Abstract
Introduction
Spirituality is increasingly recognized as an integral component of patient-centered care in serious illness. Despite substantial evidence supporting its benefits, the integration of spiritual care into medical education remains inconsistent. This narrative review examines how spiritual care is incorporated into serious illness curricula in medical schools and evaluates its impact on student learning.
Methods
Articles published between 2000 and 2024 describing medical school curricula addressing spiritual care in palliative care, serious illness, hospice, or end-of-life care were reviewed. Studies were categorized using the Kirkpatrick 4-tier framework to evaluate educational outcomes.
Results
Among the 1974 studies screened, 85 met the inclusion criteria. Of these, 31 (36.5%) explicitly mentioned spirituality as part of the curricula. Only 16 studies (18.8%) assessed student growth in spiritual care competencies, focusing primarily on student reactions (n = 9), followed by changes in self-reported efficacy (n = 5), knowledge gains (n = 2), and skill gains (n = 1).
Conclusion
Despite evidence linking spirituality to improved health outcomes in serious illness, spiritual care remains underrepresented in medical school curricula. Substantial variability in teaching methods and assessment strategies highlights the need for structured, evidence-informed frameworks to better prepare future physicians to address the spiritual needs of patients facing serious illness.
Introduction
In the United States, over 12 million adults and 400,000 children live with serious illnesses such as cancer, heart disease, kidney disease, and dementia. 1 Each day, approximately 7000 people die as a result of these and other medical conditions. 2 The field of palliative care has emerged to address the multifaceted needs of this population, delivering whole-person, patient-centered care that spans the trajectory of serious illness and extends through end-of-life (EOL). 3 For the purposes of this review, the term “serious illness” will collectively refer to serious illness and end-of-life contexts, and “serious illness care” will denote the specific approaches to care within these domains.
Serious illness care encompasses both palliative and hospice services, which aim to improve the quality of life for individuals with serious illnesses and support them in living well. Grounded in the biopsychosocial-spiritual model, serious illness care is holistic in its approach, addressing the physical, emotional, psychological, social, and spiritual dimensions of illness. 4
Spirituality, defined as the way individuals seek and express meaning, purpose, and connection to themselves, others, nature, and the sacred, has become an integral aspect of patient-centered, whole-person care in serious illness settings. 5 A systematic review by Balboni et al demonstrated a link between spirituality and health outcomes in serious illness, including improved quality of life, reduced anxiety and depression, and care that more closely aligns with patients’ values and preferences. 6 In response to this growing body of evidence, best practice guidelines, such as the National Consensus Project’s Practice Guidelines for Quality Palliative Care, have recognized spiritual care as essential to the quality of life and well-being of patients and families facing serious illness. 7
Physicians play an important role in addressing patients’ spiritual needs in serious illness settings; however, most do not provide such care. Research indicates that many patients facing life-limiting conditions want their physicians to inquire about their spiritual beliefs. 8 Another study of over 1000 US physicians found that 65% of them believe it is essential to address spiritual concerns at the EOL to provide comprehensive care. 9
Despite this recognition, the integration of spirituality into serious illness care remains inadequate. Although spiritual needs are common in seriously ill patients, most do not receive the spiritual care they desire. 5 In a study by Balboni et al, 50% to 96% of patients expressed a desire for spiritual care, yet only 9% to 51% reported receiving it from their medical team. 6 Additionally, physicians report feeling unprepared or burdened when attempting to address spiritual needs. 10 Another study by Balboni et al found physicians cite lack of time as the primary barrier to providing spiritual care. But their analysis also found no substantial association between time constraints and actual provision of spiritual care. Instead, the strongest predictors of reduced spiritual care were inadequate training, perceived power inequity between physician and patient, and the belief that such care falls outside the physician’s professional role. 11 These findings suggest that spiritual care training is essential to aligning clinical practice with quality care standards.
