize the many services the chaplain can offer? Is the chaplain or minister part of the healing team? Does he participate in medical rounds or conferences and contribute to the total understanding of the patient? Or is there a chaplain at all? What is the attitude of the student toward the presence of the chaplain? Unanswered questions of this sort create an intellectual vacuum that should stimulate an appropriate response from more of our medical educators. There is evident concern and need for additional information about the religious nature of man. Medical education must grapple with this problem effectively, and n o w : Before attempting to resolve some of these issues, we may find it helpful to take a further look at the current situation. What is the educational background of the average applicant to medical school today? Examination of the transcripts of such applicants reveals a great number who lack sufficient preparation in the humanities, including religion. The apparent concentration of study still centers in the biological and quantitative sciences, despite the considerable lip service being given to the value of
Religion in Medical Education
361
a broad premedical education. Preference continues to be given to the applicant with a heavy background in the sciences. This inconsistency has produced discouragement and cynicism among students and has concerned some educators. Understandably enough, many premedical advisors continue to urge students to select scientific courses to enhance their chances for admission to medical school. Surely, enlightened medical admissions committees and premedical advisors can exert great influence by encouraging candidates for medical school to prepare themselves broadly and to consider such broad preparation as a plus factor in their selection. The noted medical educator, Sir William Osler, said that a physician should have the education of a gentleman, if not of a scholar. The list of books Osier recommended for the physician's reading included the Bible and certain classics in the field of literature? Medical educators remember Abraham Flexner best for his insistence that medical schools offer a firm foundation in the medical sciences as part of their curriculum. A lesser-known fact is that shortly before Flexner's death in 1959, he was greatly concerned to return a balanced emphasis to the humanities in medical education, from whence they had been ousted by a preoccupation with medical sciences,r In 1960, the Academy of Religion and Mental Health held a symposium on the place of value systems in medical education. There was general agreement by this panel of philosophers, educators, physicians, and theologians, that value systems had a definite place in the medical curriculum. This report is good reading for anyone interested in informed opinion in this important area? But these opinions, past and present, are still largely ignored. It is somewhat disturbing to realize that many schools now have all of the ingredients necessary for presenting total-care concepts, yet fail to do so by neglecting the field of religion. In such a situation, we see a modern medical teaching center, wherein physicians, psychiatrists, social workers, and chaplains all work; but while the first three usually work together, the work of the chaplain, where there is one, is not integrated into the educational fabric of the system. Indeed, the role of the hospital chaplain is largely misunderstood, if considered at all, by the average medical student. The appearance of the
362
Journal of Religion and Health
chaplain may then signify impending disaster, demise, or a nuisance. Yet we are beginning to see the role of the chaplain entering into the healing team in some centers, and it is more and more apparent that his role, in addition to his patient care, can also be that of a resource person to the students and faculty. This is another neglected area that should be utilized in teaching religious values. Newer schools do not have quite the same problem as do some of the older ones--especially those geared to a relatively conventional philosophy of education. It has been noted that most of the new schools currently operating or in the planning stage have included some provision for presenting the religious dimension.9 Unhappily, others continue-to suffer from fragmentation of these different disciplines, for although medical, psychological, and social aspects of the person's disease are considered, the religious factor is not. All four of these dimensions make up the total constitution of man, and the medical student must be made aware of this fact. Then there is the problem of finding time in the medical curriculum for religious instruction. First of all, anyone who has ever served on or approached a curriculum committee knows how difficult it is to acquire any time for any new offering. Couple this with the resistance to "religion," realized or unconscious, of the faculty who may sit on such committees, and you may understand the slowness and reluctance with which such courses are often initiated in the average school of medicine. Yet it must be re-emphasized that the medical curriculum should be as concerned with the art of medicine as with the science, an approach too often forgotten, z~ Certainly religion, as a part of the whole-man concept, occupies a valid position within the art of medicine. If a medical school faculty shares this opinion, then time will be found somewhere in the curriculum. If we can now agree that religion is an essential part of the make-up of man and that some instruction in this area seems indicated, what shall be offered, how, and when? In regard to the when, the most desirable time for such instruction would be prior to medical school, in college or even earlier. College or high school preparation might include such courses as comparative religion, history of religion, religious ethics, philosophy of religion, etc. Such pre-
