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Making space for spirituality

Beth Howard , special to AAMCNews
June 25, 2019

Fist bumps instead of handshakes. Residencies that offer flexibility on the Sabbath. Healing ceremonies. Medical schools and teaching hospitals increasingly embrace students’ faith-based traditions.

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When Native American students start the academic year at the University of Arizona College of Medicine—Tucson, they’re invited to attend a blessing ceremony. A traditional healer burns cedar and prays, then fans the smoke with eagle feathers to bless those in attendance, a practice known as smudging, which is believed to provide physical and spiritual strength.

“Medical school is very stressful,” says Carlos Gonzales, MD, assistant dean of curricular affairs and associate professor of family and community medicine at the school, and a member of the Pascua-Yaqui tribe. “If you can reflect back on ceremonies like these, it reminds you, ‘Yeah, I'm having a hard time, but people here care.’”

The practice serves an important function. “If you want to have students feel at home at predominantly white institutions, you have to do something to let them know that they're valued, that their culture is valued,” says Gonzales, who says such rituals have helped increase the number of Native American students from one or two 10 years ago to 28 in this year’s class.

“If you want to have students feel at home at predominantly white institutions, you have to do something to let them know that they're valued, that their culture is valued.”

Carlos Gonzales, MD
University of Arizona College of Medicine—Tucson

The ceremony is just one of the ways that medical schools and residency programs are accommodating the religious and cultural traditions of students and residents. Among many perceived benefits, “it allows us to attract really talented residents,” says Keith B. Armitage, MD, director of the Internal Medicine Residency Training Program at University Hospitals Cleveland Medical Center, which offers residency spots that allow Jewish learners to observe the Sabbath. “It expands our talent pool.”

Acknowledging students’ faith practices helps to tend their psychological needs and prevent burnout, as well as promoting greater cultural awareness. “More universities and hospitals are focusing on the concept of wellness, allowing students to express themselves, whether in meditation or prayer,” says Marium Husain, MD, oncology hospitalist at The Ohio State University Wexner Medical Center, who also oversees student and resident affairs for the Islamic Medical Association of North America. “And if you personally know someone who is Muslim or Jewish or Christian, there's an understanding that goes beyond what the books tell you about how to take care of someone. You're able to connect with that patient better.”

Here’s how some schools are accommodating, even embracing, learners’ spiritual practices.

Honoring the Sabbath

When Passover started last April, Daniel Kadosh, MD, a third-year radiology resident at Westchester Medical Center, didn’t have to worry about taking time off for the holiday, which his religion requires. It was built into his schedule, as one of eight Shomer Shabbos residencies at the center, which partners with New York Medical College.

“I'm using the same vacation days that my colleagues have,” says Kadosh, who is married and has three young daughters. “But the program is flexible in allowing me to schedule those days during the Jewish holidays, ensuring that I have that time off to be with my family.”

Westchester’s Shomer Shabbos residencies are among a small number of programs in the U.S. that guarantee Orthodox Jews are not required to work on Saturdays and sacred Jewish holidays. These include University Hospitals Cleveland Medical Center, Alleghany General Hospital in Pittsburgh, Pennsylvania, and St. Josephs University Medical Center in Paterson, New Jersey. Many others are “Shabbos-friendly,” which means they work out the accommodations more informally, says Daniel Eisenberg, MD, an assistant professor of diagnostic imaging at Thomas Jefferson University School of Medicine who writes about Shomer Shabbos residency on his blog, JewishMedicalEthics.com.

“We're trying to provide physicians with a work-life balance,” explains Frederick Bierman, MD, director of graduate medical education at Westchester Medical Center. “We want to make sure we have the best possible physician workforce by providing an environment that everyone can participate in.”

“We can't ask students to understand their patients' religious practices and how faith might inform their decision-making if we’re not paying attention to students’ own religious practices.”

Robert Folberg, MD
Oakland University William Beaumont School of Medicine

While not every hospital can afford to have residents who don’t work on Saturdays, Armitage says, “in a big, academic residency like ours, the schedule is flexible enough that it's not that hard for us to accommodate.” And Shomer Shabbos residents are usually very willing to be flexible in other scheduling issues, he says.

The effect is to reinforce the idea of the medical team. “You would think this promotes tribalism,” Bierman says. “But it really creates a sense of community.”