This gap in clinical practice mirrors challenges within medical education, where spiritual care is not consistently emphasized. More than 75% of medical students graduate feeling ill-prepared to provide spiritual care to dying patients. 12 Although the Liaison Committee on Medical Education has guidelines for courses to teach culturally competent health care, and the Commission on Osteopathic College Accreditation standards for osteopathic education emphasize the integration of body, mind, and spirit, spiritual care is inconsistently addressed in medical school curricula, including in serious illness care curricula. 13,14 A review by DeCoste-Lopez et al found that only 40% of published palliative care courses incorporate spirituality, 15 whereas another review noted that religious/cultural issues are among the least addressed in palliative care curricula. 16 Furthermore, an analysis of palliative care-related questions from the National Board of Medical Examiners revealed that psychosocial, spiritual, and cultural dimensions are the least tested, indicating a broader underemphasis on spiritual care in medical education. 17
Although recent systematic reviews have broadly examined spiritual care curricula in US medical schools, it seems further investigation is needed to understand how spiritual care is specifically integrated into serious illness care curricula and assessed for outcomes. 18,19 A survey conducted of spirituality and health in medical school curriculum found that 90% of medical schools have courses or content on spirituality and health and 73% embed that content in required courses addressing other topics. Only 7% offer stand-alone courses. 20 Current review articles focusing on stand-alone spiritual care curriculum are not capturing a key piece of the spiritual care education literature. 18,19
This review focuses on US undergraduate medical education (UME), medical training prior to residency. It aims to characterize how spirituality is incorporated into serious illness care curricula, evaluate the assessment of spiritual care competencies using the Kirkpatrick model, and identify key themes to inform future curricular development. 21
Methods
The authors conducted a comprehensive literature search across 4 major databases: OVID MEDLINE, PubMed, Embase, and the Cumulative Index to Nursing and Allied Health Literature. These databases were selected for their broad coverage of medical education, hospice and palliative care, and serious illness literature, as well as indexing overlap that allowed for a more comprehensive capture of relevant studies. Cochrane Library and American Psychological Association’s PsycINFO were excluded due to limited relevance to the inclusion criteria and redundancy with MEDLINE coverage. The lack of access to Scopus is a notable limitation. The search was limited to articles published between January 1, 2000, and August 14, 2024, the date the search was conducted, as hospice and palliative care, as well as serious illness education, are relatively new fields, and most curricular developments relevant to this review have emerged within the past 25 years.
Articles were included if they provided full-text access, were written in English, and focused on medical students, that is, curricula delivered within UME. Although the search strategy included residency-related terms to ensure comprehensive capture, only studies focused on UME were included in the final analysis, as a sufficient number of eligible studies were identified within this scope. Articles that lacked adequate detail to characterize the educational intervention, did not assess the intervention, or centered on spiritual care for medical student wellness rather than patient care were excluded.
Search terms included combinations of keywords such as “palliative care,” “serious illness,” “hospice,” “end-of-life,” “terminal illness,” “curriculum,” “education,” “teaching,” “evaluation,” “communication,” “rotation,” “rounds,” “experience,” and “medical students.” Terms like “spiritual” and “spiritual care” to capture the full breadth of serious illness curricula were purposefully omitted.
In OVID MEDLINE and PubMed, the authors used Boolean operators and MeSH terms to refine the search. In Embase, the authors applied title, abstract, and keyword searches, limiting the results to articles published in English from January 1, 2000, to August 14, 2024. In the Cumulative Index to Nursing and Allied Health Literature, a similar approach was used, filtering for peer-reviewed articles available in full text.
Results
An initial search identified 1974 titles and abstracts, of which 113 full-text articles were reviewed based on inclusion and exclusion criteria. Ultimately, 85 articles met the criteria and were included in this narrative review (see Table 1).