Religion in Medical Education
363
medical preparation would greatly enhance the subsequent exposure of the medical student to the religious dimension in a medical context as part of his general professionalization. Medical students, with or without such preparation in religion, would benefit by some orientation in the religious factor prior to entering the clinical years, so that it might be more meaningful in their evaluation of the whole man. It is in this regard that a survey course of religious values would be most helpful and necessary. If such a course were offered in the first or preferably the second year of medical school, it would help to prepare the student better for the clinical applications that would follow. As a further amplification of how such a course might be given in medical schools, some personal experiences may be helpful.11 In the spring of 1966, I initiated a course entitled "Medicine, Religion, and Healing" as a Sophomore elective in a typical and established eastern medical school. After an announcement had been made to the students about the general nature of this new course, about half of the class elected it. In a class period of one hour per week for one semester, the following topics were discussed: The whole-man concept. Survey of Western ethical thought as shaped by the Judaeo-Christian tradition. The tradition of the professional person. Chief features of the Protestant, Jewish, and Roman Catholic faiths, medically oriented, as seen by representative authorities of each. Limited discussions of specific medical-moral problems. Role of religion and clergy in healing. Collaboration of physician and clergy. Showing of the A.M.A. film, The One Who Heals. Role of the A.M.A. in the field of medicine and religion. Consideration of an ultimate source of all healing. The rights of the patient and importance of his religious thoughts and beliefs. The course was generally well received. The students elected to write brief term papers on some topic within the scope of the course; most of the papers reflected a concern and great interest in the chosen subject. Via a blind ques-
364
Journal of Religion and Health
tionnaire given at the conclusion of the course, the students reported that the course had met its stated objectives well; the consensus was that the experience had made them more aware and respectful of the rights of the patient and more tolerant of his religious views. As a logical follow-up, it seemed desirable to survey these same students two years later, when they had completed their clinical years and were ready for graduation from medical school. Questionnaires were mailed to 30 students; 17 were returned. Some of the more pertinent questions and results are as follows: 1. "Since you took the MRH course, have you encountered any reference to the religious factor in total patient care?" Yes 12 No 5 2. "Has the MRH course been helpful to you in clinical patient contacts, or case discussions?" Yes 13 No 4 3. "Do you regard the 'religious factor' as important in total patient care?" Yes 16 No 1 4. "Do you think some instruction in the religious factor--such as you had-should be part of medical education?" Yes 16 No 1 5. "Was the course of help to you in any way in developing your own values as a person?" Yes 9 No 6 Unsure 2 6. (A) "Do you think the MRH course made you more tolerant of the views of others?" Yes 14 No 3 (B) "Did it make you more respectful of the rights of the patient as a person?" Yes 12 No 5 Apparently some of the students did not equate the last two items with a development of personal values, as asked in question 5. This is interesting, as it parallels a similar tendency noted at the conclusion of the course: the apparent unwillingness of the students to say, in answer to direct questioning, that the course had in any way changed their values; but then their seeming to say they had changed, when queried in an indirect way, as in the items 6A and 6B. Perhaps this ties in with the observation made by certain educators that students do not often select courses that they suspect are aimed at improving them, but do choose courses purporting to emphasize the value of meanings,
Religion in Medical Education
365
