Incorporating Spirituality into Medical Education

08/01/2025

Spirituality has a wide definition that encompasses beliefs, practices, and experiences associated with life’s meaning and purpose. Health care and spirituality are interconnected under medical humanities, which considers the roles of biomedical, spiritual, philosophical, and sociological factors on health status. Spirituality is associated with a significant impact on physical, mental and social health. Despite most Americans considering themselves to be spiritual, not all clinicians discuss spirituality with patients.

Spirituality in Health Care

Separating spiritual beliefs from health care has the potential to disregard what may play a key role in well-being, recovery, and support. Upwards of 83% of patients want their physicians to ask about spiritual beliefs in some circumstances, especially when dealing with serious illness or loss of a loved one. The most important reason for wanting to discuss spirituality is the desire for physician-patient understanding. Incorporation of spirituality in clinical practice can begin with its inclusion within undergraduate medical education curricula. Openness to spirituality has the potential to increase empathy among medical students.

Approaches to Conduct a Spiritual History of a Patient

There are numerous approaches to conducting the spiritual history of a patient. The American College of Physicians offers four potentially useful questions clinicians can ask patients about spirituality to address aspects that are relevant to their health and wellbeing.

1. Is faith (religion, spirituality) important to you?
2. Has faith been important to you at other times in your life?
3. Do you have someone to talk to about religious matters?
4. Would you like to explore religious (spiritual) matters with someone?

Tools and mnemonics may be used as a guide to approach spiritual histories, especially for clinicians first learning about spirituality and health or those who are less confident engaging in spiritual discussions. The HOPE mnemonic is a tool used to ask patients questions that pertain to sources of hope (H), organized religion (O), personal spirituality and practices (P), and effects of medical care and end-of-life issues (E). One advantage of the HOPE mnemonic is the use of the words hope, strength, comfort, and peace rather than focusing on religion or spirituality. While the HOPE mnemonic can be lengthy, it can be helpful, depending on the patient’s circumstances. A more concise option is the open invite mnemonic, where the first question introduces spiritual discussion, and the second question invites the patient to discuss their spiritual needs if preferred. This allows for more free-flowing and patient-led conversation to help the clinician prioritize the patient’s spiritual needs.

Spirituality in Medical Education Curricula

One barrier to discussing spiritual health among practicing clinicians may be insufficient training on spirituality. While most U.S. medical schools offer courses or content related to spirituality and health, only a small percentage of schools require completion of a course dedicated to these topics. Many proponents of these courses recommend their incorporation into the standard medical school curriculum. Most medical school deans agree that spirituality is an important component of health care. Yet, fewer than half believe that incorporating spirituality into the curriculum is important or would schedule additional time to do so, even if allotted additional funding and training support. This may be due to a lack of formal curriculum on spirituality. Although few medical schools have a required course dedicated to spirituality, the majority of schools incorporate spirituality into courses on other topics.

Educational methods such as online learning, case-based discussions, skills labs, spiritual histories, simulated patients, Objective Structured Clinical Examinations (OSCEs), and chaplain or interfaith leader- led experiences can be effective in training medical students on spirituality. Sessions may address the differences between religion and spirituality, how to recognize spiritual distress, approaches to conducting a spiritual history, and the importance of spirituality to student well-being. Ideally, educators would design curricula to encourage spiritual and religious literacy, support interfaith dialogue, and expose learners to specific rituals which are impactful in patient’s lives and can affect their care. Even one short learning session followed by application of the content with standardized or hospital patients can be an effective method to teach spirituality to medical learners. Reflections and journaling may increase learners’ own spiritual awareness. Students who participated in a curriculum that included spirituality indicated increased understanding and willingness to incorporate spirituality in their care and increased confidence in conducting spiritual histories.

Incorporating spirituality into medical curricula can inform learners about the impact that spirituality can have on overall health and well-being and train them about how to discuss and address spiritual needs. Including spirituality training in medical education can have positive benefits on trainee confidence and well-being. Discussing spirituality with patients may also result in increased patient satisfaction. Structured tools and mnemonics may help prepare learners to approach spiritual conversations and incorporate spirituality into their care.

Morgan Ford is a second-year medical student at Saint Louis University School of Medicine. Ford’s areas of professional interest include pediatrics, program evaluation, and medical humanities. Ford can be followed on LinkedIn.