Table 1:
Summary of search strategy
| Database name | Search strategy |
|---|---|
| OVID MEDLINE (full text, English language, 2000–present) |
|
| PubMed (full text, English language, 2000–present) | ("palliative care"[MeSH Terms] OR "hospice care"[MeSH Terms] OR "terminal care"[MeSH Terms] OR "hospice care"[MeSH Terms] OR "serious illness"[Title/Abstract] OR "terminal illness"[Title/Abstract]) AND ("curriculum"[MeSH Terms] OR "education"[Title/Abstract] OR "teaching"[Title/Abstract] OR "communication"[Title/Abstract] OR "rotation"[Title/Abstract] OR "rounds"[Title/Abstract] OR "experience"[Title/Abstract]) AND ("students, medical"[MeSH Terms] OR "internship and residency"[MeSH Terms] OR "schools, medical"[MeSH Terms] OR "resident"[Title/Abstract]) |
| Embase (English language, full text, 2000–2024 |
|
| CINAHL (full text, peer reviewed, English language, all time) | (palliative care or terminal care or end of life care or hospice care or serious illness) AND (curriculum or education or teaching or evaluation or communication or rotation or rounds or experience) AND (medical students or resident or intern or medical school or residency) |
Residency-related terms were included in the initial search strategy to ensure a comprehensive review; however, only studies focused on undergraduate medical education met inclusion criteria and were retained for final analysis.
CINAHL, Cumulative Index to Nursing and Allied Health Literature.
Of the 85 articles included, 31 (36.5%) explicitly mentioned spirituality as part of their medical curricula in serious illness. Among these, 16 articles (18.8%) incorporated specific assessments designed to measure student growth in attitudes, knowledge, or skills related to spiritual care within serious illness care education (see Table 2).
Table 2:
Summary of spiritual dimensions of medical school serious illness curriculum
| Study author | Year/country | Instructors | Educational modalities | Results/discussion on spirituality | Kirkpatrick |
|---|---|---|---|---|---|
| Batzler et al 22 | 2024 Germany |
Hospital chaplain and physician | Lecture, case-based discussion | In a questionnaire, students reported an increase in ability to assess patients’ spiritual needs and had a better understanding of how spiritual care supports patients in clinical practice. | 2B |
| Engel et al 23 | 2023 USA |
Physicians, nurse practitioner, social worker, chaplain | Lecture, clinical experience | Surveyed students reported that their clinical experience with a chaplain showed “the intersectionality of different professions” and “patients’ medical care felt seamlessly integrated with spiritual, social, and emotional care.” | 1 |
| Erlich D et al 24 | 2023 USA |
Physicians | Role-play, reflective writing | Written reflections showed students’ appreciation for patient values, including spirituality. | 1 |
| Minor et al 25 | 2022 USA |
Physicians | Lectures, watching videos, role-play | 95% of surveyed students felt comfortable using the “Five Wishes” document for advance directives conversations. | 2A |
| Gerlach et al 26 | 2021 Germany |
Physician, psychologist, counselors | Lectures | Surveyed students found lectures on spirituality and grief helpful, but findings were arbitrary as students felt comfortable in only some aspects of spiritual discussion. | 2A |
| Pieters et al 27 | 2021 Netherlands |
N/A | Prereading, clinical experience, reflective writing | Students’ narrative report on their clinical experience showed that discussing spirituality was the most challenging compared to physical, psychological, and social domains. | 1 |
| Nagano et al 28 ,a | 2019 Japan |
Physicians | Clinical experience, reflective writing | Students conducted a “care conference” at home visits and their reflections revealed a greater appreciation for emphasizing quality of life and providing psychological and spiritual support. | 1 |
| Parikh et al 29 | 2017 USA |
Physicians | Online modules, standardized patients | Only 16% (vs 20%–25% nationally) of surveyed students felt they retained the skills necessary to discuss spiritual values with patients 1 year after the course. | 1 |
| Roji et al 30 | 2017 Spain |
Physician, nurse, psychologist | Lectures, online modules, clinical experience, reflective writing | Students postcourse survey reflections on the palliative care lectures showed that spiritual care was the least talked about. | 1 |