beliefs, and values--including religion--to the patient. TM In other words, they will accept instruction about the patient's value systems, for it is about the patient they wish to learn in order to be good physicians. But as the student listens about others and their values and needs, he begins to develop and strengthen his own. In still other questioning, the students now thought that instruction of this type should be elective, not a required premedical course. Most students indicated they had a moderate religious commitment, and that this had not appreciably changed in the course of their four years of medical school. They did not think a physician should necessarily have a true religious commitment; nor did they feel that such a commitment would make him a better physician. I really believe, in the light of these results and from personal experience, that it is unwise to use the word "religion" in a course title for medical students. For many of these people, "religion" has an unfortunate connotation, and the use of some other word or term is suggestedY It is realized that no formal course of this kind can alone provide adequate meaning for the concept of religion as a value system important in medical treatment. The total learning environment of the institution must also reflect these values in the attitudes and examples of the faculty. However, until entering medical students are more adequately prepared in these values, it is believed that such an introductory course can be of help, not only in the quality of care the student will render his future patients, but in his own philosophy of life as well. It is also felt that there is a great integrating value in such a course, bringing together, as it should, the various ideas and representatives of several disciplines. Certainly, any conference on comprehensive care that omitted a consideration of the religious factor would be incomplete, in the sense that only part of the total make-up of the patient was seen. Furthermore, it seems fair to say that at least one group of medical students, when questioned both at the conclusion of the course and two years later at graduation, thought that the instruction in the religious factor had been of value and interest to them. Even those less enthusiastic members of the group felt that the experience had been helpful. Most significant was the
366
Journal of Religion and Health
overwhelming opinion of the students responding that the course had been helpful in patient contacts. Equally important was the large number who said that the exposure had made them more tolerant of the patient's religious beliefs and his rights as a person. Stated otherwise, the course appeared to have enhanced patient care and to have helped the student personally. Such benefits can produce a better physician for the practice of medicine. Hippocrates stated 2500 years ago that "Where the love of man is, there also is love of the Art." A normative system of Western religious values places primary emphasis on the love of one's fellow-man. Compassionate medical care of good quality has been a tradition of our Western culture and of our religious values. 14 Knowledge and practice of these religious values are indispensable for the physician who would offer his patient the complete Art of Medicine, and medical education must give the student physician an appropriate exposure in this area. References
1. These sources include the American Medical Association and the American Association of Medical Colleges. The latter helped conduct a similar survey somewhat later than mine in 1966. 2. Kepler, M. O., "Ethico-Religious Instruction in Medical Schools of the United States and Canada," J. Religion and Health, 1968, 7, 242-253. 3. Frankl, V., Man's Search for Meaning. New York, Washington Square Press, 1963. 4. "Unrest on the Medical Campus," Medical World News, 1967, 8, 63-67. 5. Rusk, H. A., "Educating the Whole Student," Medical World News, 1967, 8, 135. 6. Osier, W., Aequanimitas, with Other Addresses. Third ed. Philadelphia, Blakiston, 1947, 451 ft. 7. Lasagna, L., The Doctors' Dilemmas. New York, Harper & Brothers, 1962, 67. 8. The Place of Value Systems in Medical Education. New York, The Academy of Religion and Mental Health, 1961. 9. The Milton S. Hershey Medical Center, The Pennsylvania State University Bulletin, College of Medicine, 1968-69, 14-19.
Religion in Medical Education
367
10. L. J. Evans wrote (in The Crisis in Medical Education. Ann Arbor, University of Michigan Press, 1964, 2, 36): "The success of medicine in our lifetime, as measured by current standards, has been the most brilliant in t h e w h o l e history of medicine. But, ironically, when accomplishments have resulted in fewer illnesses, and many more patients, the university and medical education have tended to become more disease oriented and less patient oriented as a result of intense concentration on acute and chronic organic illness and preoccupation with mastery of the physical and biological sciences." "Knowledge of these fundamental aspects of the biological mechanisms of disease and the life process will in turn force medicine to examine more closely the circumstances under which disease and illness occur in the human, who is a social, thinking, and feeling being." See also the quotation by Lyle Saunders on p. 8 of this work, relative to "the integration of medicine into our culture as comprised of government, religion, the family, art, education, and the economy." See also: "Trends and Issues in Medical Education" (a symposium), The Christian Scholar, 1967, Y0, 345-410. 11. Kepler, M. O., "Can the Art of Medicine Survive?" Medical Annals of the District of Columbia, 1967, 36, 311-312. 12. The Place of Value Systems in Medical Education, op. cit. 13. In the spring of 1968, the course title used was "Medicine and the Faith of Your Patient." 14. Kepler, "Medicine and Religion: A Brief Historical Survey of Their Interrelationships," Nebraska State Medical Journal, in press. 9
.