Securing spaces to pray

A lot of people in medical settings greet each other with fist bumps instead of handshakes during flu season, because it helps prevent the transmission of microbes. But at Oakland University William Beaumont School of Medicine (OUWB) in Rochester, Michigan, it’s standard procedure throughout the school year.

The practice is an acknowledgment of the religious practices of Muslim students. Observant Muslim women do not shake the hands of or touch men who are not in their families.

“If we're at commencement or a white coat ceremony, and I give everybody a handshake, but to a woman in a headscarf I shake her hand in the air, I'm singling her out as being different,” says Robert Folberg, MD, OUWB’s founding dean. “But if we give everybody a fist bump, but with Muslim women we don't quite touch, no one knows.”

Other schools have started to accommodate Muslim students’ religious practices. Georgetown Medical School has a dedicated Muslim prayer space open 24/7 for students. At the Yale Medical School library, trainees can pray in a small meditation room. Like many other schools, Brown University Alpert Medical School, Wexler Medical Center, and OUWB have nondenominational quiet rooms that are accessible for Muslims’ five daily prayers. OUWB’s is even stocked with prayer rugs.

“In the past, if there was not a mediation space nearby, I often found myself praying under staircases on the basement floor or awkwardly walking around to find a secluded spot,” says Nabiha Hashmi, a third-year medical student at OUWB. “To have a convenient location to pray has really taken that worry off my shoulders.”

The accommodations underscore one of the school’s core values. “We can't ask students to understand their patients' religious practices and how faith might inform their decision-making if we’re not paying attention to students’ own religious practices,” says Folberg.

Religious considerations even affected the timing of the school’s commencement ceremonies. A program on Friday night or Saturday would fall on the Sabbath for Jews; Sunday commencement would be a barrier for devout Mormons. Friday before sunset worked as long as it didn’t interfere with Muslim prayers, so the school consulted an Imam. “Typically in this part of the country, prayers will be around 1:40 in the afternoon,” says Folberg. “They take about 12 minutes to recite. So we have commencement at 2 p.m.”

Healing ceremonies

Last March, Lyndsay Kandi, a first-year student at the University of Arizona College of Medicine—Tucson, was feeling drained by the demands of her medical training. So she jumped at the chance to participate in a sweat lodge ceremony, which is often used to prepare someone for a challenge.

Kandi, a member of the Upper Cayuga (Iroquois) from Wilson, New York, sat inside the circular structure made of willow boughs, warmed with the steam of heated lava rocks infused with cedar and sage. When she emerged, she says, “I came out feeling rejuvenated physically, mentally, emotionally, and spiritually. It allowed me to be close with my culture and family despite being separated by distance.”

“The big take home if you're going into a community that's not your own is to be respectful of your patients’ spiritual belief systems and the ways in which they are seeking healing.”

Kirsten Courtney Concha-Moore
University of Arizona College of Medicine

Such ceremonies are common at a handful of medical colleges. At the University of North Dakota School of Medicine and Health Sciences, the Indians in Medicine program conducts a blessing ceremony in the cadaver lab where students learn anatomy because some tribes, such as the Navajo, have taboos against handling a dead body. The practice may help to ease students’ qualms and promote their psychological wellness. Students at the University of Minnesota Medical School in Duluth hold ceremonies involving smudging and drum groups through its Center of American Indian and Minority Health.

At the University of Arizona, such rituals have become popular with non-Native students, too. “It's a great way to physically understand a traditional American Indian healing ceremony, which is different than just talking about it,” says Gonzales.

Medical students at the University of Washington in Seattle can participate in a powwow, a traditional social event involving singing and dancing. “It acts as a community engagement tool for the students,” says pediatric cardiologist Jason Deen, MD, who directs the school’s Indian Health Pathway and is a member of the Blackfeet tribe.

Such opportunities complement the pathway program, a set of electives focused on Indian health. Among the pathway’s requirements, students do a traditional Indian Medicine clerkship, working with traditional healers in the community. “It really gives both Native and non-Native students who are destined to work in American Indian and Alaskan Native communities a primer for these things,” Deen says.

Similarly, University of Arizona students can do a rural health clerkship on a reservation or participate in the college’s Rural Health Professions Program — like Kirsten Courtney Concha-Moore, a fifth-year student who is affiliated with the Taos Pueblo and Jemez tribes and plans to serve Native communities. “The big take home if you're going into a community that's not your own is to be respectful of your patients’ spiritual belief systems and the ways in which they are seeking healing,” she says.

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