| Ellman et al 31 | 2016 USA |
Physician, nurse, chaplain, social worker | Online learning modules, lectures, standardized patient, role-play, clinical experience | OSCE results: students showed an improvement in gathering palliative care, but scores were lowest in psychosocial, spiritual, and cultural domains. | 3 |
| Ozcakir et al 32 | 2014 Turkey |
N/A | Movie screening, reflective writing | 80.5% of surveyed students stated the film Wit reflected the spiritual suffering of dying and rated it highly in how it encouraged them to address patients’ emotions. | 1 |
| Bridge et al 33 , | 2014 Australia |
Physician, chaplain, social worker | Lecture, clinical experience, prereading, reflective writing, watching videos | Students’ reflections showed a greater appreciation for spiritual traditions. | 1 |
| Tai et al 34 | 2014 Australia |
Physicians | Lectures, online modules, clinical experience | Surveyed students described spiritual sessions as less valuable compared to sessions on prescriptions, death, and ethics. Multiple-choice exam showed a gain in knowledge on spirituality. | 2B |
| Sweeney et al 35 , | 2013 Ireland |
Physicians | Lectures, cased-based discussion, role-play | Students completed a case-based workbook on physical, psychosocial, and spiritual aspects of patient care. Their reflections emphasized an understanding that spiritual pain was a part of total pain. | 1, 2A |
| Radwany et al 36 | 2011 USA |
Physician, palliative care team | Clinical experience, literature discussion, lectures | Students’ postcourse survey reports higher self confidence in understanding the relevance of spirituality to patients’ end-of-life experience. | 2A |
| Ross et al 37 | 2001 USA |
Physicians | Case-based discussion, lectures, clinical experiencse | Surveyed students felt more prepared in discussing domains of palliative care, but spirituality was the second lowest dimension with only about 40% of students feeling prepared. | 2A |
Spiritual education was elective, not mandatory.
OSCE, Objective Structured Clinical Examination.
In addition to the 31 articles explicitly addressing spirituality, 23 additional studies (54/85, 63.5%) included curricula that, although not explicitly labeled as “spirituality,” touched on related elements. These studies discussed assessing patient values at EOL, included chaplain-led didactics, or posed multiple-choice questions on spiritual considerations at EOL.
Among the 16 studies that included both spirituality content and assessments, the geographical distribution was as follows: 7 were conducted in the United States, 2 in Germany, and 2 in the Netherlands. Notably, 13 of these curricula were required courses in their respective institutions, underscoring the growing recognition of spirituality as an essential component of serious illness care education. These programs were implemented evenly across both clinical and nonclinical training years, reflecting their broad integration throughout the medical school curriculum.
The most common teaching methods employed in these studies were lectures (n = 11), clinical experiences (n = 9), and written reflections (n = 6). Other modalities included online modules (n = 4), role-play (n = 4), case-based discussions (n = 3), videos or movies (n = 3), and standardized patient encounters (n = 2).
Several key tools and frameworks were used to teach spirituality in the context of serious illness care. These included general spirituality in serious illness care (n = 7), the “total pain” framework (n = 2), the “Five Wishes” tool (n = 2), clinical encounters with chaplains (n = 2), and other tools such as the Faith, Importance, Community, and Assesment Spiritual History Tool (n = 1) and the Spiritual, Place, Integration, and Role Tool (n = 1). Additionally, innovative approaches such as conducting family care conferences (n = 1) and cadaver memorial services (n = 1) were noted, suggesting a commitment to addressing the emotional and spiritual dimensions of patient care.
In terms of assessment, the most common methods were postcourse surveys or questionnaires (n = 12), reflective writing (n = 6), multiple-choice exams (n = 3), and Objective Structured Clinical Examinations (OSCEs; n = 2). These assessments primarily measured students’ reactions to the course (n = 9), changes in self-reported efficacy (n = 5), knowledge gains (n = 2), and improvements in skills (n = 1).