.
358
The Importance of Religion in Medical Education
MILTON
O. K E P L E R
The very thought of offering instruction in religion to medical students will certainly raise some academic eyebrows and produce some snorts of anger among the medical profession. A similar reaction occurred when the introduction of psychiatry into the medical curriculum was considered a few decades ago. The reasons for this latter reaction were complex, but certainly dislike and misunderstanding of some of the theories of the Freudian school were key factors. Today, only a few would question the value of psychiatry in medicine; it is an accepted part of the curriculum. Similarly, medicine has taken cognizance of the sociologic factors in the production of disease and disability, and the medical social worker is an important member of the health team. But the study of religion in medical school? Is it needed? Is it being offered? The answers to these questions were not available from the usual sources of information on medical education. 1 Accordingly, I undertook to survey the medical schools of this country and Canada to discover what, if anything, was being offered in the field of religion.2 In the spring of 1966, questionnaires were sent to the 100 schools of the United States and Canada, with a subsequent return of sixty-eight. Of the sixty-eight schools replying, twenty-seven offered some form of religious exposure in their curriculum, including ten state schools. Eleven other schools, which offered no instruction, stated they had felt a need in this area. Three other schools reported that this matter was under discussion or was going to be discussed. This means that roughly 40 per cent of those schools
Religion in Medical Education
359
replying offered some form of religious education, and if the fourteen schools that indicated a need for this instruction are added, the total equals 60 per cent of the schools replying that either were offering such exposure or considered it important enough to warrant discussion. Further, the results indicated that there were two main schools of thought as to how the religious factor should be presented: one felt that some kind of formal course should be given, while the other was equally insistent that this matter could not be formally taught, but rather must be transmitted to the students via the example and attitudes of the staff and faculty. Additionally, seven schools stated flatly that they felt no need for this kind of exposure, and twenty schools left the question unanswered; it is quke possible that some of the latter felt similarly. There were also several statements indicating some hostility toward or outright rejection of any instruction in the field of religion. Obviously, a substantial number of our medical schools are offering some form of exposure to the religious factor or are currently considering it. There is disagreement as to how it should be presented as well as some rejection of the idea in any form. The issues seem far from settled, but it is evident that the subject is of some interest to medical educators. Let us return to the question of whether instruction in religion is needed or not. The psychiatrists themselves have reminded us that although psychiatry may place a mentally disturbed person back on the right track, k is religion that can supply the answer to where the track is going. Religion, they remind us, can and does provide an answer to man's search for meaning--a search in which we all participate to some degree in our lifetime? Certainly many would agree that physicians must be aware of the importance of such a meaning--or lack of it--in the lives of their patients. Much is being said and written these days about "comprehensive care," "the whole-man concept," "total care," etc. If these catch-phrases are to be meaningful, they must connote knowledge and treatment of the total constitution of man. It follows that our medical students must get to know this totality and must be shown how to approach the problem of restoration of wholeness to the patient. The student must also learn to cope with such problems as
360
Journal of Religion and Health
death, grief, tragedy, and less-than-perfect "cures," as well as crippling and chronic conditions. Such knowledge makes up the full art of medicine. But where does the student find such knowledge? What does he think about a medical education that lacks concepts such as we are discussing here? There is evidence of growing unrest among medical students over a medical curriculum that often seems unconcerned with value systems and too detached from empathic contact with the patient: There are clear signs that today's students are greatly concerned with learning more about human values and developing a social conscience. In my experience with teaching the value of religion in a medical context, the subiect has been warmly received by many medical students. They want answers to questions being raised about the religious dimension of man and its meaning in a medical context. What importance do specific religious beliefs have for the patient who is ill? Will a Jewish woman recovering from a spontaneous abortion have the same feelings or problems as will a Roman Catholic woman? An atheistic woman? What does the chaplain do in his daily rounds of the hospital? H o w may the student or graduate physician utilize the many services the chaplain can