Religion and Spirituality in Psychiatry

Teaching Religious and Spiritual Issues 337these awards, which encourage religion-spiritualityeducation in all years of residency. Ampleopportunities exist for the expansion of trainingin religion and spirituality for Canadian psychiatryresidents.3.2.2. North American Psychiatry: UnitedStatesA 1988 survey of American psychiatry residencytraining directors found that very fewresidency programs had either frequently oralways offered didactic course work (12 percent)or provided clinical supervision (33 percent)that usually addressed religious issues. (33) Twothirdsof directors reported rarely or never offeringcourses on religion-spirituality. Few residentsreceived training in the dynamics of religiousbeliefs, or were supervised regarding the dynamicsof their own or their patients’ religious beliefs,regardless of the program’s association with religiouslyaffiliated institutions.In 1992 and 1993, Waldfogel et al. (34) surveyedthe religious lives and didactic and supervisionexperiences in religion-spirituality of 121American psychiatry residents in five programsnot affiliated with religious institutions. Theyfound 86 percent of residents had a religious affiliation,higher than the 76 percent found in 1990by Bergin and Jensen. (35) This level of religiousaffiliation may have been elevated by AfricanAmerican psychiatry residents who reportedconsiderably more religious participation andpersonal religious belief than white residents.Waldfogel and colleagues found that 49 percentof residents prayed at least weekly, although only22 percent attended religious services weekly,compared with 32 percent of a national sample ofpersons of similar age. (36) Twenty-seven percentof residents and 29 percent of third-year throughfifth-year residents reported that religion wasdiscussed or presented in their didactic program.A significant relationship was found betweenhaving either didactic (p < 0.005) or supervisionexposure (p < 0.001) and residents statingthat religion is important in the clinical setting.A high percentage of residents reported feeling“somewhat (72 percent) to very (12 percent)competent” in their ability to recognize andattend to a patient’s religious and spiritual issues.Feelings of clinical competence in recognizingand dealing with patients’ religious-spiritualissues were significantly correlated with didacticor supervisory education in religion-spirituality(p < 0.05). Waldfogel’s sample,( 34) although moderatein size, shows that religious-spiritual educationof psychiatry residents can affect clinicalattitudes. It is not known if residents’ clinical skillsincreased along with their confidence.These studies indicate that American psychiatrists,like Canadian ones, remain less religiousthan their patients, but are more religiously affiliatedthan reported in the past. Even in intenselyreligious America, in the early 1990s, at most30 percent of residencies were teaching aboutreligion-spirituality. However, that began tochange as funding of religious-spiritual educationbecame available.This author believes two major factors –guidelines (discussed above) and educationgrants – and two less influential factors have generatedincreased interest in teaching religion andspirituality in American psychiatry residencyprograms. Before the 1994 accreditation requirements,the majority (67–75 percent) of psychiatryresidents in the United States were exposedto little or no training about this topic. Is this stillthe case? Not since grants for religion-spiritualityeducation have been available.More U.S. psychiatry residencies began toteach religion-spirituality after 1997 when theJohn Templeton Foundation (37) inauguratedan award program for religion and spiritualitycurricula in psychiatric residency trainingfor accredited American and Canadian adultand child psychiatry residencies. This programwas administered by the National Institute forHealthcare Research (NIHR) until it ceased operationsaround 2002. Since then, this program hasbeen administered by the George WashingtonInstitute for Spirituality and Health (GWISH)(18) of Georgetown University in Washington,DC, which funds three to five psychiatry residencyprogram awards yearly. Since 1997, atleast forty-nine American and two Canadian