Discussion
This review identified 3 key themes. First, spirituality remains underrepresented in serious illness curricula, with only 36.5% of reviewed courses explicitly addressing it. This underrepresentation may stem from competing priorities, where practical skills such as communication, advance care planning, and symptom management take precedence. Although spirituality is recognized as 1 of the 8 key domains of palliative care by the National Consensus Project, 38 it is often overlooked. Although 69% of Americans still identify as religious, down from 83% in 2007, the lack of emphasis on spirituality in medical curricula may be influenced by broader sociocultural factors, including the decrease in religious affiliation in the US. 39 As medical students, like the general population, become more secular, they may feel less inclined or prepared to incorporate spiritual care into their practice. Additionally, research shows that physicians are generally less religious than their patients, which may contribute to the diminished focus on spiritual care in both medical education and clinical practice. 40
Second, there is considerable variability in how spiritual care is taught and assessed in serious illness education. Approaches range from broad discussions of spirituality in serious illness care to the application of specific frameworks, such as the “total pain” framework or the Faith, Importance and Influence, Community, and Address (FICA) Spiritual History Tool model. Instructor backgrounds varied widely and included physicians, chaplains, social workers, and psychologists. Assessment strategies also varied widely. Most relied on postcourse surveys or reflective writing, capturing subjective insights (Kirkpatrick Levels 1 and 2A) but failing to objectively measure students’ knowledge or skill development (Kirkpatrick Levels 2B and 3). This heterogeneity makes it difficult to compare or assess the effectiveness of different teaching methods.
The variability in teaching and assessment methods may arise from differing educational objectives. Some curricula aim to introduce students to the general concept of spirituality in patient care, whereas others focus on developing specific skills for assessing and addressing spiritual needs. Future research may benefit from greater clarity regarding the purpose of spiritual care education, accompanied by pedagogical research aimed at these objectives. Although the specific goals and methods for teaching spiritual care remain subjects of ongoing debate, the current heterogeneous approaches seem to be inadequate for preparing physicians to address the spiritual needs of their patients. 5,6,10
Third, even when spirituality is integrated into serious illness curricula, it often receives less attention and performs worse compared to other educational domains. Pieters et al observed that although students recognized the importance of spiritual care, they were more likely to focus on discussing patients’ physical, mental, and social care, often neglecting the spiritual dimension. 27 Similarly, Parikh et al reported that only 16% of students retained the ability to discuss spiritual or religious values with patients, a much lower retention rate compared to other palliative care skills. 29 Ellman also found students, after completing a longitudinal curriculum in palliative care, showed overall improvement in palliative care skills as measured by OSCE, but scored lowest in the psychosocial, spiritual, and cultural domains. 31
The reasons for this disparity are likely multifactorial. Limited curricular time allocated to spiritual care may lead students to view it as less critical than other skills, such as symptom management or ethical decision-making. The lack of structured teaching and mentorship further exacerbates this issue, leaving students without adequate guidance on how to effectively address spiritual needs. In the Pieters study, for instance, students were expected to self-study spiritual care without adequate guidance, leaving them feeling ill-prepared to address these needs in clinical practice. 27
Time constraints within clinical settings further compound the challenge of integrating spirituality into serious illness care curricula. Studies utilizing OSCEs, such as Ellman et al, found that students often struggled to incorporate spiritual care into complex patient encounters, particularly when they were pressed to address other urgent needs within limited timeframes. 31 This highlights the need for more integrated and supported approaches to teaching spiritual care, where students are provided sufficient time, mentorship, and opportunities for practice.
A persistent question in medical education is how best to equip future clinicians to address the spiritual needs of patients, through dedicated stand-alone courses or by integrating spiritual care into specific curricula such as serious illness and palliative care. Recent systematic reviews of stand-alone courses indicate that much of the existing literature relies heavily on self-reported outcomes, often employing subjective instruments such as Likert scales to evaluate effectiveness. 18,19 Notably, a small number of studies using standardized patient assessments found that approximately 65% of students were able to identify spiritual concerns and take a spiritual history. 19 These findings highlight the need for more rigorous evaluation. Future research could evaluate and compare the effectiveness of stand-alone training to integrated approaches using validated outcome measures and long-term follow-up.
Limitations of this review include the restricted study period (2000–2024) and the use of only 4 research databases, which may have resulted in the omission of relevant studies. Additionally, evaluating the effectiveness of spiritual care curricula remains challenging, as few studies employed objective outcome measures to assess students’ acquisition of spiritual care competencies. These limitations constrain the strengths of the conclusions that can be drawn regarding the impact of existing spiritual care curricula.