offer? Is the chaplain or minister part of the healing team? Does he participate in medical rounds or conferences and contribute to the total understanding of the patient? Or is there a chaplain at all? What is the attitude of the student toward the presence of the chaplain? Unanswered questions of this sort create an intellectual vacuum that should stimulate an appropriate response from more of our medical educators. There is evident concern and need for additional information about the religious nature of man. Medical education must grapple with this problem effectively, and n o w : Before attempting to resolve some of these issues, we may find it helpful to take a further look at the current situation. What is the educational background of the average applicant to medical school today? Examination of the transcripts of such applicants reveals a great number who lack sufficient preparation in the humanities, including religion. The apparent concentration of study still centers in the biological and quantitative sciences, despite the considerable lip service being given to the value of
Religion in Medical Education
361
a broad premedical education. Preference continues to be given to the applicant with a heavy background in the sciences. This inconsistency has produced discouragement and cynicism among students and has concerned some educators. Understandably enough, many premedical advisors continue to urge students to select scientific courses to enhance their chances for admission to medical school. Surely, enlightened medical admissions committees and premedical advisors can exert great influence by encouraging candidates for medical school to prepare themselves broadly and to consider such broad preparation as a plus factor in their selection. The noted medical educator, Sir William Osler, said that a physician should have the education of a gentleman, if not of a scholar. The list of books Osier recommended for the physician's reading included the Bible and certain classics in the field of literature? Medical educators remember Abraham Flexner best for his insistence that medical schools offer a firm foundation in the medical sciences as part of their curriculum. A lesser-known fact is that shortly before Flexner's death in 1959, he was greatly concerned to return a balanced emphasis to the humanities in medical education, from whence they had been ousted by a preoccupation with medical sciences,r In 1960, the Academy of Religion and Mental Health held a symposium on the place of value systems in medical education. There was general agreement by this panel of philosophers, educators, physicians, and theologians, that value systems had a definite place in the medical curriculum. This report is good reading for anyone interested in informed opinion in this important area? But these opinions, past and present, are still largely ignored. It is somewhat disturbing to realize that many schools now have all of the ingredients necessary for presenting total-care concepts, yet fail to do so by neglecting the field of religion. In such a situation, we see a modern medical teaching center, wherein physicians, psychiatrists, social workers, and chaplains all work; but while the first three usually work together, the work of the chaplain, where there is one, is not integrated into the educational fabric of the system. Indeed, the role of the hospital chaplain is largely misunderstood, if considered at all, by the average medical student. The appearance of the
362
Journal of Religion and Health
chaplain may then signify impending disaster, demise, or a nuisance. Yet we are beginning to see the role of the chaplain entering into the healing team in some centers, and it is more and more apparent that his role, in addition to his patient care, can also be that of a resource person to the students and faculty. This is another neglected area that should be utilized in teaching religious values. Newer schools do not have quite the same problem as do some of the older ones--especially those geared to a relatively conventional philosophy of education. It has been noted that most of the new schools currently operating or in the planning stage have included some provision for presenting the religious dimension.9 Unhappily, others continue-to suffer from fragmentation of these different disciplines, for although medical, psychological, and social aspects of the person's disease are considered, the religious factor is not. All four of these dimensions make up the total constitution of man, and the medical student must be made aware of this fact. Then there is the problem of finding time in the medical curriculum for religious instruction. First of all, anyone who has ever served on or approached a curriculum committee knows how difficult it is to acquire any time for any new offering. Couple this with the resistance to "religion," realized or unconscious, of the faculty who may sit on such committees, and you may understand the slowness and reluctance with which such courses are often initiated in the average school of medicine. Yet it must be re-emphasized that the medical curriculum should be as concerned with the art of medicine as with the science, an approach too often forgotten, z~ Certainly religion, as a part of the whole-man concept, occupies a valid position within the art of medicine. If a medical school faculty shares this opinion, then time will be found somewhere in the curriculum. If we can now agree that religion is an essential part of the make-up of man and that some instruction in this area seems indicated, what shall be offered, how, and when? In regard to the when, the most desirable time for such instruction would be prior to medical school, in college or even earlier. College or high school preparation might include such courses as comparative religion, history of religion, religious ethics, philosophy of religion, etc. Such pre-