Conclusion
The inconsistent and limited integration of spiritual care into serious illness curricula in UME highlights the need for more structured, evidence-informed approaches to spiritual care education. This need is underscored by a growing body of research linking spiritual care to improved health outcomes in serious illness. 6 However, most physicians do not provide spiritual care, with research suggesting inadequate training as a key barrier. 11
Future research should focus on developing and validating teaching tools and frameworks that prepare physicians to deliver whole-person, patient-centered care, including addressing the spiritual needs of patients with serious illness. Comparative studies examining the effectiveness of stand-alone spiritual care curricula vs content integrated into serious illness curricula may offer valuable insights. This is particularly relevant given the observation that spiritual care often appears to underperform relative to other domains when presented within an integrated curriculum. By advancing both the rigor and relevance of spiritual care education, medical schools can better prepare future physicians to meet the multidimensional needs of patients facing serious illness.
Acknowledgments
The authors gratefully acknowledge Katherine E Staab, PhD, AHIP, for her expert assistance in conducting the literature search for this study.
Footnotes
Author Contributions: Luke Okamuro, BS, contributed to study design, data collection, data analysis, critical revision, and drafting of the manuscript. January Turner, MA, MC, EdD, BCCI, and Janet Ma, MD, participated in data analysis and contributed to manuscript drafting and critical revision. Meachelle Lum, BS, Christine Liu, MD, Christopher Ahn, BS, Bethia Kwok, BS, and David Larson, MD, were involved in the critical review and drafting of the final manuscript. Meachelle Lum also assisted in table development. Andre Cipta, MD, as the senior author, supervised study design, oversaw data analysis, and contributed to the drafting, critical revision, and final approval of the manuscript.
Conflicts of Interest: None declared
Funding: None declared
References
- 1. Morrison RS, Meier DE, Rogers M, Heitner R, Silvers A, Sinclair S. America’s care of serious illness: A state-by-state report card on access to palliative care in our nation’s hospitals. 2019. Accessed 11 September 2019. https://reportcard.capc.org/wp-content/uploads/2020/05/CAPC_State-by-State-Report-Card_051120.pdf [DOI] [PMC free article] [PubMed]
- 2. Huffman JL, Harmer B. End-of-Life Care. In: StatPearls Publishing. Treasure Island (FL): StatPearls Publishing; 2023. [Google Scholar]
- 3. Teoli D, Schoo C, Kalish VB. Palliative Care [Treasure Island, FL: StatPearls Publishing]. Accessed 6 February 2023. https://www.ncbi.nlm.nih.gov/books/NBK537113/ [PubMed]
- 4. Sulmasy DP. A biopsychosocial-spiritual model for the care of patients at the end of life. Gerontologist. 2002;42 Spec No 3:24–33. 10.1093/geront/42.suppl_3.24 [DOI] [PubMed] [Google Scholar]
- 5. Puchalski CM, Vitillo R, Hull SK, Reller N. Improving the spiritual dimension of whole person care: Reaching national and international consensus. J Palliat Med. 2014;17(6):642–656. 10.1089/jpm.2014.9427 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Balboni TA, VanderWeele TJ, Doan-Soares SD, et al. Spirituality in serious illness and health. JAMA. 2022;328(2):184–197. 10.1001/jama.2022.11086 [DOI] [PubMed] [Google Scholar]
- 7. Brandt K. National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care, 4th edition. Richmond, VA: National Coalition for Hospice and Palliative Care; 2018. Accessed 27 October 2024. https://www.nationalcoalitionhpc.org/ncp [Google Scholar]
- 8. McCord G, Gilchrist VJ, Grossman SD, et al. Discussing spirituality with patients: A rational and ethical approach. Ann Fam Med. 2004;2(4):356–361. 10.1370/afm.71 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Smyre CL, Tak HJ, Dang AP, Curlin FA, Yoon JD. Physicians’ opinions on engaging patients’ religious and spiritual concerns: A national survey. J Pain Symptom Manage. 2018;55(3):897–905. 10.1016/j.jpainsymman.2017.10.015 [DOI] [PubMed] [Google Scholar]
- 10. Kang K-A, Kim D-B, Koh S-J, et al. Spiritual care guide in hospice∙palliative care. J Hosp Palliat Care. 2023;26(4):149–159. 10.14475/jhpc.2023.26.4.149 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. Balboni MJ, Sullivan A, Enzinger AC, et al. Nurse and physician barriers to spiritual care provision at the end of life. J Pain Symptom Manage. 2014;48(3):400–410. 10.1016/j.jpainsymman.2013.09.020 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Wells G, Youssef E, Winter R, Wright J, Llewellyn C. Medical student confidence in care of the dying and their family: A systematic review. BMJ Support Palliat Care. 2021;11(3):233–241. 10.1136/bmjspcare-2019-001977 [DOI] [PubMed] [Google Scholar]
- 13. Functions and Structure of a Medical School . LCME. 2023. Accessed 27 October 2024. https://lcme.org/publications
- 14. Accreditation of Colleges of Osteopathic Medicine: COM Continuing Accreditation Standards . American Osteopathic Association October. 2024. Accessed 1 October 2024. https://osteopathic.org/accreditation/standards
- 15. DeCoste-Lopez J, Madhok J, Harman S. Curricular innovations for medical students in palliative and end-of-life care: A systematic review and assessment of study quality. J Palliat Med. 2015;18(4):338–349. 10.1089/jpm.2014.0270 [DOI] [PubMed] [Google Scholar]
- 16. Fitzpatrick D, Heah R, Patten S, Ward H. Palliative care in undergraduate medical education-How far have we come? Am J Hosp Palliat Care. 2017;34(8):762–773. 10.1177/1049909116659737 [DOI] [PubMed] [Google Scholar]
- 17. Carey EC, Paniagua M, Morrison LJ, et al. Palliative care competencies and readiness for independent practice: A report on the American academy of hospice and palliative medicine review of the US medical licensing step examinations. J Pain Symptom Manage. 2018;56(3):371–378. 10.1016/j.jpainsymman.2018.06.006 [DOI] [PubMed] [Google Scholar]
- 18. Wenham J, Best M, Kissane DW. Systematic review of medical education on spirituality. Intern Med J. 2021;51(11):1781–1790. 10.1111/imj.15421 [DOI] [PubMed] [Google Scholar]
- 19. Crozier D, Greene A, Schleicher M, Goldfarb J. Teaching spirituality to medical students: A systematic review. J Health Care Chaplain. 2022;28(3):378–399. 10.1080/08854726.2021.1916332 [DOI] [PubMed] [Google Scholar]
- 20. Koenig HG, Hooten EG, Lindsay-Calkins E, Meador KG. Spirituality in medical school curricula: Findings from a national survey. Int J Psychiatry Med. 2010;40(4):391–398. 10.2190/PM.40.4.c [DOI] [PubMed] [Google Scholar]
- 21. Kirkpatrick DL. Evaluating Training Programs: The Four Levels. Vol 1. Berrett-Koehler, San Francisco, CA; 1994. [Google Scholar]
- 22. Batzler YN, Stricker N, Bakus S, Schallenburger M, Schwartz J, Neukirchen M. Implementing spiritual care education into the teaching of palliative medicine: An outcome evaluation. BMC Med Educ. 2024;24(1):411. 10.1186/s12909-024-05415-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23. Engel KG, Millham LRI, Yeh IM, et al. Assessing the impact of a hospice and palliative medicine mentored clinical shadowing experience for first-year medical and dental students: A pilot study. Am J Hosp Palliat Care. 2024;41(9):1018–1028. 10.1177/10499091231214787 [DOI] [PubMed] [Google Scholar]
- 24. Erlich D, Lee A, Duggan A, Walec K. Preparing for the end of life: Medical students completing their own advance directives described increased empathy for patients. Fam Med. 2023;55(3):195–198. 10.22454/FamMed.2023.183324 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25. Minor S, Samuels M, Kashan S, Milanez M, Mora JC. Facilitating the advance care planning conversation with patients: An interactive virtual 1.5-hour session. South Med J. 2022;115(5):290–293. 10.14423/SMJ.0000000000001385 [DOI] [PubMed] [Google Scholar]