Religion in Medical Education
363
medical preparation would greatly enhance the subsequent exposure of the medical student to the religious dimension in a medical context as part of his general professionalization. Medical students, with or without such preparation in religion, would benefit by some orientation in the religious factor prior to entering the clinical years, so that it might be more meaningful in their evaluation of the whole man. It is in this regard that a survey course of religious values would be most helpful and necessary. If such a course were offered in the first or preferably the second year of medical school, it would help to prepare the student better for the clinical applications that would follow. As a further amplification of how such a course might be given in medical schools, some personal experiences may be helpful.11 In the spring of 1966, I initiated a course entitled "Medicine, Religion, and Healing" as a Sophomore elective in a typical and established eastern medical school. After an announcement had been made to the students about the general nature of this new course, about half of the class elected it. In a class period of one hour per week for one semester, the following topics were discussed: The whole-man concept. Survey of Western ethical thought as shaped by the Judaeo-Christian tradition. The tradition of the professional person. Chief features of the Protestant, Jewish, and Roman Catholic faiths, medically oriented, as seen by representative authorities of each. Limited discussions of specific medical-moral problems. Role of religion and clergy in healing. Collaboration of physician and clergy. Showing of the A.M.A. film, The One Who Heals. Role of the A.M.A. in the field of medicine and religion. Consideration of an ultimate source of all healing. The rights of the patient and importance of his religious thoughts and beliefs. The course was generally well received. The students elected to write brief term papers on some topic within the scope of the course; most of the papers reflected a concern and great interest in the chosen subject. Via a blind ques-
364
Journal of Religion and Health
tionnaire given at the conclusion of the course, the students reported that the course had met its stated objectives well; the consensus was that the experience had made them more aware and respectful of the rights of the patient and more tolerant of his religious views. As a logical follow-up, it seemed desirable to survey these same students two years later, when they had completed their clinical years and were ready for graduation from medical school. Questionnaires were mailed to 30 students; 17 were returned. Some of the more pertinent questions and results are as follows: 1. "Since you took the MRH course, have you encountered any reference to the religious factor in total patient care?" Yes 12 No 5 2. "Has the MRH course been helpful to you in clinical patient contacts, or case discussions?" Yes 13 No 4 3. "Do you regard the 'religious factor' as important in total patient care?" Yes 16 No 1 4. "Do you think some instruction in the religious factor--such as you had-should be part of medical education?" Yes 16 No 1 5. "Was the course of help to you in any way in developing your own values as a person?" Yes 9 No 6 Unsure 2 6. (A) "Do you think the MRH course made you more tolerant of the views of others?" Yes 14 No 3 (B) "Did it make you more respectful of the rights of the patient as a person?" Yes 12 No 5 Apparently some of the students did not equate the last two items with a development of personal values, as asked in question 5. This is interesting, as it parallels a similar tendency noted at the conclusion of the course: the apparent unwillingness of the students to say, in answer to direct questioning, that the course had in any way changed their values; but then their seeming to say they had changed, when queried in an indirect way, as in the items 6A and 6B. Perhaps this ties in with the observation made by certain educators that students do not often select courses that they suspect are aimed at improving them, but do choose courses purporting to emphasize the value of meanings,
Religion in Medical Education
365
beliefs, and values--including religion--to the patient. TM In other words, they will accept instruction about the patient's value systems, for it is about the patient they wish to learn in order to be good physicians. But as the student listens about others and their values and needs, he begins to develop and strengthen his own. In still other questioning, the students now thought that instruction of this type should be elective, not a required premedical course. Most students indicated they had a moderate religious commitment, and that this had not appreciably changed in the course of their four years of medical school. They did not think a physician should necessarily have a true religious commitment; nor did they feel that such a commitment would make him a better physician. I really believe, in the light of these results and from personal experience, that it is unwise to use the word "religion" in a course title for medical students. For many of these people, "religion" has an unfortunate connotation, and the use of some other word or term is suggestedY It is realized that no formal course of this kind can alone provide adequate meaning for the concept of religion as a value system important in medical treatment. The total learning environment of the institution must also reflect these values in the attitudes and examples of the faculty. However, until entering medical students are more adequately prepared in these values, it is believed that such an introductory course can be of help, not only in the quality of care the student will render his future patients, but in his own philosophy of life as well. It is also felt that there is a great integrating value in such a course, bringing together, as it should, the various ideas and representatives of several disciplines. Certainly, any conference on comprehensive care that omitted a consideration of the religious factor would be incomplete, in the sense that only part of the total make-up of the patient was seen. Furthermore, it seems fair to say that at least one group of medical students, when questioned both at the conclusion of the course and two years later at graduation, thought that the instruction in the religious factor had been of value and interest to them. Even those less enthusiastic members of the group felt that the experience had been helpful. Most significant was the
366
Journal of Religion and Health
overwhelming opinion of the students responding that the course had been helpful in patient contacts. Equally important was the large number who said that the exposure had made them more tolerant of the patient's religious beliefs and his rights as a person. Stated otherwise, the course appeared to have enhanced patient care and to have helped the student personally. Such benefits can produce a better physician for the practice of medicine. Hippocrates stated 2500 years ago that "Where the love of man is, there also is love of the Art." A normative system of Western religious values places primary emphasis on the love of one's fellow-man. Compassionate medical care of good quality has been a tradition of our Western culture and of our religious values. 14 Knowledge and practice of these religious values are indispensable for the physician who would offer his patient the complete Art of Medicine, and medical education must give the student physician an appropriate exposure in this area. References
1. These sources include the American Medical Association and the American Association of Medical Colleges. The latter helped conduct a similar survey somewhat later than mine in 1966. 2. Kepler, M. O., "Ethico-Religious Instruction in Medical Schools of the United States and Canada," J. Religion and Health, 1968, 7, 242-253. 3. Frankl, V., Man's Search for Meaning. New York, Washington Square Press, 1963. 4. "Unrest on the Medical Campus," Medical World News, 1967, 8, 63-67. 5. Rusk, H. A., "Educating the Whole Student," Medical World News, 1967, 8, 135. 6. Osier, W., Aequanimitas, with Other Addresses. Third ed. Philadelphia, Blakiston, 1947, 451 ft. 7. Lasagna, L., The Doctors' Dilemmas. New York, Harper & Brothers, 1962, 67. 8. The Place of Value Systems in Medical Education. New York, The Academy of Religion and Mental Health, 1961. 9. The Milton S. Hershey Medical Center, The Pennsylvania State University Bulletin, College of Medicine, 1968-69, 14-19.
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10. L. J. Evans wrote (in The Crisis in Medical Education. Ann Arbor, University of Michigan Press, 1964, 2, 36): "The success of medicine in our lifetime, as measured by current standards, has been the most brilliant in t h e w h o l e history of medicine. But, ironically, when accomplishments have resulted in fewer illnesses, and many more patients, the university and medical education have tended to become more disease oriented and less patient oriented as a result of intense concentration on acute and chronic organic illness and preoccupation with mastery of the physical and biological sciences." "Knowledge of these fundamental aspects of the biological mechanisms of disease and the life process will in turn force medicine to examine more closely the circumstances under which disease and illness occur in the human, who is a social, thinking, and feeling being." See also the quotation by Lyle Saunders on p. 8 of this work, relative to "the integration of medicine into our culture as comprised of government, religion, the family, art, education, and the economy." See also: "Trends and Issues in Medical Education" (a symposium), The Christian Scholar, 1967, Y0, 345-410. 11. Kepler, M. O., "Can the Art of Medicine Survive?" Medical Annals of the District of Columbia, 1967, 36, 311-312. 12. The Place of Value Systems in Medical Education, op. cit. 13. In the spring of 1968, the course title used was "Medicine and the Faith of Your Patient." 14. Kepler, "Medicine and Religion: A Brief Historical Survey of Their Interrelationships," Nebraska State Medical Journal, in press. 9
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