- 26. Gerlach C, Mai SS, Schmidtmann I, Weber M. Palliative care in undergraduate medical education - Consolidation of the learning contents of palliative care in the final academic year. GMS J Med Educ. 2021;38(6):Doc103. 10.3205/zma001499 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27. Pieters J, Verstegen DML, Dolmans D, Warmenhoven FC, van den Beuken-van Everdingen MHJ. Design and evaluation of a learning assignment in the undergraduate medical curricula on the four dimensions of care: A mixed method study. BMC Med Educ. 2021;21(1):309. 10.1186/s12909-021-02681-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28. Nagano H, Obara H, Takayama Y. A brief home-based palliative care learning experience for medical students and resident doctors in Okinawa, Japan. PLOS One. 2019;14(6):e0218780. 10.1371/journal.pone.0218780 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29. Parikh PP, White MT, Buckingham L, Tchorz KM. Evaluation of palliative care training and skills retention by medical students. J Surg Res. 2017;211:172–177. 10.1016/j.jss.2016.11.006 [DOI] [PubMed] [Google Scholar]
- 30. Rojí R, Noguera-Tejedor A, Pikabea-Díaz F, Carrasco JM, Centeno C. Palliative care bedside teaching: A qualitative analysis of medical students’ reflective writings after clinical practices. J Palliat Med. 2017;20(2):147–154. 10.1089/jpm.2016.0192 [DOI] [PubMed] [Google Scholar]
- 31. Ellman MS, Fortin AH VI, Putnam A, Bia M. Implementing and evaluating a four-year integrated end-of-life care curriculum for medical students. Teach Learn Med. 2016;28(2):229–239. 10.1080/10401334.2016.1146601 [DOI] [PubMed] [Google Scholar]
- 32. Ozcakir A, Bilgel N. Educating medical students about the personal meaning of terminal illness using the film, “Wit”. J Palliat Med. 2014;17(8):913–917. 10.1089/jpm.2013.0462 [DOI] [PubMed] [Google Scholar]
- 33. Bridge DT, Bennett KS. “Spirituality, suffering, and healing”: A learning option for Western Australian medical students. J Pain Symptom Manage. 2014;47(3):659–665. 10.1016/j.jpainsymman.2013.09.022 [DOI] [PubMed] [Google Scholar]
- 34. Tai V, Cameron-Taylor E, Clark K. A mixed methodology retrospective analysis of the learning experience of final year medical students attached to a 1-week intensive palliative care course based at an Australian university. Am J Hosp Palliat Care. 2014;31(6):636–640. 10.1177/1049909113496451 [DOI] [PubMed] [Google Scholar]
- 35. Sweeney C, Lynch G, Khashan A, Maher B, Murphy M, O’Brien T. The impact of a medical undergraduate student-selected module in palliative care. BMJ Support Palliat Care. 2014;4(1):92–97. 10.1136/bmjspcare-2012-000283 [DOI] [PubMed] [Google Scholar]
- 36. Radwany SM, Stovsky EJ, Frate DM, et al. A 4-year integrated curriculum in palliative care for medical undergraduates. Am J Hosp Palliat Care. 2011;28(8):528–535. 10.1177/1049909111406526 [DOI] [PubMed] [Google Scholar]
- 37. Ross DD, Fraser HC, Kutner JS. Institutionalization of a palliative and end-of-life care educational program in a medical school curriculum. J Palliat Med. 2001;4(4):512–518. 10.1089/109662101753381683 [DOI] [PubMed] [Google Scholar]
- 38. Ferrell BR, Twaddle ML, Melnick A, Meier DE. National consensus project clinical practice guidelines for quality palliative care guidelines, 4th Edition. J Palliat Med. 2018;21(12):1684–1689. 10.1089/jpm.2018.0431 [DOI] [PubMed] [Google Scholar]
- 39. Alper BA. Spirituality among Americans. Pew Research Center. 2023. Accessed 27 October 2024. https://www.pewresearch.org/religion/2023/12/07/spirituality-among-americans
- 40. Curlin FA, Lantos JD, Roach CJ, Sellergren SA, Chin MH. Religious characteristics of US physicians: A national survey. J Gen Intern Med. 2005;20(7):629–634. 10.1111/j.1525-1497.2005.0119.x [DOI] [PMC free article] [PubMed] [Google Scholar]